Category: Guest posts

Guest posts from others interested in diabetes, diabetes diets, blood sugar control and more.

Gail’s Easy Chicken Curry

kaitiscotland1 Comment
Photo by Mumtahina Tanni on Pexels.com

What’s Cooking in Gail’s Kitchen? Equal Measures: Coconut Curry Chicken! Every once in awhile you cross paths with someone who offers a product to enhance a food blog. Antonio @seasonalityspices offered me a free sample of handcrafted organic Indian Curry. Instantly, I knew the dish I would prepare. One bite of mild and spicy chicken, enhanced with the creamy flavor of organic coconut, is all it took to turn ordinary chicken into a flavorful obsession. Don’t mind if I do. Thanks, Antonio.

COCONUT CURRY CHICKEN

Ingredients:

1 cup water

1 1/4 cup sweet rice – not for low carbers!

1 tablespoon olive oil

1 tablespoon vegetable oil or preferably butter

1 pound chicken tenders, cut into bite-size pieces

1/2 cup yellow onion, chopped

2 teaspoons curry powder

3/4 teaspoon sea salt

1/4 teaspoon black pepper

13.5-ounce can organic coconut milk

2 tablespoons tomato paste

1 cup sun-dried tomatoes in olive oil, chopped

Cilantro, for garnish aka Coriander

Instructions:

Combine water, sweet rice, and olive oil. Cook in a rice cooker according to directions. (Package rice may be substituted on a stovetop.) In a large skillet, warm vegetable oil over medium-high heat. Sauté chicken and onion until chicken is no longer pink and onions are transparent. Sprinkle chicken mixture with curry powder, sea salt, and black pepper. Stir in organic coconut milk and tomato paste. Bring to a boil. Reduce heat to simmer and cook 5 minutes or until thickened. Add sun-dried tomatoes. Cook 2-3 minutes longer. Serve with sticky rice. Garnish with fresh cilantro.

My comments: Of course for low carbers don’t use rice rice, use cauliflower rice or any non-starchy vegetable accompaniment.

Thank you very much Gail for this easy, tasty recipe. There are more at snapshotsincursive: interesting stories about everyday moments.

No chips with mine thanks!

kaitiscotland4 Comments
Photo by Glady Francis on Pexels.com

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?

https://yelling-stop.blogspot.com/2021/10/whats-most-fattening-food.html

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

kaitiscotland2 Comments
Photo by Pixabay on Pexels.com

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.

A forensic pathologist tells us how to live to a good old age

kaitiscotland2 Comments
Photo by Andrea Piacquadio on Pexels.com

Adapted from Medscape August 31 2022 Would you like to live to a ripe old age? George D Lundberg MD

Do

Choose ancestors who did not die of natural causes in young adulthood or middle age (oophs…too late!)

Maintain a body mass index within the healthy range using a variety of tools

Maintain blood pressure within a normal range with or without medications

Maintain a low resting heart rate

Do eat whole grains including bran

Consume above ground leafy vegetables, some root vegetables, tree nuts, peanuts and berries

Ingest supplemental fibre such as psyllium husks

Ingest supplemental magnesium and possibly vitamins K2, C and D

Enjoy eating animal and vegetable fats including milk, cheese, meat, poultry, seafood, and eggs in moderation.

Eat two full meals a day

Do drink alcohol after 5pm

Sleep 6-8 hours a night

Walk up and downstairs and use handrails if necessary

Continue to be active physically, mentally, socially and sexually

Study and enjoy birds, bees, trees, plants, flowers and wildlife

Value your family life and participate actively while encouraging individuals to live their own lives

Read great books, fiction or non fiction a little every day

Actively engage in person or electronically with younger people

Stay informed about current world affairs and care about what you can change

Be passionate about culture such as performing and visual arts and sport

Recognise the value of spirituality and religion and feel free to live otherwise if you choose

Do your best to earn and retain as much money as needed to control your environment into old age

Take charge of your own health

Listen to your body

Maintain a long term relationship with a reliable and conservative primary care physician and certain specialists that fit the needs of older people.

Promote good vision in any way you can

Use hearing aids if you need them to retain brain function

See your dentist every 6 to 12 months and practice good oral hygiene. There is a strong correlation between the number of original teeth and length of life

Keep up to date with vaccinations

Maintain a safe distance and use mask if you may be around infective people

Take as few medications as necessary

Have as few diagnostic tests and surgical procedures as possible especially on the back and the knees

Use acupuncture and massage appropriately

Apply moisturising skin lotion especially after sun exposure

Use saline mist often to prevent nosebleeds

Walk at least 2 miles every day

If you can, swim every day

Practice yoga particularly the standing side bend, prone baby cobra, forward plank and windshield-wiper

Eat a protein rich diet and deliberately weight train or lift heavy objects to reduce sarcopenia

stand on one foot to improve balance

Use wearable exercise monitors if you find them useful

If you retire from work do some part time or volunteer jobs

Have something productive and fulfilling to do each day

Don’t

Inhale tobacco smoke

Consume sugar or sugar in anything in home cooked or restaurant meals, in soft drinks, fruit juices, pastries, desserts or processed foods

Use street drugs

Use natural or synthetic opioids except for short term relief of severe pain or the relief of pain from advanced cancer: then use all you need

Use sleep medication

Drink more than moderately or binge drink

Drive a vehicle after drinking or taking certain psychoactive drugs

Keep firearms in your home or workplace

Fret about things in your personal life or world affairs that you cannot change

Completely retire and have nothing useful to do

My comments: Dr Lundberg has a pretty long list of sensible suggestions. To these I would add, get some daily sunshine if you can and enjoy your pets. Have things to look forward to. Keep in touch with your friends and make contact with old ones who you value but don’t see often. Learn new things. What other suggestions do you have?

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

kaitiscotland1 Comment

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? 

Improved life expectancy for severe kidney disease on keto diets

kaitiscotland1 Comment

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.

Blood pressure difference between arms can be a risk factor for cognitive decline…as well as other things.

kaitiscotland4 Comments

From Systolic inter-arm blood pressure difference and cognitive decline in older people, a cohort study. Christopher E Clark. BJGP July 2020

 

A prospective study was done in 1,113 Italians whose average age was 66.4 years. Even a difference of only 5 degrees between the arms was associated with a greater level of cognitive decline.

My comment: In UK GP practices, only one arm is used to check the blood pressure. In my case, it was the arm that was nearest to the desk. Perhaps we should check both ? Inter-arm BP differences are both associated with cardiovascular disease, and this in turn affects dementia. Then of course, is the question, what can you do about it? For a further discussion of the subject here is Pharmacist Antonio Bess from Diabetes in Control.

Cognitive Decline: Just Life, or a Preventable Disease?
Feb 22, 2020

Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Antonio Bess, Pharm D Candidate, Florida Agricultural & Mechanical University School of Pharmacy

Cognitive decline is associated with many diseases and medications, but the exact mechanisms are not clearly understood.
Diabetes, obesity, and declining cognitive function are all associated with increased prevalence with increasing age.

Diabetes is a known risk factor for eye, kidney, neurological and cardiovascular diseases, but its effect on declining cognitive function has been in question. Previous studies have found associations between patients who have diabetes and poor glycemic control and significantly faster cognitive decline. Other studies have demonstrated a pattern in which diabetes, high blood pressure, and high body mass index in midlife predict dementia in late life.

In this prospective study, individuals were followed for up to ten years to find associations between indices in diabetes, insulin resistance, obesity, inflammation, and blood pressure with cognitive decline. The indices of interest were measured separately among those with and without central obesity.
The Monongahela‐Youghiogheny Healthy Aging Team is a population‐based cohort of participants recruited randomly from 2006 to 2008, who were 65 and older, and were from a group of small towns in southwestern Pennsylvania. The study is focused on the epidemiology of cognitive decline and dementia in an area that still has not recovered economically from the collapse of the steel industry in the 1970s.

Participants were analyzed at study entry, and annual follow up. To measure cognitive function, participants were given a panel of neuropsychological tests tapping the domains of attention/processing speed, executive function, memory, language, and visuospatial function. At study entry and annually, BP, BMI, waist‐hip ratio, and depressive symptoms  were measured.
Key variables at the time of blood draw, including age, sex, race (white vs. nonwhite), education (high school [HS] or less vs. more than HS), APOE*4 allele carrier status, mCES‐D score, BMI, WHR, systolic BP (SBP), and the following laboratory assay variables: CRP, glucose, HbA1c, insulin, HOMA‐IR, resistin, adiponectin, and GLP‐1 were all reviewed to identify predictors of cognitive decline.
Among 1982 participants who were recruited and underwent full assessment at baseline from 2006 to 2008, only 478 individuals were able to provide fasting blood samples. Of this group of individuals, the median age was 82 years; 66.7% were women; 96.7% were white, and 49.0% had more than HS education.

Compared to the 1504 original participants without fasting blood data, at baseline, these 478 were significantly younger (74.6 vs. 78.6 years; P < .001); more likely to be women (66.7% vs. 59.2%; P = .004); more likely to be of European descent (96.7% vs. 94.1%; P < .001); more likely to have at least HS education (49.0% vs. 38.6%; P < .001); but about equally likely to be APOE*4 carriers (19.3% vs. 21.5%; P = .350).
In unadjusted analysis in the sample as a whole, faster cognitive decline was associated with greater age, less education, APOE*4 carriage, higher depression symptoms (mCES‐D score), and higher adiponectin level. HbA1c was significantly associated with cognitive decline.

After stratifying by the median waist-hip ratio, HbA1c remained related to cognitive decline in those with higher waist-hip ratios. Faster cognitive decline was associated, in lower waist-hip ratio participants younger than 87 years, with adiponectin of 11 or greater; and in higher waist-hip ratio participants younger than 88 years, with HbA1c of 6.2% or greater. Higher adiponectin levels predicted a steeper cognitive decline in the lower waist-hip ratio group.
Abdominal obesity plays a crucial role in cognitive decline in those with diabetes. The microvascular disease may play a more significant role than macrovascular disease. Midlife obesity contributes to cognitive decline but there was no midlife data in this study. Future studies should include a large minority, midlife population. Adiponectin levels need to be carefully assessed as well.

Practice Pearls:
In individuals younger than 88 years old, central obesity can lead to faster cognitive declines.
Obesity, diabetes, and aging contribute to cognitive decline, so it’s hard to distinguish the most significant risk.
Adiponectin may be a novel independent risk factor for cognitive decline and should be reviewed.

Ganguli, Mary, et al. “Aging, Diabetes, Obesity, and Cognitive Decline: A Population‐Based Study.” Journal of the American Geriatrics Society, John Wiley & Sons, Ltd, Feb. 2020, p. jgs.16321, doi:10.1111/jgs.16321.
Ganguli, Mary, et al. Aging, Diabetes, Obesity, and Cognitive Decline: A Population-Based Study. 2020, pp. 1–8, doi:10.1111/jgs.16321.
Tuligenga, Richard H., et al. “Midlife Type 2 Diabetes and Poor Glycaemic Control as Risk Factors for Cognitive Decline in Early Old Age: A Post-Hoc Analysis of the Whitehall II Cohort Study.” The Lancet Diabetes and Endocrinology, vol. 2, no. 3, Elsevier Limited, Mar. 2014, pp. 228–35, doi:10.1016/S2213-8587(13)70192-X.
Cukierman, T., et al. “Cognitive Decline and Dementia in Diabetes – Systematic Overview of Prospective Observational Studies.” Diabetologia, vol. 48, no. 12, Springer, 8 Dec. 2005, pp. 2460–69, doi:10.1007/s00125-005-0023-4.

Antonio Bess, Florida Agricultural and Mechanical University College of Pharmacy

Should you get tested for coeliac?

kaitiscotland3 Comments

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.

 

 

Jovina cooks seafood: New England Clam Chowder

kaitiscotland6 Comments

America’s Culinary Food Stories-New England Clam Chowder
by Jovina Coughlin

From Manhattan to New England, clam chowder is known for its competing varieties as much as for its comforting briny flavor. It seems every state on the East Coast has its own take on the popular soup.
New England clam chowder is the most well-known and popular clam chowder. Though it’s named after New England and associated most with Massachusetts and Maine, food historians believe that French, Nova Scotian, or British settlers introduced the soup to the area and it became a common dish by the 1700s. The soup continued to gain popularity throughout the years and, according to “What’s Cooking America”, was being served in Boston at Ye Olde Union Oyster House (the oldest continuously operating restaurant in the country) by 1836.
New England clam chowder, occasionally called “Boston Clam Chowder,” is made with the usual clams and potatoes, but it also has a milk or cream base. It is usually thick and hearty; Today. the soup can be found all over the country but is still most popular in the North East.
New England Clam Chowder
Yield: 8 to 10 servings
Ingredients
3 strips thick-cut bacon
1 tablespoon unsalted butter
1 medium onion, cut into 1/4-inch cubes
1 medium leek, washed and sliced
2 celery ribs with tops cut into 1/4-inch slices
1 teaspoon chopped fresh thyme leaves
2 bay leaves
1/2 teaspoon seafood seasoning (Old Bay)
3 medium-size white potatoes, peeled and cut into 1/2-inch cubes
1/2 cup all-purpose flour (optional, you can thicken the soup by using double cream and cut down on the seafood stock)
4 cups seafood stock or bottled clam juice, divided
1 pound chopped fresh clam meat with juices or 2 (6.5 oz) cans of clams in broth
Kosher salt to taste
2 cups half & half
1 teaspoon white pepper
Chopped fresh parsley for garnish
Directions

Place a 4- to 6-quart pot over medium-low heat. Add the bacon and cook, turning occasionally, until crisp, 10 to 12 minutes. Remove the bacon, leaving the fat in the pot, and crumble into small pieces onto a plate; set aside.
Add the butter, onion, leek, celery, thyme, seafood seasoning and bay leaves to the pot. Cook, stirring often, until onions and potatoes are tender, 6 to 8 minutes.
Return the bacon to the pot and increase the heat to medium-low.
Dissolve the flour in 1 cup of the clam broth or seafood stock. Add the mixture gradually, stirring continuously, until incorporated. Stir and cook 5 minutes. (or you can take the worry about lumpy soup by not using it at all!)
Increase the heat to medium and slowly add the remaining clam broth or stock, 1 cup at a time, incorporating it into the mixture before adding more.
Increase the heat to medium-high and add the clam meat with its juices. Keep stirring 5 minutes, until the clams are tender.
Add the cream slowly; then stir in the white pepper.
Discard the bay leaves before serving. Garnish each serving with chopped parsley.
Note
Many USA supermarkets carry frozen, chopped clam meat in 1-pound containers, which is fresher than canned and just as convenient. Simply defrost before using.

My comments: I’ve had the pleasure of having several different versions of clam chowder in various parts of the USA and the creamy version without added tomatoes is my favourite. I’ve had it in New England and San Francisco.  I can’t remember where I had the one that had tomatoes in it, but I was rather disappointed. How you make this soup will depend on how low you wish to cut carbs and how tolerant of wheat you are. Clam chowder is very filling so you will need only light accompaniments eg a salad or fruit.

 

NICE: Hydrogen peroxide for impetigo

kaitiscotland2 Comments

 Adapted from :NICE issues antimicrobial prescribing guidance for impetigo

curated by Pavankumar Kamat UK Medical News 28 Feb 2020

National Institute for Health and Care Excellence (NICE) recently published antimicrobial prescribing guidance which describes the antimicrobial strategy for adults, young people and children aged ≥72 hours with impetigo.

According to the new NICE guidance, GPs should prescribe topical hydrogen peroxide 1% instead of topical antibiotics for patients with localised non-bullous impetigo.
The guidance states that hydrogen peroxide 1% cream is as effective as topical antibiotics in patients with localised, non-bullous impetigo, provided they are not systemically unwell or at risk for complications.

If hydrogen peroxide 1% cream is not suitable or if symptoms have worsened or not improved, a short course of a topical antibiotic may be considered.
A topical or oral antibiotic is recommended for patients with widespread non-bullous impetigo, provided they are not systemically unwell or at risk for complications. Oral antibiotic treatment is recommended for patients who have bullous impetigo or if they are systemically unwell or at high risk for complications.
NICE does not recommend a combination of topical and oral antibiotic. There is no evidence that the combination works more effectively than a topical treatment alone.
The primary choice of topical antibiotic is fusidic acid 2%, and the secondary option is mupirocin 2%. The drug of choice for first-line oral antibiotic therapy is flucloxacillin, with clarithromycin and erythromycin (for pregnant women) as secondary choices.

References
Impetigo: antimicrobial prescribing: NICE guideline [NG153]. National Institute for Health and Care Excellence. 2020 February.

My comment: Impetigo is a common skin infection caused by staphloccus which tends to colonise up people’s noses. It spreads rapidly in the nursery and primary school environments. Previously it was treated with oral penicillin. Children are advised to stay off school to reduce spread. Any effective topical, non antibiotic treatment, is welcome as this will help reduce antibiotic resistance.