The best diet for optimal blood sugar control & health
There is some evidence that a low carb diet can help prevent cancer and also improve the outlook for people who already have the condition. Here are too sites that discuss the issue.
Dr Mercola provides an article.
Dr Gary Fettke appears on video.
https://www.youtube.com/watch?v=qa5Bcm8T9nU
Harvard researchers find as many as 40 percent of cancer cases, and half of cancer deaths, come down to things people could easily change.
Many Americans often worry about whether chemicals, pollution or other factors out of their control cause cancer, but a new analysis shows otherwise: people are firmly in charge of much of their own risk of cancer. As we get older, our risk goes up, which could come from doing the same bad habits over a long period of time. The same can be said for being diagnosed with diabetes and prediabetes. Eating one large order of French fries will not increase your risk for cancer or diabetes, but eating two orders a week over 40 years would be over 4,000 orders, or over 2,000,000 calories and 259,000 carbohydrates, which can certainly be injurious to your health.
The team at Harvard Medical School calculated that 20 to 40 percent of cancer cases, and half of cancer deaths, could be prevented if people quit smoking, avoided heavy drinking, kept a healthy weight, and got just a half hour a day of moderate exercise. They used data from long-term studies of about 140,000 health professionals who update researchers on their health every two years for the analysis, published in the Journal of the American Medical Association’s JAMA Oncology.
“Not surprisingly, these figures increased to 40 percent to 70 percent when assessed with regard to the broader U.S. population of whites, which has a much worse lifestyle pattern than our cohorts,” wrote Dr. Edward Giovannucci of Harvard Medical School. The analysis was simple. They broke the 140,000 people into two groups: those with a healthy lifestyle, and everyone else. The healthy lifestyle definition was based on a large body of studies that have shown what personal habits are linked with higher or lower risks of cancer. They include not smoking; drinking no more than one drink a day for women, two drinks a day for men; keeping a healthy weight, defined as body mass index of between a very slender 18.5 and a slightly overweight 27.5; and getting the equivalent of just over an hour of vigorous exercise or two and a half hours of moderate exercise a week.
Heavy drinking raises colon, breast, liver and head and neck cancer rates. Obesity raises the risk of esophageal, colon, pancreatic and other cancers. Smoking causes 80 to 90 percent of lung cancer deaths. Only about 28,000 of the people analyzed qualified as following a healthy lifestyle. When the rates of cancer in their group were compared to rates in the rest of the volunteers, the differences were clear.
The purpose of the study was to estimate the proportion of cases and deaths of carcinoma (all cancers except skin, brain, lymphatic, hematologic, and nonfatal prostate malignancies) among whites in the United States that can be potentially prevented by lifestyle modification.The incidence rates of cancer were 463 per 100,000 for women in the “healthy” group, versus 618 per 100,000 for those not meeting the healthy goals. For men, it was 283 per 100,000 who met the healthy lifestyle goals versus 425 among those who did not. And these were health professionals, who should at least try to be healthier. When Giovannucci compared the healthy group to the general, white, U.S. public, the differences were even bigger. Plus, they didn’t add in other known factors, such as eating a healthy diet rich in fruits and vegetables, although they said those who followed the other healthy patterns did tend to eat better, also.
“These compelling data together with the findings of the current study provide strong support for the argument that a large proportion of cancers are due to environmental factors and can be prevented by lifestyle modification.” By “environmental,” they mean non-genetic causes. To a scientist, environment includes diet, exercise and other factors.
89,571 women and 46,339 men from 2 cohorts were included in the study: 16,531 women and 11,731 men had a healthy lifestyle pattern (low-risk group), and the remaining 73,040 women and 34,608 men made up the high-risk group. Within the 2 cohorts, the PARs for incidence and mortality of total carcinoma were 25% and 48% in women, and 33% and 44% in men, respectively. For individual cancers, the respective PARs in women and men were 82% and 78% for lung, 29% and 20% for colon and rectum, 30% and 29% for pancreas, and 36% and 44% for bladder. Similar estimates were obtained for mortality. The PARs were 4% and 12% for breast cancer incidence and mortality, and 21% for fatal prostate cancer. Substantially higher PARs were obtained when the low-risk group was compared with the US population. For example, the PARs in women and men were 41% and 63% for incidence of total carcinoma, and 60% and 59% for colorectal cancer, respectively.
From the results, it was concluded that a substantial cancer burden may be prevented through lifestyle modification. Primary prevention should remain a priority for cancer control.
Practice Pearls:
•89,571 women and 46,339 men from 2 cohorts were included in the study.
•Many cancer cases and even more deaths among U.S. white individuals might be prevented by quitting smoking, avoiding heavy alcohol consumption, maintaining a BMI between 18.5 and 27.5, and exercising at a moderate intensity for at least 150 minutes or at a vigorous intensity for at least 75 minutes every week.
•These compelling data together with the findings of the current study provide strong support for the argument that a large proportion of cancers are due to environmental factors and can be prevented by lifestyle modification.
Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States. May 19, 2016. doi:10.1001/jamaoncol.2016.0843.
Diabetes in Control June 11th, 2016
My Free Style Libre trial ended this week. Was it a good/bad/in different experience?
The Free Style Libre is a new way of testing your blood glucose levels. You attach a sensor to your upper arm (right arm if you’re left-handed like me and vice versa), and then you use a reader to scan the sensor and it gives you your results in a second.
You can also see what your blood glucose has been doing for the last eight hours, and you can tell if it’s going up or down, quickly or slowly, or staying stable.
There’s also a feature for calculating insulin doses, and you can use the reader in the traditional way to test blood glucose through a finger prick if you have the strips suitable for the system. I didn’t use either of these features.
It was interesting. As someone who only recently managed to get out of the slightly obsessive compulsive blood testing habit, I scanned a lot. It’ll be hard to go back to limited tests. Seeing what your blood sugar does over eight hours – particularly overnight – is also fascinating.
In general, my blood sugar dips first thing, and then rises through the hours of the morning – something I believe is common in most people.
I liked it because I could check frequently. Do I think it improved my overall control? Too hard to tell and two weeks doesn’t give you that knowledge. Would I like to keep it? Yes. It’s wonderful being able to check your levels whenever you want. Jokes aside about obsessive compulsive testing – and actually, I didn’t do check half as much as I thought I would – knowing that you can check whenever you want is liberating. I get through five boxes of 50 blood testing strips every two months and sometimes it’s feels as if I’m eking them out, as that works out as less than five strips a day.
As I said in my original post, which you can read here, the biggest drawback of the Free Style Libre is that it is not available on the NHS. The sensors need to be replaced every 14 days and they cost £56 (£48 when you apply the VAT exemption you are entitled to as a type 1 diabetic), which works out at £1,248 a year if you use it all the time.
Occasional use is an option though. It would be nice to have a few sensors in stock for that possibility.
Have you used the Free Style Libre – or is it something that appeals to you? What do you think the benefits to you could be? We’d love to know.
The Society for Vascular Surgery, the American Podiatric Medical Association and the Society for Vascular Medicine collaboratively publish first-ever set of clinical practice guidelines for treating the diabetic foot. These took three years to develop and are available online.
Specific areas of focus included (1) prevention of diabetic foot ulceration, (2) off-loading, (3) diagnosis of osteomyelitis, (4) wound care, and (5) peripheral arterial disease.
They include preventive recommendations such as those for adequate glycemic control, periodic foot inspection, and patient and family education.
They recommend using custom therapeutic footwear in high-risk diabetic patients, including those with significant neuropathy, foot deformities, or previous amputation. In patients with plantar diabetic foot ulcer (DFU), they recommend off-loading with a total contact cast or irremovable fixed ankle walking boot.
In patients with a new DFU, they recommend probe to bone test and plain films to be followed by magnetic resonance imaging if a soft tissue abscess or osteomyelitis is suspected.
They provide recommendations on comprehensive wound care and various débridement methods. For DFUs that fail to improve (>50% wound area reduction) after a minimum of 4 weeks of standard wound therapy, they recommend adjunctive wound therapy options.
In patients with DFU who have peripheral arterial disease, they recommend revascularization by either surgical bypass or endovascular therapy.
Whereas these guidelines have addressed five key areas in the care of DFUs, they do not cover all the aspects of this complex condition. Going forward as future evidence accumulates, they plan to update recommendations accordingly.
Diabetes is one of the leading causes of chronic disease and limb loss worldwide, currently affecting 382 million people. It is predicted that by 2035, the number of reported diabetes cases will soar to 592 million. This disease affects the developing countries disproportionately as >80% of diabetes deaths occur in low- and middle-income countries.
As the number of people with diabetes is increasing globally, its consequences are worsening. The World Health Organization projects that diabetes will be the seventh leading cause of death in 2030. A further effect of the explosive growth in diabetes worldwide is that it has become one of the leading causes of limb loss. Every year, >1 million people with diabetes suffer limb loss as a result of diabetes. This means that every 20 seconds an amputation occurs in the world as an outcome of this debilitating disease. Diabetic foot disease is common, and its incidence will only increase as the population ages and the obesity epidemic continues.
Approximately 80% of diabetes-related lower extremity amputations are preceded by a foot ulcer. The patient demographics related to diabetic foot ulceration are typical for patients with long-standing diabetes. Risk factors for ulceration include neuropathy, PAD, foot deformity, limited ankle range of motion, high plantar foot pressures, minor trauma, previous ulceration or amputation, and visual impairment. Once an ulcer has developed, infection and PAD are the major factors contributing to subsequent amputation.
Available U.S. data suggest that the incidence of amputation in persons with diabetes has recently decreased; toe, foot, and below-knee amputation declined from 3.2, 1.1, and 2.1 per 1,000 diabetics, respectively, in 1993 to 1.8, 0.5, and 0.9 per 1,000 in 2009. However, including the costs of outpatient ulcer care, the annual cost of diabetic foot disease in the United States has been estimated to be at least $6 billion. A Markov modeling approach suggests that a combination of intensive glycemic control and optimal foot care is cost-effective and may even be cost-saving.
DFUs and their consequences represent a major personal tragedy for the person experiencing the ulcer and his or her family as well as a considerable financial burden on the healthcare system and society. At least one-quarter of these ulcers will not heal, and up to 28% may result in some form of amputation. Therefore, establishing diabetic foot care guidelines is crucial to ensure the most cost-effective healthcare expenditure. These guidelines need to be goal focused and properly implemented.
This progression from foot ulcer to amputation leads to several possible steps where intervention based on evidence-based guidelines may prevent major amputation. Considering the disease burden and the existing variations in care that make decision-making very challenging for patients and clinicians, the SVS, American Podiatric Medical Association, and Society for Vascular Medicine deemed the management of DFU a priority topic for clinical practice guideline development. These recommendations are meant to pertain to all people with diabetes regardless of etiology.
Practice Pearls:
•“The Management of the Diabetic Foot,” was developed after three years of studies and later published online and in print in the Journal for Vascular Surgery.
•This progression from foot ulcer to amputation lends to several possible steps where intervention based on evidence-based guidelines may prevent major amputation.
•Every year, >1 million people with diabetes suffer limb loss as a result of diabetes.
Researched and prepared by Steve Freed, BPharm, Diabetes Educator, Publisher and reviewed by Dave Joffe, BSPharm, CDE
Anil Hingorani, MD Glenn M. LaMuraglia, MD, Journal of Vascular Surgery Feb 2016 , Volume 63, Issue 2, Supplement, Pages 3S–21S
April 23rd, 2016 Diabetes in Control
A Finnish study has shown that growing up with a dog in the house improves the immune response of babies. Early respiratory infections, gastroenteritis and allergic reactions are reduced.
If a man has type one diabetes his chance of passing this on to his children is one in three. Maternal type one diabetes also increases the risk of type one in children but to a much lesser degree. Genetic susceptibility is reduced to a small extent if the baby is brought up in a house where the dog lives in the house. Unfortunately cats don’t confer the same benefit.
Reported in JAMA Paediatrics 2014 and BMJ 19th July 2014
Dana, what is the range of health conditions that you have seen respond to a low carb diet in your readers?
The most exciting, perhaps, is polycystic ovarian syndrome, the most common cause of female infertility, and very definitely an insulin-driven illness. Back when I was still self-published, I got an email from a woman who had tried for years to get pregnant, but couldn’t because of PCOS. She read How I Gave Up My Low Fat Diet and Lost 40 Pounds, went low carb, got pregnant, and carried the child to term. That’s the kind of thing that keeps me grinning for days.
Commonly, I hear of vastly improved blood work – one fellow had his triglycerides plummet by 1200 points in 2 weeks. People regularly report low trigs and high HDL.
Blood pressure reliably drops, too. It’s common for detractors to say “Oh, you only lost water weight on that diet.” That’s nonsense, of course, but it is true that the very rapid loss of 5-10 pounds in the first week or so is largely water. That’s because when insulin levels drop the kidneys resume excreting sodium properly, and with it the water it was holding. Because of this, blood pressure comes down quickly. (For this reason, people who are medicated for high blood pressure must be under a doctor’s care when they first go low carb. They may need a reduction in medication within days.)
By the way, the proper excretion of sodium means that many low carbers need to increase their salt intake – I’m one of them. If a new low carber is feeling tired, achy, dizzy, headache-y, the first thing to try is increasing salt – heavily salted broth or bouillon works wonderfully.
Energy swings vanish when the blood sugar swings stop. Many annoying symptoms of generalized inflammation, such as arthritis, are reduced or eliminated.
Gastroesophageal reflux, aka heartburn, generally clears up.
And all kinds of little things – skin conditions, bleeding gums, stuff like that. My husband, who has a mouth full of crowns, hasn’t had a single new cavity since we went low carb 20 years ago. (I still have no fillings at the age of 57.)
Perhaps most surprising was the woman who wrote me to say that since she and her husband had gone low carb, a range of problems had cleared up, including that he had “stopped coughing up blood.” She finished with “You have been a miracle for our family.”
I have no idea how a low carb diet would stop the coughing up of blood, but I’m certainly glad it did.
Dana Carpender is the author of nine cookbooks, including the best-selling 500 Low-Carb Recipes.
The England and Wales National Diabetes Audit is the largest annual clinical audit in the world and the most comprehensive of its kind. It gives information on how much of NICE policy is being implemented.
In the 2013-15 populations the percentage of registered diabetics has risen to 5.1% although it is thought that 7.1% of men and 5.3% of women have the condition from the Health Survey for England 2014.
Nine care processes are recommended by NICE. Overall 39% of type one diabetics and 59% of type two diabetics got all of the checks covered in the audit. Worryingly only 27% of type ones under the age of 40 got all the necessary checks. There is a large range in variability in performance. For type ones in some areas 17% had all the checks and the best managed 62%.
Overall diabetics have a good chance of getting their bloods taken and blood pressure taken. The offer of structured education for newly diagnosed type one patients rose from 17% to 76%. Although 78% of type twos are offered structured education, only 5% take it up.
Only 30% of type one diabetics have glycaemic values of 7.5% HbA1c or 58 mmol/mol. Only 8.7% of type ones got 6.5% or 48 mmol/mol or below. 29% of type twos achieved this target.
The quality of care seems to be worse for type one diabetics especially in the younger age groups. Most of these people will be seen by hospital teams rather than a General Practitioner. The reasons why structured education is sidelined by patients is also mysterious.
Based on an article by Steve Chaplin Medical Correspondent for Practical Diabetes March 2016.
Persistent depression is associated with twice the risk of stroke in adults over 50.
Researchers interviewed 16,178 people every two years from 1998 over a 12 year period and assessed depressive symptoms and stroke. They showed that those people who scored significantly for depression on at least two consecutive interviews had double the risk of having a first stroke in the two years after the assessment compared to those with low depressive symptoms. The risk was slightly higher for women and those who had had previous depressive symptoms.
Paola Gilsanz of Harvard University said, ” Our findings suggest that depression may increase stroke risk over the long term. This risk remains elevated even if depressive symptoms have resolved, suggesting a cumulative mechanism linking depression and stroke. Physiological changes may lead to vascular damage over the long term. Depression is also linked to hypertension, ill effects on the autonomic nervous system and inflammatory responses that all cause vascular disease. In addition depressed people are more likely to smoke and by physically inactive.”
From Research News BMJ 23 May 2015
People who have diabetes diagnosed in midlife have a higher risk of cognitive decline over the following 20 years compared to people with normal glucose levels. A prospective study done in the USA showed that there was a 19% increased risk of cognitive decline over the 20 years for those who had diabetes. This meant that having diabetes aged cognitive function by about five more years than normal.
The level of decline was associated with the degree of control of the diabetes. Those with HbA1cs over 7% were more at risk than those with a better degree of control. Increased duration of diabetes also led to a higher risk.
The study reviewed 13,351 year olds who were aged 48-67 at the start of the study for 20 years. Associate professor of epidemiology Elizabeth Selvin of John Hopkins University said of her findings, ” The lesson is that to have a healthy brain when you are 70, you need to eat right and exercise when you are 50. Maintaining cognitive function is a critical aspect of successful ageing. Preventing diabetes and improving glucose control in people with diabetes offers important opportunities for preventing cognitive decline and delaying progression to dementia”.
The Daily Telegraph reported this week that a large pilot study of low-carb diets has suggested that they can successfully control type 2 diabetes.
That’s no news to us here at the Diabetes Diet, but the study is interesting because it involved a huge number of people – 80,000 of them, who gave up low-fat, high carbohydrate diets and found that their blood glucose levels dropped after 10 weeks.
That study was carried out after what was described as “an online revolt” by patients in which 120,000 people signed up for the “low-carb” diet plan launched by the global diabetes community website, diabetes.co.uk. The low-carb plan goes against official advice given by the NHS and Diabetes UK.
More than 80 percent of the people surveyed said they had lost weight, with 10 percent of them losing 9kg or more. More than 70 percent of the patients experienced improvements in their blood glucose levels and a fifth of participants said they no longer needed drugs to regulate their blood glucose levels.
The people taking part had followed diabetes.co.uk’s 10-week low-carb plan.
The website’s low carb plan is available here, but you can find plenty of help and advice for following a low-carb diet in our book, the Diabetes Diet. Our website also has lots of low-carb recipes – from starters, to main courses, snacks and sweets. Use the search button or check out the recipe category to find what you want.
Diabetes Diet 