Public Health Collaboration Conference 2018: a great success for Lifestyle Medicine

I was delighted to attend and speak at the third PHC conference in London this year.  We met at the Royal College of General Practitioners in London on the sweltering weekend of the Royal Wedding. Apart from superb international speakers we were treated to low carb, high protein food, such as one would typically eat on a ketogenic diet. Instead of picking at our dinners as we often have to do with mass catering  we could eat the whole lot. Great!

Dr Peter Brukner from Australia started off the weekend with a review of what was happening in the low carb world. There are more and more reports coming out describing the advantages of ketogenic and low carb diets to different groups of people but the establishment are fighting back viciously as can be seen by the attack on Professor Tim Noakes in South Africa.  Indeed if his defence lawyers and expert witnesses had not worked for free he would be bankrupt.  This is a terrible way to wage war on doctors who are acting in the best interests of their patients.

Dr Aseem Malhotra also described bullying tactics that had been used against him when he was a junior doctor and first becoming publicly engaged in the low carb debate. I have been subjected to this as well.  Professor Iain Broom showed that the proof that low carb diets are superior to low fat diets goes back 40 years.

Dr Zoe Harcombe gave us an explanation of how the calories in- calories out idea just doesn’t add up. The well known formulas about how many calories you need to avoid to lose weight don’t work in practice because of the complex compensatory mechanisms we have to avoid death from starvation.  How you put this over to patients and give them useful strategies for weight loss and blood sugar control was explored by Dr Trudi Deakin.

Food addiction is a real issue, at least it is for the majority of the audience in attendance, who answered the sort of questions usually posed by psychiatrists when they are evaluating drug addiction.  Unlike drugs, food can’t entirely be avoided but ketogenic diets are one tool that can be used to break  unhealthy food dependence. This worked for presenter Dr Jen Unwin who at one point had a really big thing for Caramac bars.  I haven’t seen these in years but they did have a unique taste.

Dr David Unwin showed clearly that fatty liver is easily treatable with a low carb diet.

Dr Joanne McCormick describes how her fortnightly patient group meetings are making change accessible for her patients and how many GPs in the audience could broach the subject in a ten minute consultation.

The website Diabetes.co.uk will shortly be starting up a type one educational programme online that all are welcome to join. I discussed the issue of what blood sugar targets are suitable for different people and how they can achieve this with dietary and insulin adjustment.

Dr David Cavan spoke about reversing diabetes in patients in Bermuda. Although Bermuda looks idyllic the reality is that good quality food is about five times as expensive in the UK as it is all shipped in. Many inhabitants work their socks off but barely cover their costs and cheap sugared drinks and buns are their staple diet. Despite these setbacks he managed to persuade a lot of diabetic patients to ditch the carbs and this had favourable results even after the educational programme had stopped.

A cardiologist Dr Scott Murray described the effects of metabolic syndrome on the heart and really why sticking stents in diseased arteries is too little, too late. He is convinced dietary change is needed to reverse and prevent heart disease. This is the first time I have been told that certain types of heart failure and atrial fibrillation are direct effects of metabolic syndrome on the heart.

The importance of exercise for physical and mental well being was not neglected and we had Dr Zoe Williams describing the great benefits that even the minimum recommended exercise can produce.

Dr Simon Tobin and Tom Williams spoke enthusiastically about Parkrun. This is a free event that runs every Saturday morning in parks all over the world. You can choose to walk, jog or run the course.

Claire McDonnell-Liu is the mother of two children who have greatly benefited from a ketogenic diet. The conditions are urticaria and epilepsy.  Although NHS dieticians do help families with childhood epilepsy who want to use a ketogenic diet, they can’t do it unless drugs have failed, as this is NICE guidance. I wonder how many children would benefit in fit reduction without side effects of drugs if this guidance was changed?

This was a fabulous conference with a positive enthusiastic vibrancy. Thanks to Sam Feltham for organising this event especially since he has become a new dad as well.

The Public Health Collaboration are putting all the talks on You Tube.

I was interviewed about diabetes and women’s health issues for Diabetes.co.uk and Diet Doctor and these interviews and many others will be available for you all to see to improve your lives with diabetes.

 

 

 

Jovina cooks Spanish: Gazpacho

Gazpacho_in_Mijas.jpg
This cold soup is delicious and refreshing—a perfect summertime starter.
Ingredients
1 clove garlic, roughly chopped
1/2 red onion, roughly chopped
1/2 red bell pepper, seeded and roughly chopped
1/2 green bell pepper, seeded and roughly chopped
1 cup peeled, seeded and roughly chopped cucumber
3 cups  good quality tomato juice
1 tablespoon extra virgin olive oil
1 teaspoon white wine vinegar
1/2 teaspoon sea salt
1/4 teaspoon ground black pepper

A few drops of Tabasco for added kick (optional)
Garnish: chopped cucumber, onion or bell pepper
Directions
Place all ingredients in a food processor or blender and process until smooth.
Chill in the refrigerator for twenty four hours for the best flavor.  Garnish with chopped vegetables, if desired.

Eat green leafy vegetables to give your brain many extra years

parsley-1444019_960_720

If you eat one or two portions of green leafy vegetables a day you could have a brain 11 years younger than you otherwise would.

That is the conclusion of a longitudinal study of almost a thousand elderly  people in the USA. Compared to people who rarely or never ate green vegetables there was a very marked difference in brain function over time.

This seems to be due to the folate, phylloquinone and lutein in the foodstuffs.

So eat up and protect your brain. If like me, you prefer your salad well dressed and your vegetables laced with fat and garlic and spices look around the site for our recipes. Spinach in a cheese and garlic sauce, and buttered peas and leeks are my favourites.

Adapted from BMJ 13 Jan 2018 from an article in Neurology

 

 

 

 

 

 

 

 

Fittoservegroup: Peanut Butter Cookies

cookies.jpg

 

Low Carb Keto Peanut Butter Cookies

by fittoservegroup

I grew up always baking and my parents gave me free license in the kitchen to do so. I remember begging my father to buy me my first Betty Crocker cookbook and then proceeding to wear that book out.  From measuring the ingredients, to the enticing smells  coming from the kitchen that bring the family together, I love everything about baking. Well, maybe not the cleanup afterwards. My point is, that baking has always played a big role in my life. So, when I went low carb keto, I was pretty certain I would have to hang up my baking apron. Needless to say, I was pretty sad about that possibility.

Frankly in the beginning, I really struggled to understand how to use alternate low carb flours. Working with gluten-free flours can be quite tricky. It’s that darn gluten that makes everything so tasty and easy to work with. However, I will tell you that it was my determination to figure out how to bake again, that pushed me to learn.

It’s hard to believe it’s been three solid years of this lifestyle for Randy and I. Today, I know my way around the low carb keto baking kitchen. I am not saying those first few attempts were not an epic fail. Trust me when I tell you, you would not have liked what was coming out of that oven. I threw out my fair share of low carb baked goods that no one ever even tasted. Sure it took some trial and error, but once I understood the basics, I was off and running. I hope this encourages you to keep trying. The satisfaction of knowing you are not only making something delicious but healthy, is powerful.

Creating a low carb keto peanut butter cookie was something I really wanted to accomplish. I love peanut butter and the thought of never having a peanut butter cookie, was just not an option. This is a simple recipe and one that I am confident any one can recreate.

Peanut allergy? Not a problem, just substitute the peanut butter for a sugar-free almond butter, or other favorite nut butter.

If you enjoy our melt-in-your-mouth low carb keto peanut butter cookies, please consider sharing the recipe.

Wondering how to transition into a low carb keto diet effortlessly? Allow me to introduce you to keto//OS the first and most delicious way to raise your ketone levels by drinking therapeutic ketones. Ready to get started? Order keto//OS here

Watch this short video to explain how it works.

Low Carb Keto Peanut Butter Cookies

Ingredients

1 cup sugar-free chunky peanut butter

1 stick ½ cup of unsalted softened butter

1 cup of sugar substitute, I us Swerve or other erythritol blend.

1 egg

1 cup of almond flour

1 tsp of baking powder

½ tsp sea salt

Parchment lined cookie sheet

Directions

Pre-heat oven to 350 degrees. In a stand-up mixer, beat well the peanut butter, sugar-substitute, and egg. Next add the almond flour and baking powder. Stir mixture until fully combined.

Drop a teaspoon amount of dough to form little balls and place on a parchment lined cookie sheet. Once the dough is on the cookie sheet, flatten them with the tines of fork and to make the classic peanut butter design.

Bake in a 350-degree oven until lightly brown around the edges around 10 min.  Allow them to fully cool for another 10 minutes before eating and story.  T

Makes about 1 ½ dozen cookies.  2.5 net carbs per cookie

Note: This recipe doubles easily.

Enjoy in good health!

 

Orthopaedic surgeon who wants to reduce amputations silenced by regulatory body

fb_BPhotography_Belinda-Fettke_No-Fructose_Gary-Fettke_LAFM_Fairsies-Fat-Busters.jpg

It would be funny if it wasn’t so tragic. Gary Fettke, a Tasmanian orthopaedic surgeon has been banned from talking to patients about the nutritional changes they can make to prevent amputations.

His wife, a nurse, tells his story here:

 

http://www.nofructose.com/gary-fettke/

 

Gary’s presentation on you tube is here:

 

 

 

 

PUBLIC HEALTH COLLABORATION: WHAT TO LOOK OUT FOR WHEN STARTING A LOW CARBOHYDRATE DIET

PHC-Space-Top

 

FOR EVERYONE

As you start a low carbohydrate diet your kidneys get better at excreting salt thus you will usually find that you lose a lot of water from the tissues of the body.  This can make you instantly slimmer, particularly around the legs, but also can give some cramps in the muscles when you exert yourself.  Be aware of this and add extra salt to your food, and drink plenty of water.  When you are on a low carbohydrate natural foods diet you will be consuming considerably less sodium chloride, which is present in many processed foods including sweet ones.  Bread for instance has a lot of added salt that most people are completely unaware of, therefore feel free to be liberal with the salt cellar.

 

BLOOD PRESSURE

Blood pressure comes down, partly due to less water retention, but also due to lowered natural insulin levels in the body.  As the weight comes down as well, blood pressure tends to drop.  For most people who are not on any antihypertensive drugs they may feel slightly lightheaded from time-to-time.  This can be abolished by adding more salt to the diet.

For people who are on medication to reduce their blood pressure they should have their blood pressure measured by their general practitioner and cut back on medication on embarking on a low carbohydrate diet if their blood pressure is under 140/90.  After a few weeks on a low carbohydrate diet they will be adjusted to a lower level of blood pressure.  Thereafter blood pressure only requires to be checked on several occasions with each extra half stone of fat loss.

It is helpful to buy your own blood pressure monitor as measurements done when you are relaxed at home tend to be more accurate than those undertaken in a surgery.

As many blood pressure medications have more than one use, and different effects on the body, it is worth discussing with your general practitioner which ones would be better to cut out altogether or which ones could be reduced in dose.  This is because certain drugs such as ACE inhibitors and sartans have an extra protective effect on the kidney and this can be important for diabetic patients. They also help improve heart function in cardiac failure.

Beta-blockers are sometimes given to people with atrial fibrillation, or who have had a heart attack, or who suffer from angina, and continuing these may be a priority for some individuals.

BLOOD SUGAR REDUCTIONS

Blood sugar reductions happen rapidly with a low carbohydrate diet.  This is mainly due to the lack of sugar and starch being turned into blood glucose.  This has several effects.

The most pronounced and rapid effect could be on the eyesight.  The lens of the eye adjusts to a particular blood sugar and if the level goes suddenly up, or suddenly down, your vision can become blurry, particularly for reading print.  It is worthwhile avoiding getting new spectacles for about 6 months to give time for the lens of your eye to adjust otherwise you can end up having to get another pair of spectacles at a very short interval and this can be rather expensive.

 

INSULIN and ORAL HYPOGLYCAEMIC DRUG USERS NEED TO TAKE EXTRA PRECAUTIONS

Type 1 diabetics will have been using insulin from the time of diagnosis.  Increasing numbers of Type 2 patients are going on insulin as their pancreas needs more support as time goes on.  A rapid change in pattern of sugar and starch intake can give dangerously low levels of blood sugar unless the insulin dose is proportionately reduced from the outset of the diet.  The amount of reduction will depend on how high your blood sugars run normally, and how strict your low carbohydrate diet is.

For many people who are taking insulin, or sulphonylurea drugs which also have a marked blood sugar reduction effect, starting on a moderately low carb diet of 100g or so a day may cushion the effect somewhat.

Most diabetics will need to cut their insulin quite dramatically, particularly if they go on less than 50g of carbohydrate a day.  It is normal to have to cut insulin by a half or even two thirds in some individuals.

A close eye on blood sugar monitoring needs to be done and we would recommend that, for particularly people who are operating machinery or driving, they start a low carbohydrate diet over a period of holiday when there are other people around who can assist them should they have low blood sugars, and also people to undertake driving on their behalf.

 

Your own general practitioner or hospital endocrinologist is the best person with whom to discuss your planned reduction in insulin or sulphonylurea medications.

Many patients on sulphonylureas are able to stop these drugs completely prior to starting a low carbohydrate diet and thus remove the risk of low blood sugars completely.  People who use insulin however are not able to do this and must have a degree of background insulin to prevent them developing dangerously high blood sugars and ketoacidosis.

  The normal blood sugar ranges between 4 and 7 at most times.  Drivers must not drive unless their blood sugar is at least 5, and they should re-check their blood sugar after every 1-2 hours of driving.  To treat a hypo use 15-20g of glucose and do not drive till blood sugars are completely normal and you have fully recovered.

Setting an alarm to check blood sugars in the middle of the night, and taking blood sugars at 2½ hourly intervals through the day is advised in the first few days for insulin users.

The normal correction dose is one unit of rapid acting insulin for every 2.5 units of blood sugar elevation. This can be helpful to know if you have cut down your insulin doses a bit too much.

Aiming for blood sugars between 6 and 8 mmol can be a safe strategy in the first 2 weeks after starting a low carbohydrate diet.  Thereafter the blood sugars can be tightened up when insulin requirements are more predictable.  To prevent blood sugars going up and down unpredictably it is best to stick to 3 main meals a day and avoid snacking.

EDUCATIONAL COURSES

For insulin users and people on sulphonylureas it is best to fully understand the implications of a low carbohydrate diet and know how to control your blood sugars and insulin as well as having a good grasp of carb counting prior to undertaking a low carbohydrate diet.  There are many educational resources on the web to do this.  Some of these resources are Dr Bernstein’s Diabetes University on you tube, diabetes.co.uk website and Low Carbohydrate Course which is web based, and diabetesdietblog.com which has two written courses.

LONG TERM

Although it can be daunting to think about the initial difficulties that can occur with a low carbohydrate diet, the long term benefits of improved blood sugars, weight, blood pressure and lipids make the outlook for pre-diabetics, the overweight and people suffering from diabetes much brighter indeed.  It is worth educating yourself about your condition and how to effectively use a low carbohydrate diet to change your health destiny.  The extra planning that you need to do for meals, more frequent shopping for fresh ingredients and often increased expense are worth the long term health benefits.

ALCOHOL

Alcohol can be a pleasant part of life.  Many alcoholic drinks are high in sugar, such as beer and sweet wines, and also cocktails.  These need to be eliminated for success in a low carbohydrate diet.  Spirits such as whisky, gin and vodka have less impact on the blood sugar, and dry red and white wines are also suitable.

For insulin users, and particularly Type 1 insulin users however, alcohol can tip them into unexpected hypoglycaemia if they are consuming more than 1-2 units of alcohol without a corresponding increase in dietary carbohydrate.  This is because alcohol limits the ability of the liver to manufacture glucose, and also blood sugars tend to run much more towards the normal range, around 4.6, when diabetes undergoes an apparent reversal on a low carbohydrate diet.

EXERCISE

Exercise is a very beneficial and pleasant adjunct to a low carbohydrate diet for increased mood and health.  For insulin users and those on medication such as sulphonylureas, adding exercise into the regime early on in the stages of a low carbohydrate diet add an increasing layer of complexity to blood sugar management.  We therefore recommend that unaccustomed exercise is avoided for the first 2 weeks until blood sugar stability is achieved.

 

Dr Katharine Morrison

 

 

Public Health Collaboration: Free booklets

 

LA2-vx06-konsthallen-skulpturThis is the link to the Public Health Collaboration site where you can download for free or order print versions, at a modest cost, of illustrated health booklets that will help you:

 

know what to eat for a wide variety of good health outcomes

plan your meals

count your carbohydrates

lose fat

https://www.PHCuk.org/booklets/

 

Hopefully you will end up somewhere between the extremes of our sisters up there!