Adapted from Early life antibiotic exposure linked to asthma, obesity and coeliac disease by Heather Mason Univadis Medical News 24 Nov 2020.
Antibiotic exposure in the first two years of life increased the lifetime risk of developing various immunological, metabolic and neurodevelopmental conditions. This is thought to occur from the effect of the antibiotics on the gut microbiome.
Aversa Z et al published their findings in the Mayo Clinic Proceedings this year. They looked at over 14 thousand children. Half were boys and half were girls. 70% of the children had received an antibiotic during the first two years of life. These children were compared to the ones that had not had any antibiotics. The follow up was for the next 9 years.
All children were at increased risk of asthma and allergic rhinitis with a strong dose-response relationship. There was also an increased risk for attention deficit hyperactivity disorder. Girls were particularly susceptible to atopic dermatitis and coeliac disease and boys were more susceptible to obesity.
Aversa Z et al. Association of infant antibiotic exposure with childhood health outcomes. Mayo Clinic Proceedings. 2020 Nov6:S0025-6196(20)30785-0.
My comment: I wonder how much effect prematurity may have affected these results? It is well known that these babies have markedly less robust immune systems and their parents may also be more anxious about their health. I was premature and was given copious doses of penicillin for the tonsillitis that I got every 2 months. I remember that missing school and listening to the Jimmy Young show on the radio while my mum did the housework as being much better than going to school. As an adult I am very adversely affected by wheat. Whatever is going on, this article does lend credence to the fact that our gut bacteria have a lot more influence on our health than we have ever imagined. I easily recall the extreme pressure put on doctors to prescribe antibiotics for the most trivial of complaints. The younger the child, the more difficult it is to resist the “just in case” half plea-half threat from the parents.
From Mary Ann Demasi’s Editorial in BMJ Evidence based Medicine Summer 2020
In the current COVID-19 pandemic, governments mandate social distancing and good hand hygiene, but little attention is paid to the potential impact of diet on health outcomes. Poor diet is the most significant contributor to the burden of chronic, lifestyle-related diseases like obesity, type 2 diabetes and cardiovascular disease.1 As of 30 May 2020, the Centers for Disease Control and Prevention reported that among COVID-19 cases, the two most common underlying health conditions were cardiovascular disease (32%) and diabetes (30%).2 Hospitalisations were six times higher among patients with a reported underlying condition (45.4%) than those without reported underlying conditions (7.6%). Deaths were 12 times higher among patients with reported underlying conditions (19.5%) compared to those without reported underlying conditions (1.6%).2 Two-thirds of people in the UK who have fallen seriously ill with COVID-19 were overweight or obese and 99% of deaths in Italy have been in patients with pre-existing conditions, such as hypertension, diabetes and heart disease.3 These conditions, collectively known as metabolic syndrome, are linked to impaired immune function,4 and more severe symptoms and complications from COVID-19.5
A major factor that drives the pathophysiology of metabolic syndrome is insulin resistance,6 defined as an impaired biological response to insulin, the hormone that regulates blood glucose levels. The dysregulation of blood glucose levels plays an important role in inflammation and respiratory disease. A study of patients with COVID-19 with pre-existing type 2 diabetes showed that those with better regulated blood glucose control fared better than those with poor blood glucose control.7 Specifically, well-controlled blood glucose (glycaemic variability within 3.9–10.0 mmol/L) was associated with reduced medical interventions, major organ injuries and all-cause mortality during hospitalisation, compared with individuals with poorly controlled blood glucose (glycaemic variability exceeding 10.0 mmol/L). Another study showed hospitalised patients with hyperglycaemia treated with insulin infusion had a lower risk of death from COVID-19 than patients without insulin infusion, likely due to reduced inflammatory mediators.8
The most significant factor that determines blood glucose levels is the consumption of dietary carbohydrate, that is, refined carbs, starches and simple sugars. However, the official dietary recommendations of most Western countries advocate for a reduced (low) fat, high-carbohydrate diet, which can exaccerbate hyperglycaemia. These dietary guidelines form the basis of menus in nursing homes and hospital wards where people with COVID-19 and pre-existing metabolic syndrome are undergoing recovery and respite.
The problem is not only confined to nursing homes and hospitals. As people self-isolate at home, many are stockpiling non-perishable staple foods that are cheap such as (carbohydrate-rich) pasta, bread, rice and cereal.9 Our food supply is dominated by highly processed, packaged foods; 71% of available food in the USA is classified as ‘ultra-processed’.10 Food and beverages such as pizza, doughnuts and fruit juices and other sugary drinks are likely to drive hyperinsulinaemia and inflammation, especially in those with metabolic syndrome.
Since the world is facing the rapid transmission of a novel virus, there has been little opportunity to conduct trials on whether patients with COVID-19 fare better on low-carbohydrate diets compared with other diets. However, there is robust evidence that restriction of dietary carbohydrate is a safe and effective way to achieve good glycaemic control and weight loss, and reduce the need for medication in the management of type 2 diabetes.11 12 A systematic review comparing low-carb diets to low-fat diets showed that the low-carb diets were superior for achieving glucose control, as well as for limiting cardiovascular risk factors in the short and long term for people with type 2 diabetes.13
There has been a reluctance to accept the benefits of low-carbohydrate diets, mainly because of the contradiction to official dietary guidelines which recommend that carbohydrates make up between 45 and 65 percent of total daily calories, but significant progress has been made in recent years. For example in 2018, Diabetes Australia released a position statement stating there was reliable evidence that lower carb eating can be safe and useful in reducing blood glucose levels, reducing body weight and managing heart disease risk factors such as raised cholesterol and raised blood pressure.14 Further, in 2019 the American Diabetes Association and in 2020 Diabetes Canada, both endorsed low carbohydrate diets as a viable option to improve glycaemia and the potential to reduce medications for individuals with type 2 diabetes.15 16
There are some medical institutions leading the way. One US-based hospital in West Virginia has answered calls to improve the food environment for its patients by removing all sugary drinks from its vending machines and cafeterias.17 The Jefferson Medical Center is also one of the first hospitals in the USA to offer low-carb meals to its patients with diabetes. Tameside Hospital in Manchester became the first in Britain to remove all added sugar from the meals it prepares for visitors and health service workers and it has taken sugary snacks and fizzy drinks off its menu.18
Restriction of dietary carbohydrates is a simple and safe intervention which results in rapid improvements in glycaemic control and can be implemented alongside usual care in a medical or domestic setting. While the pathophysiology of COVID-19 is multifactorial, insulin resistance is among the strongest determinants of impaired metabolic function. Since 88% of the US population is metabolically unhealthy,19 the extent to which it contributes to the severity of COVID-19 infection is likely to be significant. Therefore, the adoption of dietary advice for people with underlying metabolic syndrome as proposed in the UK,20 should be more widely endorsed by governments and policy makers globally, to mitigate the burden of pre-existing metabolic disease in those who contract COVID-19, now and into the future.
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.
Carbohydrate restriction regulates the adaptive response to fasting S. Klein and R. R. Wolfe Department of Internal Medicine, University of Texas Medical Branch, Galveston.
The importance of either carbohydrate or energy restriction in initiating the metabolic response to fasting was studied in five normal volunteers.
The subjects participated in two study protocols in a randomized crossover fashion. In one study the subjects fasted for 84 h (control study), and in the other a lipid emulsion was infused daily to meet resting energy requirements during the 84-h oral fast (lipid study).
Glycerol and palmitic acid rates of appearance in plasma were determined by infusing [2H5]glycerol and [1-13C]palmitic acid, respectively, after 12 and 84 h of oral fasting.
Changes in plasma glucose, free fatty acids, ketone bodies, insulin, and epinephrine concentrations during fasting were the same in both the control and lipid studies.
Glycerol and palmitic acid rates of appearance increased by 1.63 +/- 0.42 and 1.41 +/- 0.46 mumol.kg-1.min-1, respectively, during fasting in the control study and by 1.35 +/- 0.41 and 1.43 +/- 0.44 mumol.kg-1.min-1, respectively, in the lipid study.
These results demonstrate that restriction of dietary carbohydrate, not the general absence of energy intake itself, is responsible for initiating the metabolic response to short-term fasting.
CrossFit is a website which you may enjoy visiting.
In one site you can find detailed exercise advice, often in the form of videos, for strength training, recipes, and research findings related to health and dietary composition.
There is information on the low carb diet, which is particularly helpful for those with diabetes, who wish to lose body fat, or who wish to reduce their cardiovascular risk.
Lectures by a wide variety of speakers are also included.
Adapted from BMJ Sept 19 Promoting physical activity to patients by Christine Haseler et al.
The Academy of Medical Royal Colleges has described walking as a miracle cure. Despite this many of us are not as active as we should be and inactivity is thought to result in as many deaths as smoking. More than a quarter of UK adults do less than 30 minutes physical activity a week.
Quantified, these are the benefits of just plain walking:
30% lower all cause mortality, even 10 minutes a day is worthwhile.
20-30% lower risk of dementia.
Better relief from back pain than back exercises
30% lower risk of colon cancer
30% reduction in falls for older adults
22-83% reduction in osteoarthritis
even lower body fat than playing sports
20-35% lower risk of cardiovascular disease
20% lower risk of breast cancer
30-40% lower risk of metabolic syndrome or type two diabetes
The people who need to see their GP before undertaking exercise are few but include people with unstable angina, aortic stenosis or uncontrolled severe hypertension.
In pregnancy the sort of activities that need to stop are: impact activities, lying on the back for long periods, high altitude activities and underwater activities.
From Pernicova I et al. Lancet Diabetes Endocrinol 25 Feb 2020
Long-term glucocorticoids, most often prednisolone, are prescribed for about 3% of European adults. The long term exposure can raise metabolic, infectious and cardiovascular risks.
This was a trial of 53 adults who had inflammatory disease treated with prednisolone but did not have diabetes, who were given either 12 weeks of metformin or a placebo.
The dose of prednisolone was 20mg or more for the first month and then 10mg or more for the next 12 weeks. The dose of metformin given was up to 850mg three times a day.
What improved:
Facial fatness was in seen in 52% of the placebo group but only 10% in the metformin group.
Increased blood sugar was seen in 33% of the placebo group and none of the metformin group.
There was improvement in insulin resistance, beta cell function, liver function, fibrinolysis, carotid intima media thickness, inflammatory parameters and disease activity severity markers in the metformin group.
There were fewer cases of pneumonia, moderate to severe infections and all causes of hospitalisation for adverse events in the metformin group.
What got worse:
Diarrhea was worse in the metformin group.
What didn’t get better:
Visceral to subcutaneous fat ratio was unchanged between the groups.
My comment: Looks like a clear winner for adding metformin to long term prednisolone treatments.
An Australian study looked at how 1,000 community living Australians aged between 70 and 90 got on with memory and cognition tests over a six year period.
It found no differences between people who took statins and those who had never taken them. If anything, statin use reduced decline in memory especially in those with heart disease or who were carriers of apolipoprotein E4.
Magnetic resonance imaging of some of the group detected no effects of statins on total brain volume or on hippocampal or para-hippocampal volumes.
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.
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.
Diabetes Diet 