research – Diabetes Diet

Worsening obesity in children can be reversed with a ketogenic diet

Mar 15, 2023Mar 8, 2023 kaitiscotland5 Comments

*Photo by Alexander Dummer on Pexels.com*

Adapted from Independent Diabetes Trust Newsletter March 2023

The National Child Measurement Programme 16 March 2022

In the western world obesity rates continue to climb in children. In the UK when children start primary school at the age of 4-5 14.4% are obese and a further 13.3% are overweight. In Primary 6, at the age of 10-11 25.5% are obese and 15.4% are overweight.

My comment: from my own schooldays, there was only one overweight child in my primary class and she was on steroids and had a heart complaint that stopped her from participating in any exercise. In primary 7, there was one girl who was overweight and she had started puberty earlier than the rest of us.

In the USA in 2019 more than 30% of children were overweight or obese, similar to the UK figures. Physicians are reporting that since the Covid epidemic children are usually between 5 and 10 pounds heavier than they were at any given age, so these figures are likely to worsen even more.

Since 2006 Duke University has treated more than 15,000 children with a restricted carbohydrate diet which encourages the eating of vegetables, fatty fish, nuts and other features of the Mediterranean diet.

Meghan Pauley and colleagues from the Marshall University School of Medicine in Huntington West Virginia have cut the carbohydrate intake for children further to 30g or less a day and have been effective in short term weight loss in severely obese children and teenagers.

The ages of the subjects ranged from 5 years to 18 years. The study lasted 3-4 months. The children were otherwise told to eat as much fat and protein as desired with no limit on calories.

Two groups of analyses were done of different intakes into the programme in 2017 and 2018.

In Group A, 310 participants began the diet, 130 (42%) returned after 3-4 months. Group B had 14 enrollees who began the diet, and 8 followed up at 3-4 months (57%).

Girls compared with boys were more likely to complete the diet. Participants less than 12 years age were almost twice as likely to complete the diet compared with those 12-18 years, however, the older group subjects who completed the diet had the same percentage of weight loss compared with those under 12 years. Group A had reductions in weight of 5.1 kg , body mass index (BMI) 2.5 kg/m² , and percentage weight loss 6.9% .

Group B had reductions in weight 9.6 kg , BMI 4 kg/m² , and percentage weight loss 9% . In addition, participants had significant reductions of fasting serum insulin and triglycerides.

This study demonstrated that a carbohydrate-restricted diet, utilized short term, effectively reduced weight in a large percentage of severely obese youth, and can be replicated in a busy primary care office.

Metformin users have fewer knee and hip joint replacement than other type two diabetics

Jan 12, 2023Dec 27, 2022 kaitiscotland4 Comments

A study published in the Journal of the Canadian Medical Association in Dec 2020, has found that type two diabetics who are on Metformin have about two thirds of the risk of having a hip or knee joint replacement compared to diabetics on other medications.

The study was undertaken by Dr Zhaohua Zhu from Zhujiang Hospital in Guangzhou in China. They compared the records of over twenty thousand patients in each group and compared the duration that they were on the diabetes medications and surgical outcomes.

As they found that Metformin use was associated with a significantly reduced risk of joint replacement, this suggests a potential therapeutic effect in patients who have osteoarthritis. They recommend that randomised controlled trials are undertaken to see if there is a beneficial effect in this group.

My comment: As Metformin has already been shown to reduce cancer incidence, is inexpensive, and reasonably well tolerated both by diabetics and non-diabetics, it would seem a good idea to me for such trials to be carried out.

Nutrients and exercise can reduce cancer risk

Dec 13, 2022Nov 5, 2022 kaitiscotland3 Comments

Adapted from Nutrients and exercise affect tumour development by Carla Martinez May 27 2022 and

Three pronged approach may reduce cancer risk in the elderly by Nadine Ekert June 7 2022 Medscape

In a Madrid Oncology conference researchers discussed an update on lifestyle factors and cancer.

Diet and lifestyle can have an influence on each of the successive stages that occur in the development of cancer: initiation, promotion and progression.

A deficit of certain nutrients is one of the factors involved in the initiation stage. Various deficiencies affect different parts of cell metabolism adversely. Such nutrients include folate, B12, B6 and B3, Vitamin C, Selenium, Zinc, Magnesium and Vitamin D.

Aflatoxins from foods of vegetable origin are detrimental. The foods include cassava, pepper, corn, millet, rice, sorghum, wheat, sunflower seeds and peanuts, but the effect very much depends on how these foodstuffs are stored.

Added nitrates to foods such as processed meats and sausages because they become nitrosamines which affect cancer development. Natural nitrates in food however do not cause cancer.

Smoking causes 72% of lung cancer and 15% of all cancers. Eating processed meat causes 13% of intestinal cancers and 1.5% of all cancers. The most problematic foods for nitrosamines are cured meat, and smoked meat and fish. Cooking meats also causes polycyclic aromatic hydrocarbons especially chicken.

Various cooking strategies will reduce the formation or dilute the effects of polycyclic aromatic hydrocarbons.

Marinate mean in an acid solution for more than one hour.

Season meats and fish before grilling them. Good spices to use are: pepper, paprika, garlic, onion, ginger, turmeric, cumin, cinnamon, clove, fennel, and star anise.

Cook at a low temperature eg boiling.

Eat meats with lots of brassicas such as broccoli, cabbage, kale, turnip, brussel sprouts and mustard.

Grilled foods contain benzopyrene which can cause a mutation in DNA and thus cause cancer. Brassicas are rich in sulforphane which works on genes that produce glutathione s-transferase which promotes the elimination of benzopyrene.

Other factors that promote cancer include psychological stress, circadian disruption such as shift work, physical inactivity, obesity, hyperglycaemia, hyperinsulinaemia, gut bacteria disruption, and vitamin D deficiency.

The common factor here is increased inflammation. Some nutrients act as anti-inflammatories including the omega 3 oils EPA and DHA. Ginger, green tea, turmeric and broccoli all help too.

Daily rituals determine our health, so think about how you can optimise your routines.

The influence of exercise on cancer has only been studied in the last ten years.

Hypoxia is one of the main triggers of tumour aggression. Exercise has been shown to improve oxygenation and reduce hypoxia. Physical exercise in combination with chemotherapy has been proven to reduce tumour volume and progression. The best exercises in this regard are those that build up lactate in the muscle such as resistance exercise and cycling.

In the DO-HEALTH study, more than 2,000 healthy elderly people over the age of 70, were observed over three years. A combination of high dose vitamin D, omega 3 fatty acids and a simple home training programme reduced the risk of cancer by 61% compared to placebo.

The risk of getting cancer increases as you get older. Apart from not smoking and sun protection, getting appropriate vaccines and screening, there is not that much left to do. As Vitamin D, omega 3 fatty acids and physical exercise are all promising factors in cancer reduction, various combinations of them were tried. Blood pressure, physical performance, cognition, fractures and infections were looked at. They were divided into 8 groups looking at placebo, training only, and then various combinations and single interventions.

Most groups showed no difference from placebo but the combination of vitamin D, omega 3s and training did. The number needed to treat to prevent one cancer over the three years was 53 which is considered pretty good. Researchers thought the outcome was good enough to recommend this to any one over 70 who was looking to improve their health.

BMJ: What is junk food and what is the harm?

Dec 1, 2022Nov 4, 2022 kaitiscotland5 Comments

*Photo by Polina Tankilevitch on Pexels.com*

Adapted from: BMJ 3 Sept 22 People need nourishing food that promotes health, not the opposite by Carlos Monteiro et al.

Everybody needs food, but nobody needs ultra- processed food with the exception of infants who are not being breast fed and need infant formula.

The foods that are “ultra- processed” include: soft drinks, packaged snacks, commercial breads, cakes and biscuits, confectionery, sweetened breakfast cereals, sugared milk based and fruit drinks, margarine and pre-processed ready to eat or heat products such as burgers, pastas and pizzas.

These foods are industrial formulations made by deconstructing whole foods into chemical constituents, altering them and recombining them with additives into products that are alternatives to fresh and minimally processed foods and freshly prepared meals.

In low amounts, they wouldn’t necessarily be a problem. But most ultra- processed foods are made, sold and promoted by corporations, typically transnational, that formulate them to be convenient, ready to eat, affordable, due to low -cost ingredients, and hyperpalatable. These foods are liable to displace other foods and also to be overconsumed.

Systemic reviews of large well -designed cohort studies worldwide have shown that consumption of ultra-processed foods increase: obesity, type two diabetes, hypertension, cardiovascular and cerebrovascular diseases, depression, and all- cause mortality.

Other prospectively associated conditions include dyslipidaemias, gout, renal function decline, non-alcoholic liver disease, Crohn’s disease, breast cancer and in men colorectal cancer. They also cause multiple nutrient imbalances.

It is calculated that ingestion of these foods compared to fresh ingredients, matched for macronutients, sugar, sodium and fibre adds a typical 500kcal daily, which leads to the inevitable fat accumulation.

US investigators have found that dietary emulsifiers and some artificial sweeteners alter the gut bacteria causing greater inflammatory potential, so replacing sugar with these isn’t a good idea either.

In the UK policies to limit promotion and consumption of ultra-processed food have recently been rejected, mainly because of the belief that in our current economic situation people need access to cheap food. As no one really wants to support foods that cause illness, the obvious solution is to promote foods that are fresh and minimally processed, available, attractive and affordable. Such a strategy would improve family life, public health, the economy and environment.

There are physiological reasons why your brain feels full up after a day’s work

Nov 19, 2022Nov 3, 2022 kaitiscotland7 Comments

*Photo by Andrea Piacquadio on Pexels.com*

Adapted from Medscape, Why our brains wear out at the end of the day, F Perry Wilson Aug 15 2022

We can all recognise from our own experience that as a long day goes on, our performance on mental tasks gets worse. In chess players for example, as the game goes on over several hours, they take longer to make decisions, and they make more mistakes. This is known as cognitive fatigue.

It has been found that the cognitive control centre in the brain is in the left, lateral, prefrontal cortex.(LLFC).

The LLFC is responsible for higher level thinking. It is what causes you to be inhibited. It shuts down with alcohol and leads to impulsive behaviours. It has reduced activity in functional MRI studies as you become more and more cognitively fatigued. The LLFC helps you think through choices. So how does cognitive fatigue happen? As a matter of interest the role of glucose has already been studied and it has been found that this does NOT vary in non- diabetic subjects.

Researchers did experiments with people to induce cognitive fatigue. They had to look at letters and indicate whether the letter was if it was a consonant or a vowel if it was red or if it was upper or lower case if it was green.

Both groups did this for six hours, but one group had much less switching around than the other, so that there was an “easy” group and a “hard” group. They all sounded terribly tedious to me!

The hard group made more mistakes than the easy group, but of course the task was harder to start with. The hard group got a little bit more tired at the end, but both groups were pretty fatigued. The hard group took longer to respond all through the testing hours, but they didn’t take longer by the end of the task. So, overall, there was no clear indicator that could determine who had done the easy tasks or the hard tasks.

The researchers then started adding a new game after the six hours. The subjects were told that they would now play a “reward game”. For instance:

Would you rather have a 25% chance of earning $50 or a 95% chance of earning $17.30?

Would you rather earn $50 but your next task session will be hard or earn $40 and your next task session will be easy?

It has been previously shown that as people become more fatigued they will tend to pick the low- cost choice over the high- win choice. Perhaps we all recognise that after a difficult workday we may be more likely to go with the flow and do something easy rather than the “best” thing. We often don’t feel we have much decision- making power left. I know this is a factor for prescribing more antibiotics on a Friday afternoon.

Interestingly pupil dilatation is a physiologic measure that demonstrates when your brain is “full up”.

When you are interested in something your pupils dilate a little. In the hard group, as time went on, pupil dilatation stopped and constricted in some people. In the easy group however, the dilatation continued through the tasks.

By doing a very fancy labelled hydrogen MRI on the subjects they looked at differences in brain metabolites in the LLPC area of the brain during the tasks.

They found that the level of glutamate and glutamic acid rose in the LLPC but not other metabolites and not in other parts of the brain. They also found that the glutamate leaked from inside the cells to outside the cells.

It is statistically significant that the higher the levels of glutamate in the LLPC, the more likely you are to just make the easy decision as opposed to really think things through.

Perhaps a good night’s sleep is clearing out the excess glutamate in the LLPC and allowing you to perform well the next day.

My comment: The hours pilots and air traffic controllers work are highly regulated because of the effect of fatigue on decisions and performance. Yet, this does not extend to GPs and hospital doctors to anything like the same extent. It is considered important for lorry drivers. For all drivers and for all students, particularly before exams, it is a good idea to recognise that we are all human. Tiredness isn’t something that you can really overcome with will power.

Colorectal cancer is affected by your experience in the womb

Sep 8, 2022May 16, 2022 kaitiscotland1 Comment

Adapted from BMJ: 18 Sept 2021

A longitudinal study of women from Oakland California has been following 19 thousand of their offspring since the early 1960s.

So far 68 people have been diagnosed with colorectal cancer.

Risk factors include: obesity in the mother, weight gain during pregnancy, and a high birthweight. This suggests that uterine life has something to do with why this cancer develops. This could explain why there has been a relatively recent increase in colorectal cancer in younger aged adults. Unfortunately there is little you can do yourself about these factors.

Sleep deprivation gives you a fatter belly

Aug 21, 2022May 10, 2022 kaitiscotland3 Comments

In young adults sleep deprivation has been found to cause fat accumulation in the belly for the first time.

Naima Covassin from the Mayo Clinic Rochester Minnesota studied 12 healthy slim young people aged between 19 and 39. The poor souls were randomised to two weeks of just 4 hours sleep a night or 9 hours sleep followed by a three day recovery period. During this time the subjects were kept in hospital and factors such as calorie intake and energy output were measured.

Over the two weeks of sleep deprivation, the subjects put on an average of a pound or half a kilogram and all of it on the belly.

This was because they consumed an extra 308 calories a day compared to the 9 hours a night group.

Despite stopping the study after two weeks and then during recovery sleeping more, eating fewer calories and their total weight coming down, their bellies continued to get bigger, by an average of 3 cm by day 21 of the study.

This could be why shift workers are so prone to gaining fat around the belly.

The continued rise in belly fat could have been missed if body weight, BMI and overall body fat percentage were the only factors measured.

Dr Harold Bays who is an endocrinologist and president of the Louisville Metabolic and Atherosclerosis Research Centre says “Sleep disruption results in fat dysfunction and this may result in increased cardiovascular risk factors and unhealthy body composition including an increase in visceral fat.”

What do white rings round your corneas indicate?

Aug 9, 2022May 5, 2022 kaitiscotland1 Comment

Adapted from BMJ 23 Nov 2021

In a German study of ten thousand people aged between 40 and 80 years old, 21% of men and 17% of women had white rings round their irises of the eyes. You may have noticed these in your parents or yourself and may have wondered what this means.

The average age of the group was 60. Researchers noted that corneal arcus is more likely in men than women, increases with age, and increases with lipid levels.

Corneal arcus has no relevance to socioeconomic status, body mass index, arterial blood pressure or HbA1c levels.

A ketogenic drink has been found to improve cognitive performance in those with mild cognitive impairment

Aug 3, 2022May 4, 2022 kaitiscotland1 Comment

Adapted from A ketogenic drink improves cognition in mild cognitive impairment: Results of a 6 month RCT by Melanie Fortier et al. Alzheimer’s and Dementia. 2021.

Brain energy rescue is being tested to see if it can reduce cognitive decline in patients with mild cognitive impairment. It has previously been discovered that the brain has problems using glucose for fuel even before symptoms develop, but brain ketone use remains constant in both Alzheimers (A) and Mild Cognitive Impairment (MCI). Increasing ketones available to the brain has been shown to improve cognitive symptoms.

A really easy way to increase blood ketone levels is to give a drink containing ketogenic medium chain fatty acids. This has been found to increase brain energy uptake via PET scans. This follow on trial was done to assess whether improvement in cognition after six months occurred.

This study was conducted in Quebec Canada. Very strict entry criteria were applied and the patients were randomised to the ketogenic drink or to a placebo drink. The drinks appeared and tasted identical.

122 participants were enrolled. In total 39 completed the ketogenic arm and 44 the placebo arm. They were well matched regarding age, sex, education, functional ability and cognitive scores, absence of depressive features, blood pressure, blood chemistry and APOE 4 status. ( A genetic variability that greatly increases the chance of developing dementia).

More participants dropped out of the ketogenic group mainly due to gastrointestinal side effects. The drop out rate overall was 32% and 38% in the ketogenic group. None of the side effects were serious.

The results showed that performance on widely used tests of episodic memory, executive function and language improved over 6 months in the ketogenic group compared to the placebo group. Improvement was directly correlated with the plasma level of ketones.

The dose used was 15g of kMCT twice a day.

This seems to be a very reasonable intervention for early cognitive decline particularly since no drugs are approved for MCI and drugs used for Alzheimers do not delay cognitive decline in MCI. It is possible that effects would be enhanced if patients also undertook a ketogenic diet. Further trials are now warranted to see if diagnosis of Alzheimers can be delayed in those suffering from mild cognitive impairment.