BMJ: What is junk food and what is the harm?

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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.

Would you eat earlier to improve your blood sugar control?

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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.

One third of young adults are following a specific eating pattern

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Food Insight have published a survey of just over a thousand young adults aged 18 to 34 to question them about their dietary habits over the previous year. The study was published in 2018.

At that time a third were following some sort of diet. 16% were following some sort of low carb diet. The most frequent eating pattern was intermittent fasting coming in at 10% of those questioned.

In order of frequency the dietary patterns were:

Intermittent fasting, Paleo (10%) Gluten free, Low carb, Mediterranean, Whole 30, High protein, Vegetarian or Vegan (about 5%), Weight loss plan, Cleanse, DASH diet, Ketogenic or high fat diet, and other.

My comment: my personal diet is a mixture of Gluten fee, Low carb, Mediterranean, High Protein and High fat so I can see that there is certainly room for difficulty in assigning your diet a category. There seems to be a lot of publicity over Vegan and Vegetarian diets and I was surprised that there were not more young people on these. I would imagine that it would depend where the sample was from and other demographic information.

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? 

If you can avoid competitive eating as a child you will be thinner

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Adapted from Independent Diabetes Trust Newsletter Dec 2021 and BMJ 29 Jan 2022

In the journal of Clinical Obesity researchers have shown that people who eat faster tend to gain more weight and are at higher risk of obesity than slow eaters. This is because it takes at least 20 minutes for stomach hormones to tell your brain that your hunger is satisfied.

They also found that only children didn’t tend to eat as fast as children who had siblings. The fast eating habit tends to persist in to adulthood and thus weight gain compared to only children.

My comments: I was one of four children and we certainly ate fast. If you didn’t grab the food quick enough it disappeared! This stood me in good stead as a doctor when there was very little time for eating on the job. My husband was one of three and is great at competitive eating too! He said it helped when working off shore when meals were slotted in during less busy periods. I had forgotten most of the childhood meal behaviours till I went to one of my friends houses with her husband and noticed that he carefully guarded his plate with his arm. I recalled that this was common practice in our house but that I had stopped doing it since leaving home. He was one of four children again. He had simply never changed his eating posture since leaving home!

In the American College of Cardiology 2021 they report that teenagers who have high BMIs have a 9% greater risk of getting type 2 diabetes, and an 0.8% greater risk of having a heart attack in their 30s and 40s than normal weight teens. Regardless of their adult BMI, teens who were heavier went on to have a 2.6% greater risk of having poorer overall health in adulthood.

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.

Dietary gluten in pregnancy is related to an increased risk of type one diabetes in the child

Adapted from Antvorskov JC et al. Association between maternal gluten intake and type one diabetes in offspring. BMJ 22 September 2018

This research was based on a study of Danish women’s food frequency questionnaires completed 25 weeks after their first pregnancies ended. The incidence of diabetes in the children was then noted from January 1996 till May 2016 from the Danish Registry of Childhood and Adolescent Diabetes. After certain exclusions had been made over 63,500 were analysed.

The mean gluten intake per day was 13g ranging from 7g to more than 20g per day.

The incidence of diabetes in the child increased proportionately according to gluten intake. The women who had  20g or more intake had double the type one diabetes in their offspring compared to those who ate 7g or less.

As type one diabetes has risen seemingly inexplicably over the last few decades, there has been a lot of consideration into possible environmental triggers. Gluten is a storage protein found in wheat, rye and barley.  In animal studies, a wheat free diet in the mother has been found to dramatically reduce the incidence of diabetes in the child.

It has been suggested that gluten can affect gut permeability, gut microbiotica and cause low grade inflammation.

Although there is this association between gluten and type one diabetes it could be that other factors, for example the advanced glycation products from the baking process, that are to blame.  Unwanted additives to grain  could also be a factor eg mycotoxins, heavy metals, pesticides and fertilisers.

Mothers who eat a lot of gluten may similarly feed their children a lot of gluten. They also may pass gliadin from wheat into the breast milk.

Although this research suggests that high amounts of gluten may be problematic in pregnancy, further research will need to be done before dietary recommendations are likely to be changed.

Should you get tested for coeliac?

From Allergy and Autoimmune Disease for Healthcare Professionals October 9 2019

Apparently 70% of people who have coeliac have yet to be tested for it.

Who may have it?

4.7% of those with irritable bowel syndrome.

20% of those with mouth ulcers.

8% of infertile couples.

16% of type one diabetics.

7.5% of first degree relatives of people with coeliac.

About 50% of people who are diagnosed have iron deficiency diagnosis  at the time of coeliac diagnosis.

Other people who need to be tested may have:

Pancreatic insufficiency

Early onset osteoporosis or osteopenia

vitamin and mineral deficiencies

gall bladder malfunction

secondary lactose intolerance

peripheral and central nervous system disorders

Turner’s syndrome

Down’s syndrome

Dental enamel defects

persistent raised liver enzymes of unknown cause

peripheral neuropathy or ataxia

metabolic bone disorders

autoimmune thyroid disease

unexplained iron, vitamin D or folate deficiency

unexpected weight loss

prolonged fatigue

faltering growth

second degree relative with coeliac disease

My comment: I had years of  the mouth ulcers, iron deficiency anaemia and irritable bowel symptoms which all resolved completely on a wheat free diet. The problem is that if I did want tested I would need to go back on wheat for a minimum of six weeks to give my antibodies a chance to build up sufficiently to test positive.  Thus, best to get a test BEFORE you go on a wheat free diet.

 

 

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