Tag: health

New UK “Eat Well Plate”: same old rubbish!

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The UK government has released a new version of the risable “Eat well plate” which gives us at diabetesdietblog.com even more heartburn, if that were possible.

In this they have given due pominence to fruit and vegetables but have also advised even more starch such as bread, potatoes, breakfast cereals, pasta and rice. Low fat dairy is encouraged and protein is under represented again. Vegetable oil and low fat spread is given a little sliver of prominence. They have advised us to eat 30g of fibre a day and limit sugar to 30g a day.  Lordy, some of us don’t even eat this in total carbs a day! carbohydrate.jpgThey have said that 150g of fruit juice or smoothie can count as one of “your five a day”.

Cardiologist Aseem Mahhotra has tweeted, “Is this a joke?” Well, sad to say, probably not.

The government are grimly determined to back a diet that will lead to more obesity, diabetes, acid reflux, cancer and cardiovascular disease. Isn’t the NHS in enough of a mess already? Obviously the government don’t think so.

 

Eggs make a good start to the day

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Eggs have been shown to improve satiety and increase circulating HDL. They contain nutrients that may reduce the risk of T2D and CVD. Current guidelines regarding egg consumption and dietary cholesterol intake differ among countries: Australia recommends a max of 6 egg/wk for people with T2D. The US recommends that patients with T2D limit dietary cholesterol to <300 mg/d and <4 eggs/wk; and the UK has no suggested limit, but they do emphasize a dietary reduction of saturated fatty acids. Previous studies regarding the effect of a high-egg diet had confounding factors and/or limitations with respect to data. Australian researchers decided to address those limitations by analyzing the health effects of a high-egg diet.

In a 3-month prospective RCT, 140 patients with BMI >25 kg/m2, and either prediabetes or T2D, were randomly assigned to 2 diet groups. Patients in the high-egg group consumed 2 eggs/day for 6 days/wk, while the low-egg diet group consumed <2 eggs/wk with 10 g lean protein for breakfast. The primary outcome was change in HDL cholesterol at 3 months, while changes in anthropometric measurements, vital signs, nutritional analysis, and satisfaction were all doneeggs secondarily. Blood samples were collected for FBG, HbA1c, lipid panel, C-reative protein, apolipoprotein B, CBC, thyroid function, liver and renal function. Height and waist circumference was measured and a patient food diary was collected at baseline and 3-months. Questionnaires were used to obtain food, physical activity and quality of life information from the patients.

The study results showed that there were no significant differences in HDL from screening to 3 months between the two groups. There were also no significant differences in total cholesterol, LDL, TGs, or apolipoprotein B. Both groups had no significant differences in FBG or HbA1c. Waist circumference, total body fat, fat free mass, BP, and HR did not show any significant differences. Both group had an increase in overall satisfaction with the diets they were on. However, the high-egg group showed a higher enjoyment with the food they were eating and were less bored with food options. The high-egg group also trended toward being more satisfied with a high-egg diet compared to a low-egg diet with a significantly greater satiety and less hunger reported after breakfast.

Previous studies and current guidelines do not provide a clear message as to the whether eggs are safe and suitable as a dietary protein source for people with T2D with a high risk for CVD complications. This study showed there were no significant differences in circulating HDL, LDL, TC, or TGs between the high- and low-egg diet groups. The high-egg diet group also showed a significantly greater food-acceptability score and scored their diet with less hunger and greater satiety after breakfast; this suggest that a high-egg diet does not result in boredom and may likely improve nutritional management in patients with T2D.

Practice Pearls:
•This study compared the health effects of a high-egg diet (2 eggs/day for 6 days/wk) with a low-egg diet (<2 eggs/wjk).
•The high-egg diet group showed no significant difference in their lipid panel at 3 months, compared to the low-egg diet group.
•Test patients showed a greater satiety after breakfast and greater food-acceptability in the high-egg diet, suggesting that a high-egg diet can be used to help improve nutritional management.

NR Fuller. The effect of a high-egg diet on cardiovascular risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) study –a 3-mo randomized controlled trial. Am J Clin Nutr. 2015; 101: 705-713.

 

Based on an article in Diabetes in Control April 2016

Dr Peter Attia’s advice on dodging death

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Do you want to live to a good old age? Researcher Dr Peter Attia discussed his top tips with paleo diet enthusiast Chris Kresser in March 16. This is summary of what he had to say.

Henny Nonne (geb. Heye), Max Nonne
Professor Max Nonne und Frau [Henny Nonne], geb. Heye
There are a few obvious big things that we can all do to dodge death at a prematurely.

  1. Choose to be a non- smoker.
  2. Don’t die by suicide.
  3. Avoid accidental deaths.  Most of these are caused by three things, Road Traffic Accidents, accidental poisoning, including the wrong use of prescription medication, and falls. You can minimise these by using a seatbelt, driving carefully, particularly at junctions, not using the phone when driving and avoiding any alcohol use at all when driving.  When you are a pedestrian be wary of drivers, cross the road in safe places and be very careful regarding alcohol intake.
  4. About 80% of all deaths in the over 40s are caused by the diseases of civilisation: atheromatous disease causing heart attacks and strokes, cancer and neurodegenerative disease such as Alzheimer’s and Parkinson’s disease.  Some of these have a genetic basis that we can do nothing about, but there are lifestyle measures you can take to delay or avoid them.
  5. Keep your blood glucose and therefore blood insulin levels low and with a low level of variability. A high fat, moderate to low protein and low carbohydrate diet is best for this. Dr Attia’s opinion is that 20% carb 20% protein 60% fat is about right.
  6. Avoid stress. There are two components to this. To feel fulfilled and happy you need meaning in your life. You will be happier if you can give support to others and receive it from them too. Minimise stress if you can. Consider meditation practice.
  7. Get a good sleep every night. Sleep deprivation causes severe insulin resistance. Keep the bedroom completely dark. Keep it cool to even cold. Avoid blue light from computers, phones or lights for several hours before sleep. Consider using melatonin, phosphatidylserine, magnesium, L-threonate and vitamin D to enhance your sleep if you are not sleeping well.
  8. Exercise. This has stress benefits of its own and also improves glucose uptake into the muscles if the right exercises are done. For best increase in muscle insulin sensitivity Peter advises squats and deadlifts done with good form and with very heavy weights.
  9. Decide what you are going to do for your optimum benefit and then change your habits so that they become second nature. Repetition is the key.
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Bacteria that causes gum disease and arterial plaques identified

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A study, published in Infection and Immunity, has clarified the mechanism behind a known link between gum disease and heart disease. Periodontitis, which results in an infection that damages the soft-tissue surrounding teeth and the bone supporting the teeth, is commonly caused by Porphyromonas gingivalis. P. gingivalis is a Gram-negative anaerobe that colonizes mouth tissues for lengthy periods of time after initial infection. It is commonly found within the arterial plaques common to heart disease patients.

The study authors discovered that the bacteria alters the gene expression of pro-inflammatory proteins that also promote coronary artery atherosclerosis. This was discovered by infecting cultured human aortic smooth muscle cells with P. gingivalis. Aortic smooth muscle cells were used because they contract the aorta after the pumping of the heart stretches it out.

After P. gingivalis was injected into the cells, the bacteria released gingipains. Gingipains are enzymes that change the ratio between different angiopoietins (inflammatory proteins) in such a way that inflammation is increased. The pro-inflammatory angiopoietin 2 had its expression increased by the gingipains, whereas the anti-inflammatory angiopoietin 1 had its expression reduced. P gingivalis was found to affect the levels of these proteins independent of tumor necrosis factor (TNF).

The study is significant because it helps to pinpoint the relationship between periodontitis and heart disease. Further research can help clarify potential targets for treatment of atherosclerosis.

Practice Pearls:
•Periodontitis and heart disease share a common pathogen, P. gingivitis.
•A study found that P. gingivitis alters gene expression to increase production of the pro-inflammatory protein angiopoietin 2 and decreases presence of the anti-inflammatory protein angiopoietin 1. This results in increased atherosclerosis.
•The study further clarifies the cardiovascular risk of poor oral health and hygiene.

Paddock C. Scientists uncover bacterial mechanism that links gum disease to heart disease. published in the journal Infection and Immunity. September 14, 2015.

Published in Diabetes in Control September 15

Diabetics benefit from moderate red wine with meals

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Red wine consumption has been linked with improved cardiovascular outcomes in patients. The results of a new study published in the Annals of Internal Medicine suggest that these benefits extend to diabetic patients as well. In addition, moderate consumption did not cause liver damage.

The study was a two-year randomized clinical trial that took place in Israel. The study included 224 randomly assigned subjects who were all following the Mediterranean diet without caloric restriction. All subjects were alcohol-abstaining and had well-controlled type 2 diabetes. The subjects were randomly assigned to drink 150 mL of mineral water, white wine, or red wine with dinner for the duration of the trial.

The study authors looked at two primary outcomes: lipid profiles and glycemic control. Patients in the red wine group saw their HDL cholesterol levels significantly increased by 2.0 mg/dL (95% CI, 1.6 to 2.2 mg/dL; P < 0.001) and their apolipoprotein(a)1 levels increased significantly by 0.03 g/L (95% CI, 0.01 to 0.06 g/L; P = 0.05). Furthermore, their total cholesterol to HDL cholesterol ratio decreased by an average of 0.27 (95% CI, -0.52 to -0.01; P = 0.039). Red wine also reduced the number of components of metabolic syndrome by 0.34 more than the mineral water group (95% CI, -0.68 to -0.001; P = 0.049).

Red and white wine patients who were slow ethanol metabolizers (carriers of the ADH1B*1 alcohol dehydrogenase allele) had significant improvements in fasting plasma glucose, insulin resistance, and hemoglobin A1c. Fast ethanol metabolizers (patients homozygous for ADH1B*2) did not see these benefits.

There were no changes among the groups for blood pressure, adiposity, drug therapy, symptoms, or liver function. This suggests that moderate wine with dinner will not cause liver damage. There was one quality of life improvement that patients in both wine groups saw over the mineral water drinkers: increased sleep quality (P = 0.040). Overall, this study suggests that moderate red wine intake in well-controlled diabetics in conjunction with a healthy diet is safe and improves lipid profiles. Patients who are slow ethanol metabolizers may also have glycemic control benefits.

This trial did have several flaws though. Patients and researchers both knew which group consumed what beverage. This could potentially have influenced the increased sleep quality reported in both wine groups. Perhaps more importantly, all the patients in this study were already adhering to a healthy Mediterranean diet, which is suspected to improve heart health itself and had well-controlled diabetes. Further studies are needed to elucidate the mechanisms and extent of ethanol’s benefits, especially in patients who are not well-controlled or consuming ideal diets. Patients should be cautioned that red wine consumption is not a substitute for heart or diabetes medicine.

Practice Pearls:
•In a study of well-controlled diabetes patients adhering to the Mediterranean diet, 150 mL of red wine with dinner improved lipid profiles.
•Patients who were slow ethanol metabolizers had improvements in glycemic control in both the red wine and white wine groups.
•The red wine and white wine groups did not have differences in liver function with the mineral water group.

Gepnyer Y, Golan R, Harma-Boehm I, et al. Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes: A 2-Year Randomized, Controlled Trial. Ann Intern Med. 2015 Oct 13. Epublished ahead of print. doi: 10.7326/M14-1650.

From Diabetes in Control October 15

Trends in standards of care for pregnant diabetes patients in the UK

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Are care standards for diabetic pregnant patients being achieved?The short answer to the question is NO. The National Diabetes Audit indicates that while the diabetes epidemic continues to grow, medical care continues to fall way short of the standards devised to reduce the burden of complications both on individuals and the economy.

Women who are pregnant tend to get off to a bad start by not being on the right dose of folic acid before they embark on the pregnancy. They are advised to take 5mg of the vitamin a day in order to reduce the chance of their baby developing spina bifida. Of the type one diabetic women 45%  met this standard but only 24% of type two diabetic women did so.

In order to eliminate foetal abnormalities related to hyperglycaemia the HbA1c should be preferably below 6.0 in the first trimester and  yet only 8% of women with type one and 22% of those with type two managed a HbA1c of 6.1% (43 mmol/mol) or less. Pregnancy is advised to be avoided all together if the HbA1c  is over 10% (86) but 12% of type ones and 8% of type two women were over this. The women most adversely affected tended to be living in the greatest areas of deprivation, and also of Asian or Black ethnicity.

Oral glucose lowering drugs apart from metformin are advised for women trying for a baby and insulin should be used if necessary to achieve blood sugar targets. Statins, ACE inhibitors (prils), and ARBS (sartans) should be stopped prior to pregnancy as these can be teratogenic.  But 57% of type two diabetic women were on at least one of these drugs at the onset of pregnancy.

Hypoglycaemia, severe enough to need hospital treatment, was experienced by 9.3% of pregnant women with type one diabetes.

Currently 67% of type one women have a caesarean section compared with 52% of type twos. The rates of stillbirth for offspring are almost 12.8 per 1000 births compared to 4.7 for the general population. Neonatal deaths are 7.6 per 1000 compared to 2.6 for the general population. The rate of congenital abnormalities approximately double that for the general population at 44.2 per 1000 compared to 22.7.  Adverse pregnancy outcomes of all types are related to the HbA1c particularly in the first and third trimesters.

Despite the growth of specialist diabetic-obstetric teams there has been very little improvement in these outcomes over the last ten years. How can we help diabetic women prepare for their pregnancies? Why are so many women and babies not getting the medical care that could help them?

Some basic advice: see your GP well before you plan a pregnancy if you have diabetes and tell them that you are planning for having a baby.

Use effective contraception until your glycaemic goals have been met. For most women this means a Hba1c of 6.5% or under and ideally under 6.0%.

Start folic acid 5mg daily.

Stop statins, ACE inhibitors, ARBs and seek alternative blood pressure control drugs instead, if you have high blood pressure.

Get your weight down to normal if at all possible.

Start a gentle exercise regime if you haven’t already started.

If you have type two diabetes discuss moving onto insulin with your consultant diabetologist.

If you have type two diabetes you will usually continue metformin but stop other drugs on the advice of your consultant diabetologist or GP.

 

Based on Analysing newly-published diabetes audits: are care standards being achieved? Written by Steve Chaplin B Pharm MSc Medical Correspondent in Practical Diabetes March 2016

Is there any point in taking calcium supplements to reduce your fracture risk?

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Mark J Bolland et al have studied whether increasing dietary and supplemental calcium can prevent fractures or not.

Calcium supplementation has long been standard practice and is usually included in vitamin D formulations for the elderly, those on long term steroids, and those who have established osteoporosis. Diabetics are also at increased risk of osteoporosis.

In this systematic review of randomised controlled trials and cohort studies dietary calcium had no effect on fracture risk at all. Calcium supplementation meanwhile only had a small and inconsistent effect on fracture prevention.

So probably not worth it then?

What could be more useful is supplementation with straight vitamin D3.

Dr Lee Wah Phin and Dr John Holden from North West England checked the vitamin D status of 302 GP patients. They took 75 mmol/l as the cut off point for low vitamin D and found that 90% of the adult population were deficient. This is in keeping with my own findings in GP in the West of Scotland.  They wonder if there should be some way of screening and supplementing  the population.

Based on BMJ 3 October 2015 and RCGP letter October 15.

 

Who gets boils?

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A London General Practice has studied all the people who came to see them over the course of a years with boils. As many of you know, diabetics are more commonly afflicted than their non diabetic friends. Is there anything you can do to reduce the chance of getting these blighters?

Well, according to the survey, not that much, if you are already pretty health conscious. Most of the factors associated with boils are not usually under your direct control. Some are, such as smoking, being overweight and having had an antibiotic prescription in the previous six months.

People who got them also tended to be from  socio-economically deprived groups. There were some gender differences but it is not well known whether this was due to true incidence or whether it was due to more tendency to consult a doctor.

Overall women attended more than men especially in younger age groups, but was this due to less tolerance for the boils?  Older men, over the age of 65 also attended more frequently, but was this because their wives made them?

There is a sharp increase in boils in adolescence onwards and then it tends to subside after men are 25 and women are 35, so hormonal factors have something to do with it. The bad news is that boils tend to recur and overall ten percent of those afflicted will be back to the doctor’s at least once in the year after they first attend.

Based on RCGP article by Laura J Shallcross October 2015.

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How reading fiction reaps surprising rewards

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The Surprising Power of Reading Fiction

9 ways reading literary fiction can take your happiness to the next level.

 

 

Courtney has compiled some surprising ways that reading good fiction can enhance your well -being.

I like to read for ten minutes just before I go to sleep and although I wouldn’t call my current book, the adventures of MC Beaton’s heroine Agatha Raisin, “literary fiction” I do enjoy a journey into someone else’s life.

Of course, during holidays and on public transport, I love nothing better than getting stuck in for hours on end.

What books have you enjoyed reading lately?

 

How good are you at looking after yourself?

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Last week I was at a workshop to teach health care professionals how to do focus centred behaviour change for diabetics. It was run by two psychologists.  One of the “documents you may wish to use with patients” was a list of self -care behaviours and next to it a grade of how good you think you are doing it.

These are the dietary based entries:

The food I choose to eat makes it easy to achieve optimal blood sugar levels.

Occasionally I eat lots of sweets or other foods rich in carbohydrates.

Sometimes I have real “food binges” (not triggered by hypoglycaemia)

The third one is assessing  emotional eating. But the first two are squarely advocating a low carbohydrate diet. Nada about dietary fat in the whole thing.

I was surprised and delighted but decided to stay silent. There were three dieticians in the room. I saw one bridle as she read the document. She asked, “Where did this come from?”.

Here is its source.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751743/

This is a German/UK collaboration with a good scientific basis.

Table 1

Diabetes Self-Management Questionnaire (DSMQ)

The following statements describe self-care activities related to your diabetes. Thinking about your self-care over the last 8 weeks, please specify the extent to which each statement applies to you. Applies to me very much Applies to me to a consider-able degree Applies to me to some degree Does not apply to me
1. I check my blood sugar levels with care and attention.
☐ Blood sugar measurement is not required as a part of my treatment.		 ☐3 ☐2 ☐1 ☐0
2. The food I choose to eat makes it easy to achieve optimal blood sugar levels. ☐3 ☐2 ☐1 ☐0
3. I keep all doctors’ appointments recommended for my diabetes treatment. ☐3 ☐2 ☐1 ☐0
4. I take my diabetes medication (e. g. insulin, tablets) as prescribed.
☐ Diabetes medication / insulin is not required as a part of my treatment.		 ☐3 ☐2 ☐1 ☐0
5. Occasionally I eat lots of sweets or other foods rich in carbohydrates. ☐3 ☐2 ☐1 ☐0
6. I record my blood sugar levels regularly (or analyse the value chart with my blood glucose meter).
☐ Blood sugar measurement is not required as a part of my treatment.		 ☐3 ☐2 ☐1 ☐0
7. I tend to avoid diabetes-related doctors’ appointments. ☐3 ☐2 ☐1 ☐0
8. I do regular physical activity to achieve optimal blood sugar levels. ☐3 ☐2 ☐1 ☐0
9. I strictly follow the dietary recommendations given by my doctor or diabetes specialist. ☐3 ☐2 ☐1 ☐0
10. I do not check my blood sugar levels frequently enough as would be required for achieving good blood glucose control.
☐ Blood sugar measurement is not required as a part of my treatment.		 ☐3 ☐2 ☐1 ☐0
11. I avoid physical activity, although it would improve my diabetes. ☐3 ☐2 ☐1 ☐0
12. I tend to forget to take or skip my diabetes medication (e. g. insulin, tablets).
☐ Diabetes medication / insulin is not required as a part of my treatment.		 ☐3 ☐2 ☐1 ☐0
13. Sometimes I have real ‘food binges’ (not triggered by hypoglycaemia). ☐3 ☐2 ☐1 ☐0
14. Regarding my diabetes care, I should see my medical practitioner(s) more often. ☐3 ☐2 ☐1 ☐0
15. I tend to skip planned physical activity. ☐3 ☐2 ☐1 ☐0
16. My diabetes self-care is poor. ☐3 ☐2 ☐1 ☐0

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It is very refreshing and welcome to see that prioritising eating based on the effects on glycaemic control for diabetics is being adopted over following dogma with no scientific basis.