The best diet for optimal blood sugar control & health
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.
This is a message from dietician Adele Hite:
I am thrilled to announce that Diet Doctor is now offering a free CME activity to all interested clinicians, patients and carers: Treating metabolic syndrome, type 2 diabetes, and obesity with therapeutic carbohydrate restriction.
Thanks to the support of our members, we can offer this CME at no cost to clinicians.
This fully referenced, evidence-based CME activity is certified for three AMA PRA Category 1 Credit(s)™. It is jointly provided by Postgraduate Institute for Medicine (PIM) and Diet Doctor and is intended for physicians, physician assistants, registered nurses, and dietitians engaged in the care of patients with metabolic syndrome, type 2 diabetes, and obesity.
The course was designed by clinicians for clinicians. As this course outline shows, it covers all clinicians need to know about dietary carbohydrate restriction and how to implement it safely and effectively with patients for whom it is appropriate. In keeping with Diet Doctor’s mission to “make low carb simple,” the course also comes with supplemental materials for clinicians and their patients to make it easy to translate evidence into practice.
We hope that this course will help reaffirm the scientific and clinical support for this approach and — along with other efforts by LowCarbUSA and expert clinicians — act as another step in solidifying a standard of care around low-carb nutrition. We would love it if you would share the news about this course with colleagues. You can forward this email to them or use this flyer to share or post.
Diet Doctor also has some new resources to help make low carb simple for patients and clinicians alike. For patients, we have:
‒ a sample menu
‒ shopping list
‒ a meal planning guide
‒ a substitutes for favorite foods handout
‒ simple meals and planned leftovers, and
‒ information about target protein ranges
For clinicians, we have handy one-pagers on:
‒ monitoring ketones
‒ fasting insulin and HOMA-IR ranges
‒ lab tests and follow-up schedule
‒ type 2 diabetes medication reduction, and
‒ a 5-day food diary for patients who need to monitor their intake
Of course, for those on the list who are not clinicians, anyone can register for and view the course. You just won’t be eligible for CME credits.
For clinicians, please let us know if we can help you help your patients in other ways. And if you are interested in supporting us as we continue to develop materials to make low carb easy for clinicians and patients, please think about becoming a Diet Doctor member yourself.
Finally, we are happy to hear suggestions for improvements moving forward. If you take the time to view the course, we’d love to hear what you think.
Best regards,
Adele
The Public Health collaboration online conference 2020 was very successful. The videos are available on You Tube for free making the conference even more accessible for everyone who needs advice on what to eat to stay healthy.
If you are able to contribute to the PHC fund to keep up our good work please do so. Sam Feltham has suggested £2.00. This is via the PHC site.
This year there were contributions from mainly the UK but also the USA.
Visitors to this site will be very pleased to know that keeping your weight in the normal range, keeping your blood sugars tightly controlled, keeping your vitamin D levels up, and keeping fit from activity and exercise, are all important factors in having a good result if you are unfortunate enough to be affected by Covid-19. We have been promoting these factors in our book and website for several years now, mainly with the view to making life more enjoyable, especially for people with diabetes, now and in the future. The reduction in the severity to the effects of coronavirus is a side effect of these healthy living practices.
Several talks went into the factors and reasons for this, but in a nutshell, if you are in a pro-inflammatory state already, you will have a much more pronounced cytokine inflammatory response to the virus than is useful for clearing the virus, and you end up with inflammed lung tissue which leaks fluid thereby impairing your blood oxygen levels.
A talk that I found particularly apt was the talk from a GP who had had a heart attack at the age of 44 despite a lack of risk factors except for massive stress. He gives a list of self care practices that helped him. I would also include playing with your animals. Emma and I are cat lovers and can vouch for this!
My talk is about VR Fitness, which was the only talk this year which was specifically exercise related. The Oculus Quest has only been out a year and has been sold out since shortly after New Year. I was fortunate enough to buy one in anticipation of my imminent retirement, and it has been great as an exercise tool over the long, cold, dark winter and more useful than I had ever anticipated over the lockdown as a social tool.
There were several very professional cooking and baking demonstrations on the conference this year, and indeed, this could not have otherwise happened on a traditional stage format. We had low carb “rice”, bread, pancakes and pizza demonstrations which may well help you if you prefer to see how it is done step by step or if you want to broaden your repertoire.
I was particularly taken with the pizza base idea from Emma Porter and I will follow up with this in a later post. The whole video is available from the PHC site which takes you to all the videos on You Tube.
Videos of the lectures given at the Public Health Collaboration conference 2018 which was held in May over the royal wedding weekend have now been released on You Tube.
You can see my talk, Achieving your optimal blood sugar target, as well as others, on the link below. There are a wide variety of lifestyle topics discussed. Happy viewing.
https://www.youtube.com/results?search_query=public+health+collaboration+conference+2018
The Royal College of General Practitioners have recently released an educational programme for UK doctors which they have very kindly allowed me to link to our website.
I recorded this over a year ago and I think the college held off production until their type two diabetes low carb course was also released for doctors.
This means that the RCGP joins the American Association of Clinical Endocrinologists as supporters of low carbing for both type one and two diabetes. Surely the other clinical associations and Royal Colleges will follow in due course?
The screencast includes information on diagnosis, emergency situations, blood sugar and dietary management and contraception.
“I have also separately produced an educational screencast on Diabetes in adults (type 1), children and young people (type 1&2) for the Royal College of General Practitioners in my role as an RCGP Clinical Adviser”
http://elearning.rcgp.org.uk/mod/page/view.php?id=8368
A survey by Walnut Unlimited asked 1,000 UK people, what can the effects of having diabetes be?
None of them were aware of the pregnancy related consequences of diabetes.
2% knew about stroke, 4% about kidney damage, and 6% about heart disease. Similarly low numbers knew that diabetes is related to a shorter life span. A quarter of those surveyed however did know that amputation and sight loss were complications of diabetes.
Diabetes affects more individuals in the UK than any other serious health condition such as dementia or cancer. 3.7 million people in the UK have diabetes. There are 8,700 diabetes related amputations and 1,600 cases of visual impairment every year.
Diabetic complications can be minimised or avoided by early diagnosis, education and support.
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.
If adults get the same level of education about blood sugar management there is only a tiny improvement in blood sugar control with a pump compared to a basal bolus injection regime.
The REPOSE trial was based in the UK with 315 participants across eight sites. Using small groups the patients were taught the DAFNE course, Dose Adjustment for Normal Eating. After the course the patients were randomised to either multiple daily injections which is standard UK management, or insulin pump use.
The organisers wanted to see how many people managed to get their hba1c below 7.5% after two years and what effects the regimes had on quality of life and hypoglycaemia.
Out of the original 315 patients, 260 finished the courses and entered the trial. There were small improvements in both groups for hba1c. The pump group got a 0.85% improvement in hba1c and the injectors got 0.42% improvement. This was not considered to be good enough to recommend pump provision, which is more expensive than pen injectors, to adults as a routine measure.
The pump group started with hba1s averaging around 9.5% and ended up around 8.7%. The injectors started with an average of 9.0% and ended up around 8.5%. In addition there was no particular difference in hypoglycaemia or psychosocial outcomes.
My comment: It is a pity that DAFNE is considered the gold standard educational tool for type one diabetics when the outcomes are so underwhelming. The main problems are that although carb counting is included, carbohydrate restriction is not. Insulin coverage of protein is not done and the seven unit rule is ignored. These are the main reasons that the outcomes are so poor. Structured education in person is expensive and time consuming for health care professionals. Why not grasp the nettle and actually teach people what they need to know to get normal blood sugars and not hba1cs of 8.5-8.7 which are certain to lead to diabetic complications?
Based on BMJ article BMJ 2017;356:j1285
Learning and Diabetes
Rowan Hillson
Practical Diabetes Nov/Dec 16
Only 32% of type one diabetics and 78% of type two diabetics are currently offered structural education in England. Even then, not all will attend. Will it have any positive long term effects for those who do? Many issues affect learning. This article discusses some of them.
Literacy and numeracy
In England in 2011, 15% of the population aged 16-65 had the learning that is expected of an eleven year old child. This is considered “functionally illiterate” by the National Literacy Trust. Although they would not be able to pass an English GCE, they can read simple texts on familiar topics. More than 50,000 UK diabetics are at this basic level of reading ability.
Numeracy problems are higher with 24% of adults function at the same level as your average eleven year old. Testing diabetics shows that numeracy and literacy are linked and that blood sugar control is better in those with better numeracy and literacy. This is not surprising since so many tasks need these skills.
Weighing foods and estimating portion sizes
Addition
Converting between metric and imperial systems
Multiplying and dividing
Using decimals
Recognising and understanding fractions
Working with ratios, proportions and percentages
Readability
Arial 12 point font, upper and lower case, on white or off white backgrounds, using short words, short sentences and short paragraphs all improve readability.
Health Literacy
Health literacy includes reading, writing, numeracy, listening, speaking and understanding.
In the type two diabetes population, lower health literacy was significantly associated with less knowledge of diabetes, poorer glucose self- management, less exercise and more smoking.
In the USA people understood food labels better if they had higher income and education. Overall 31% gave the wrong answer to food label questions. Many diabetics have problems with misinterpreting glucose meter readings, miscalculating carbohydrate intake and medication doses.
Lower scores were associated with being older, non-white, fewer years in education, lower income and lower literacy and numeracy scores.
When an internet based patient system was offered, those with limited health literacy were less likely to sign in and had more difficulty navigating the system.
Cognitive impairment
Alzheimer’s disease, vascular dementia and other cognitive impairments are more likely in diabetics particularly those with type two diabetes. A longer duration of diabetes and a younger age of onset were associated with cognitive impairment.
Hyperglycaemia
High blood sugars can cause poor concentration, tension, irritability, restlessness and agitation. In experiments, high blood sugar induced delayed information processing, poorer working memory, and impaired attention.
In five to eighteen year olds with new type one diabetes most neuropsychological tests showed considerable impairment. One year post diagnosis, dominant hand reaction time was worse in those with poor glycaemic control.
Long term, type ones diagnosed before the age of 18 had five times the risk of cognitive impairment compared to their non- diabetic counterparts. Chronic hyperglycaemia increased the risk.
Hypoglycaemia
Most friends and relatives can recognise if someone well known to them has a low blood sugar, often faster than the individual. Cognitive performance drops at blood sugars of 2.6-3 in non- diabetic subjects. In type one children, those who had recurrent severe hypoglycaemia had more impaired memory and learning.
Psychological issues
Both depression and anxiety can impair test performance. Both of these and other mental illnesses are more common in diabetics.
Sensory and motor problems
Visual impairment and deafness can make some learning methods difficult.
Conclusion
We all learn in different ways. A substantial proportion of the population has low literacy and numeracy. This impairs health literacy which impairs diabetes knowledge for self -care. Poor numeracy may worsen blood sugar control. Clearly written, easily readable information helps everyone. Having diabetes increases the risk of cognitive impairment both at diagnosis and long term. Both high and low blood sugars affect current ability to learn and may have long term adverse effects on cognition.
Before teaching diabetics it is worth having a think about any difficulties your patient could be having assimilating the learning. If so, how can you tailor your teaching to their needs?
The BBC has adult learning resources at http://www.bbc.co.uk/learning/adults/
NICE want to see structural education for all new diabetics but particularly children and their families. Sadly the end results sometimes doesn’t seem to justify the effort put in. The wrong focus on eating lots of starch we wonder? Here is the abstract of one teams considerable efforts with the full paper here: :http://drc.bmj.com/content/3/1/e000065.full?sid=90e5f16a-f3de-4a5d-94dc-c57e973c4587
Implementing a structured education program for children with diabetes: lessons learnt from an integrated process evaluation | BMJ Open Diabetes Research & Care <!– [if lt IE 10]>http://drc.bmj.com/sites/all/themes/highwire/axon/js/media.match.min.js<![endif]–>
Background There is recognition of an urgent need for clinic-based interventions for young people with type 1 diabetes mellitus that improve glycemic control and quality of life.
The Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE) is a structured educational group program, using psychological techniques, delivered primarily by diabetes nurses.
Composed of four modules, it is designed for children with poor diabetic control and their parents. A mixed methods process evaluation, embedded within a cluster randomized control trial, aimed to assess the feasibility, acceptability, fidelity, and perceived impact of CASCADE.
Methods 28 pediatric diabetes clinics across England participated and 362 children aged 8–16 years, with type 1 diabetes and a mean glycosylated hemoglobin (HbA1c) of 8.5 or above, took part. The process evaluation used a wide range of research methods.
Results Of the 180 families in the intervention group, only 55 (30%) received the full program with 53% attending at least one module. Only 68% of possible groups were run.
Staff found organizing the groups burdensome in terms of arranging suitable dates/times and satisfactory group composition. Some staff also reported difficulties in mastering the psychological techniques.
Uptake, by families, was influenced by the number of groups run and by school, work and other commitments. Attendees described improved: family relationships; knowledge and understanding; confidence; motivation to manage the disease. The results of the trial showed that the intervention did not significantly improve HbA1c at 12 or 24 months.
Conclusions Clinic-based structured group education delivered by staff using psychological techniques had perceived benefits for parents and young people. Staff and families considered it a valuable intervention, yet uptake was poor and the burden on staff was high. Recommendations are made to inform issues related to organization, design, and delivery in order to potentially enhance the impact of CASCADE and future programs.
Current Controlled Trials ISRCTN52537669.
The Child and Adolescent Structured Competencies Approach to Diabetes Education (CASCADE) structured education program is perceived by young people and parents who attend as having benefits but practical challenges associated with attendance result in low uptake.
Staff are positive about the potential of the program but organizational aspects are unacceptably burdensome.
CASCADE is potentially deliverable to families as part of routine care and could be a useful intervention. However, improvements in clinical and administrative support, staff training, program content, and service structures are required to ensure fidelity to the program and feasibility and acceptability to key stakeholders.
Diabetes Diet 