Improved life expectancy for severe kidney disease on keto diets

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.

Fibre is not the answer for diverticulosis prevention

Adapted from A high fiber diet does not protect against asymptomatic diverticulosis by Anne F Peery et al. Gastroenterology Volume 142, Issue 2, February 2012 Pages 266-272.

The complications of diverticulosis cause considerable morbidity in the developed world. Many physicians and patients believe that a high fibre diet and frequent bowel movements are the key to its prevention. We sought to determine whether low fibre or high fat diets that include large quantities of red meat, constiptation or physical inactivity increase the risk for asymptomatic diverticulosis.

We performed a cross sectional study of 2,104 adults aged 30 to 80 who were getting an outpatient colonoscopy from 1998 to 2010. Diet and physical activity were assessed in interviews using validated techniques.

As we expected the numbers of people with diverticulosis increased as they aged. High fibre intake did not reduce the prevalence of diverticulosis. Indeed, those in the highest quartile of fibre intake had more diverticulosis per person than the lowest. Risk increased with increasing amounts of total fibre, fibre from grains, soluble and insoluble fibre. Constipation was also not a risk factor. Those who had more than 15 bowel movements a week had a 70% higher risk compared to those with less than 7 bowel movements a week. Neither physical inactivity or intake of fat or red meat was associated with diverticulosis.

These results indicated that the generally accepted “risk factors” for diverticulosis need to be reconsidered.

For one poor man’s real life experience with this condition read:

He found that wheat products and seed oils were the main factor and he wishes he had found this out before having a miserable 15 years with gut pain and diarrhea.

Tim Noakes: Nutrition Network Courses for Health Professionals

Homepage | Nutrition Network (

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.

University College London: Diabetes has trebled in England in the last 25 years

Researchers from UCL analysed the results the latest results from the Health Survey for England.

Data from 8,200 adults and 2,000 children living in private households showed that diabetes has risen in men from 3% to 9% and from 2% to 6% in women since 1994.

Those from poorer households and those with obesity are much more likely to be affected than the slim and affluent. 16% from the poorest homes had diabetes compared to 7% in the highest income group. If you are of normal weight there is a 5% chance of diabetes, 9% if you are overweight and 15% if you are obese.

Obesity is a marker for poverty. 39% of women in deprived areas were obese compared to 22% from least deprived areas. The weight of children was closely correlated with their parents.

Professor Jennifer Mindell said,” Diabetes has become more common in both high and low income countries over the last few decades. It increases the risks of circulatory diseases and cancers. This year we have also seen a rise in serious infection and death such as with Covid-19. Obesity reduction would help all of these problems.”

The survey also asked about GP visits. 69% of men and 82% of women had consulted a GP in the previous six months. GP consultations are more common in older ages, especially among men and those who are overweight or obese. 84% said they went about their physical health problems, 11% for physical and mental problems and 5% for an emotional or mental health problem. Women tended to seek more help for mental health problems than men.

Echoing all the other parameters, consultations for mental health problems were more frequent in those with lower incomes. 25% consulted from the lowest income group compared to 15% from the most affluent group.

Elizabeth Fuller, Research Director at NatCen said, ” One in five women and one in eight men screened positive for a possible eating disorder. This can mean eating too much or too little, obsessing with weight or body shape, having strict routines around food or purging after eating. People who are obese, younger adults and women are more likely to be affected.”

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

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

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.

CrossFit: exercise, diet and research

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.

Metformin improves side effects of steroid treatment

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.

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.



Dr Michael Eades: Omega 6 fats make you fat way beyond their caloric value

There is a hypothesis gaining ground which is that the omega 6 fats in vegetable oil disrupt metabolism and promote fat gain way beyond their simple caloric value.

Dr Michael Eades explains the epidemiology which suggests that this is the case and then the biochemistry which provides a plausible explanation.

This video is 45 minutes long and is quite technical in parts.


Abstract and video here: