Proportion of diabetes patients undergoing coronary artery bypass grafting rises from 7% to 37% in 40 years

Analysis of More Than 55,000 CABG Patients Documents Worse Outcomes and Burgeoning Costs for Patients with Diabetes, According to Reports in The Journal of Thoracic and Cardiovascular Surgery

Summary: Four papers published in The Journal of Thoracic and Cardiovascular Surgery frame one of the most important health problems facing the modern world - diabetes accompanied by coronary artery disease - and offer solutions for the next generation. Joseph Sabik III, MD, Sajjad Raza, MD, and colleagues from Cleveland Clinic provide evidence for the increasing numbers of diabetic patients presenting with coronary artery disease requiring surgical revascularization. Although surgical outcomes have improved substantially, this combination has become an excessively costly healthcare burden. In two accompanying editorials, Columbia University Medical Center's Paul Kurlansky, MD, and the Baylor Research Institute's Mani Arsalan, MD, and Michael Mack, MD, focus on the burden diabetes has placed on our society and the insights gleaned from the Cleveland Clinic report.

In the 40 years between 1970-2010, the proportion of patients with diabetes undergoing coronary artery bypass grafting (CABG) escalated from 7% to 37%. The results of a large study from Cleveland Clinic just published in The Journal of Thoracic and Cardiovascular Surgery, the official publication of the American Association for Thoracic Surgery (AATS), documents the five-fold increase in the proportion of patients with diabetes undergoing this procedure between 1970 and 2010. These patients have more postoperative complications and decreased long-term survival than those without diabetes, and represent a growing challenge to reining in healthcare costs.

"Diabetes is both a marker for high-risk, resource-intensive, and expensive care after CABG, and an independent risk factor for reduced long-term survival," explained lead investigator Joseph F. Sabik III, MD, Chairman of Thoracic and Cardiovascular Surgery and Director of the Cardiothoracic Residency Training Program at the Sydell and Arnold Miller Heart & Vascular Institute, Cleveland Clinic (Cleveland, OH). In response, surgeons are issuing a call-to-action to implement steps to minimize operative risks and improve outcomes for the escalating proportion of patients with diabetes who are undergoing surgery for coronary artery disease.

While endocrinologists may be the physicians bearing the greatest responsibility for managing patients with diabetes, diabetes is also having a tremendous impact on surgery, as shown in this analysis of a robust and well-maintained registry of more than 57,000 patients who underwent CABG at Cleveland Clinic between 1970 and 2010. The registry included 10,362 patients with diabetes and 45,139 patients without the disease.

The study showed that diabetics undergoing CABG had worse outcomes, with more in-hospital deaths (2.0% vs. 1.3%), deep sternal wound infections (2.3% vs. 1.2%), strokes (2.2% vs. 1.4%), renal failure (4.0% vs. 1.3%), and prolonged postoperative hospital stays (9.6% vs. 6.0%), compared to nondiabetic patients.

Survival after CABG among patients with diabetes was worse at 1, 5, 10, and 20 years. For example, survival after 20 years was 18% for patients with diabetes compared with 42% for those without the disease.

The study also compared outcomes of CABG patients with diabetes to CABG patients without diabetes who were propensity matched as having similar levels of risk for complications. In these comparisons, individuals with diabetes still experienced more deep sternal wound infections and strokes and had worse late survival.

Total costs were 9% higher in patients with diabetes who underwent CABG, driven mainly by clinical and laboratory tests, imaging studies, medicines, nursing costs, and longer ICU and postoperative stays. "Clearly, policies and programs focused on controlling the factors that promote diabetes are critical to improving global public health and reining in the rising cost of healthcare," stated Dr. Sabik.

The study provided valuable insights about ways to improve surgical outcomes for patients with diabetes, such as the choice of whether to use unilateral or bilateral internal thoracic artery (ITA) grafts. "Despite compelling evidence of survival benefit of bilateral internal thoracic arteries from the authors' own institution, the use of bilateral thoracic arteries remains distressingly low," commented Mani Arsalan, MD, and Michael Mack, MD, of the Baylor Research Institute (Dallas, TX) in an editorial. In the registry, only 18% (11% of nondiabetic patients and 7.5% of diabetic patients) received bilateral ITA grafts. They suggest using both ITAs in those patients who are not at inordinate risk and stand most to benefit, such as those who are young and nonobese with a greater than 10-year life expectancy.

The Cleveland Clinic results also indicated that worse long-term survival after CABG in diabetic patients was more likely due to their greater comorbidity burden than the ineffectiveness of CABG, according to Dr. Sabik. Because the use of bilateral ITA grafts is associated with more complications, including sternal wound infection, the method of choice for an elderly, morbidly obese woman with high atherosclerotic burden and low life expectancy might be to use a single ITA graft.

"Bypass grafting is clearly superior to interventional approaches for the diabetic patient," added Paul Kurlansky, MD, Assistant Professor, Department of Surgery at Columbia University Medical Center (New York). "The Cleveland Clinic Study provides many important historical, clinical, and social insights. Their careful data analysis seems to have teased out the associated comorbidities from the mere fact of diabetes itself, to suggest that the incremental impact of diabetes, independent of associated risk factors, is not discernable in the early postoperative period, but rather takes an increasing toll on late mortality." He also noted that diabetes is likely to remain a surgical concern for the foreseeable future.

Another step surgeons can take is to postpone elective procedures until patients with diabetes have achieved better blood sugar levels and glycemic control. "The weight may be increasingly on our patients, but the real weight is on us as surgeons to help improve their early- and long-term survival," wrote Dr. Arsalan and Dr. Mack.

http://www.news-medical.net/

Graham

Jamie Oliver talks a lot of bollocks at times !

“There’s a lot of bollocks out there.” Jamie Oliver slams wellness experts for their unhealthy advice.

It’s touted as the healthy wonder ingredient that will not only revolutionise your cooking but your beauty routine too, but celebrity chef Jamie Oliver is having none of it.

Yes, we’re talking about the wellness industries obsession with coconut oil as a “healthier” option.

“A lot of people say coconut oil is the best thing on the planet but it’s also one of the most saturated fats, so let’s get our facts right,” he told Body + Soul magazine.

“There’s a lot of factually incorrect stuff, a lot of bollocks out there and some dangerous stuff as well. I’m conscious of trendy radical people endorsing things that you shouldn’t have,” he said.

While it’s frequently praised and used by health and wellness bloggers in their recipes, Oliver is not alone in having concerns about coconut oil. Dietician and nutritionist Melanie McGrice says that there’s been a lot of confusion about coconut oil over the past few years.

“Coconut oil is high in saturated fats – in fact it’s 93 per cent saturated (bad) fats, One teaspoon of coconut oil contains almost four grams of saturated fat,” she explains.

While benefits of coconut oil include its stability at high temperatures and ability to help to increase good cholesterol, it’s so high in saturated fat that it will also increase bad cholesterol.

More complete "bollocks" from Jamie can be read here.

And Jamie Oliver talks a lot of bollocks at times, but cannot fault him on his self aggrandisement and money making skills. Nothing wrong with natural saturated fats "‘health bloggers without the proper qualifications or expertise may be partly to blame" Without health bloggers we would all be shoverling the highly processed carbs and junk down our necks. Has Jamie stopped selling all the high carb and sugar foods in his restaurants? No he has started to charge a surcharge to his customers, more grist to his very large wallet.

Eddie

I am looking forward to the Tim Noakes ‘trial’ in November.

I suspect many of you follow Professor Tim Noakes. Tim is a qualified medical Doctor, but as far as I can make out, has not practised in that discipline for years. His specialty as a University Professor is in exercise and sports science. He has written books on the subject and on diet. For years Tim was a super fit marathon runner and had no problem with carbs. To cut a long story short, Tim became a type two diabetic and done a 180 on his diet, he started a low carb higher fat regime. He reversed his type two diabetes and returned to normal weight and fitness. He researched big time and was brave and honest enough to say I was wrong. He had come to realise for so many people, a high carb low fat diet is detrimental to health. Like so many of us, Tim had to find out the hardway. Let’s move on a bit.

Earlier this year and after Tim gave dietary advice regarding an infant on the internet. The president of Dietician SA, Claire Julsing-Strydom reported Tim and he is facing charges of unprofessional conduct, for encouraging a higher fat, lower carbohydrate diet for a toddler. The case was scheduled for two days back in June, but ended on the first day due to point of law legal argument and re-scheduled for November this year. This hearing will have a longer time frame, because Tims legal team say they need at least seven days to forward their argument on the benefits of a lower carb higher fat diet. Clearly Tims legal team are loaded for bear, they know how important this case is, it will have ramifications across the world.

Some may know of the case regarding Dr. Annika Dahlquist. Annika was subjected to the same third degree, for advising her diabetic and overweight patients, to follow a low carb higher fat diet. After two years the authorities agreed with Annika, and the bullying authorities lost the case, because no evidence could be presented to prove a low carb higher fat diet was dangerous.

My money is on Tim being exonerated. That being the case, it will be another nail in the coffin for the dietary stupidity doled out by the likes of the NHS, BDA, DUK etc. and countless dietary not fit for purpose organisations around the world.

Follow the money, regarding so many health and dietary organisations, as can be seen here. Make up your own mind. Last words to two great men.

Eddie

"The low-fat, high-carbohydrate diet, promulgated vigorously by the National Cholesterol Education Programme, National Institutes of Health and American Heart Association since the Lipid Research Clinics-Primary Prevention Program in 1984, and earlier by the US Department of Agriculture food pyramid, may well have played an unintended role in the current epidemics of obesity, lipid abnormalities, type 2 diabetes and metabolic syndromes.

This diet can no longer be defended by appeal to the authority of prestigious medical organisations or by rejecting clinical experience and a growing medical literature suggesting that the much-maligned low-carbohydrate, high-protein diet may have a salutary effect on the epidemics in question."

Sylvan Weinberg, former president of the American College of Cardiology

"There are three kinds of foods--fats, proteins, and carbohydrates. All of these provide calories. But the carbohydrates provide calories and nothing else. They have none of the essential elements to build up or to repair the tissues of the body. A man, given carbohydrates alone, however liberally, would starve to death on calories. The body must have proteins and animal fats. It has no need for carbohydrates, and, given the two essential foodstuffs, it can get all the calories it needs from them."

Sir Heneage Ogilvie, former vice president of the Royal College of Surgeons, England.

Zucchini / Courgette, Carrot and Olive Loaf : Grain Free : Gluten Free

If you ever wondered whether it’s possible to make a grain free, gluten free bread that tastes good, then wonder no more. Here’s a recipe for those of you who are sensitive to, or need to follow a grain/gluten free diet.

Please note that this recipe contains eggs.

Ingredients

Makes One Loaf

2 1/2 cups of almond meal
1/2 cup LSA ( linseeds, sunflower seeds and almonds - or more almond meal)

1 tsp baking soda
1 tsp gluten free baking powder
1/2 tsp Himalayan pink salt
1/4 cup of coconut oil
1 cup of grated zucchini, liquid squeezed out as much as possible
1 cup of grated carrot
1/4 cup chopped olives of choice
1/2 tsp dried oregano
1 tsp fresh thyme (1/2 if dried)
4 eggs (the best you can afford)

Method

1.Turn on oven to 160 degrees Celcius. Line a loaf tin with baking paper and set aside.

2.In a large bowl, add eggs and whisk lightly, add oil, zucchini, carrots, olives and stir well to combine.

3.In a medium bowl, add all the dry ingredients and combine well. Combine with wet ingredients and stir until the mixture is well incorporated into each other.

4.Spoon mixture into the prepared loaf tin, and use a spatula or back of a spoon to smooth the surface.

5. Place in pre-heated oven and bake for 1.5 hours. It is ready when a skewer placed in the centre comes out clean.

6.Be mindful that all ovens are slightly different so start checking the bread after the 1 hour mark.

7.Leave bread to cool completely before slicing.

Note: 

This bread stores well cut into slices and in the freezer, or you can store it at room temperature for up to 3 days. Otherwise, keep unused bread, tightly wrapped in cling wrap, in the fridge.

And how about this idea ...

... fry a slice in a skillet / pan with a little bit of coconut oil and serve it hot with smashed avocado, fresh tomato, etc etc ... The choice is yours.

Recipe idea from Brenda here

Another lovely bread recipe is Broccoli protein bread here

... and have you seen this flaxseed loaf or this rosemary and thyme loaf ?

Happy baking ... I can smell the aroma from here

All the best Jan

Gary Taubes: Diet Advice That Ignores Hunger

TOWARD the end of the Second World War, researchers at the University of Minnesota began a legendary experiment on the psychology and physiology of human starvation — and, thus, on hunger. The subjects were 36 conscientious objectors, some lean, some not. For 24 weeks, these men were semi-starved, fed not quite 1,600 calories a day of foods chosen to represent the fare of European famine areas: “whole-wheat bread, potatoes, cereals and considerable amounts of turnips and cabbage” with “token amounts” of meat and dairy.

As diets go, it was what nutritionists today would consider a low-calorie, and very low-fat diet, with only 17 percent of calories coming from fat.

What happened to these men is a lesson in our ability to deal with caloric deprivation, which means, as well, a lesson in any expectations we might have about most current weight-loss advice, and perhaps particularly the kind that begins with “eat less” and “restrict fat.”

The men lost an average of a pound of body fat a week over the first 12 weeks, but averaged only a quarter-pound per week over the next 12, despite the continued deprivation. And this was not their only physiological reaction. Their extremities swelled; their hair fell out; wounds healed slowly. They felt continually cold; their metabolism slowed.

More troubling were the psychological effects. The men became depressed, lethargic and irritable. They threw tantrums. They lost their libido. They thought obsessively about food, day and night. The Minnesota researchers called this “semi-starvation neurosis.” Four developed “character neurosis.” Two had breakdowns, one with “weeping, talk of suicide and threats of violence.” He was committed to the psychiatric ward. The “personality deterioration” of the other “culminated in two attempts at self-mutilation.” He nearly detached the tip of one finger and later chopped off three with an ax.

When the period of imposed starvation ended, the subjects were allowed to “refeed.” At first they were allowed to eat more calories, but restricted as to how much. A subset under continued observation was then allowed to eat to satiety, which was surprisingly hard to achieve. The men consumed prodigious amounts of food, up to 10,000 calories a day. They regained weight and fat with remarkable rapidity. After 20 weeks of recovery, they averaged 50 percent more body fat than they had when it began — “post-starvation obesity,” the researchers called it.

Implicit in many discussions of how best to lose weight is the assumption that hunger, which is a consequence of caloric deprivation, is not an issue. Health and government organizations tell the obese and overweight, who now make up just over two-thirds of our adult population, to do what the study’s subjects did: Eat less, cut back on calories.

That advice implies that the ensuing hunger will be an easily bearable burden (no depression, lethargy, irritability — no tantrums, please!). And bearable not just for 24 weeks, but a lifetime. The Minnesota experiment tells us that when semi-starvation ends, the refeeding period will not end well.

This issue of how to diet, and how to lose weight, was in the news again recently when a study was published by researchers at the National Institutes of Health. The researchers confined their obese subjects (nine women, 10 men) to a hospital ward and then put them on diets that approached semi-starvation, feeding them an average of more than 820 fewer calories a day than they needed to maintain their weight. They averaged about 1,920 calories a day, but one diet was composed of foods that were 29 percent carbohydrates and 50 percent fat — the carb-restricted diet — and the other was composed of foods that were 71 percent carbohydrates and only 8 percent fat — the fat-restricted diet.

The subjects were then required to eat these diets, not a calorie more or less, for six days — not 24 weeks.

An N.I.H. official hailed the study as providing “invaluable evidence on how different types of calories affect metabolism and body composition.” Google News referenced well over 200 entries about the study in the first three days after publication.

What made the headlines? That the subjects lost more fat by restricting dietary fat than they did by restricting the same number of carbohydrate calories. “Scientists (sort of) settle debate on low-carb vs. low-fat diets,” as The Washington Post put it.

But the devil in nutrition studies is always in the kind of details that are encapsulated by phrases like “sort of.” Whether the evidence was invaluable, as the N.I.H. claimed, depends on a number of issues. Is the experience of six days relevant to what happens over months, years or a lifetime? There’s little reason to think so. Can humans survive (and if so, for how long) on a diet of 8 percent fat? The Food and Agriculture Organization of the United Nations has said 15 percent is the lower limit. And then is a diet with about 30 percent carbohydrates sufficiently restricted to be considered a low-carb diet — the N.I.H. diet included blueberry muffins at breakfast, spaghetti at lunch and wraps for dinner.

Those who argue publicly (as I do) that refined grains and sugars cause obesity believe that losing meaningful weight requires far more significant changes in the quality of carbohydrates consumed (far less refined) and in the amount (less than 20 percent, perhaps less than 10).

Finally, what about hunger? By inflicting caloric deprivation for only six days, the researchers seem to have made the implicit decision that hunger — the biological response to caloric deprivation — is irrelevant to how we should think about a weight-loss diet. That the subjects might be hungrier on one diet than the other was also not addressed.

The low-fat diet of the N.I.H. experiment had significantly less fat (8 percent vs. 17 percent) and only 350 more calories a day than the diet on which the Minnesota researchers drove their conscientious objectors to the point of character neurosis and mental breakdowns. The N.I.H. diet had more protein, too. But the history of diet studies (and human populations) suggests that caloric deprivation is unsustainable.

That humans or any other organism will lose weight if starved sufficiently has never been news. The trick, if such a thing exists, is finding a way to do it without hunger so weight loss can be sustained indefinitely. A selling point for carbohydrate-restricted diets has always been that you can eat to satiety; counting calories is unnecessary, so long as carbohydrates are mostly avoided.

But this advice raises a pair of obvious questions, or at least it should: If people on low-carb diets eat less (the conventional explanation for any loss of fat that ensues), why aren’t they hungry? Where’s the semi-starvation neurosis? And if they don’t eat less, why do they lose weight? It implies a mechanism of weight loss other than caloric deprivation and suggests that the carbohydrates and fats consumed make a difference.

Questions like these about the relationship between calories, macronutrients and hunger have haunted nutrition and obesity research since the late 1940s. But rarely are they asked. We believe so implicitly in the rationale of eat less, move more, that we (at least those of us who are lean) will implicitly fault the obese for their failures to sustain a calorie-restricted regimen, without ever apparently asking ourselves whether we could sustain it either. I have a colleague who spent his research career studying hunger. Asking people to eat less, he says, is like asking them to breathe less. It sounds reasonable, so long as you don’t expect them to keep it up for long.

Much of the obesity research for the past century has focused on elucidating behavioral techniques that could induce the obese to eat less, tolerate hunger better, and so, by this logic, lose weight. The obesity epidemic suggests that it has failed.

For those who believe that hunger is somehow all in the mind, rather than a powerful biological response to caloric deprivation, it is tempting to wish on them the fate that the goddess Ceres bestowed on King Erysichthon of Thessaly in Greek mythology. She “devised a punishment to rouse men’s pity… to torment him with baleful Hunger.” Erysichthon then eats himself out of castle and kingdom and ultimately dies by feeding, “little by little, on his own body.”

http://www.nytimes.com/

Graham

English Country Garden : The Perfect Bank Holiday Drink !

Well it is the Bank Holiday Weekend. The weather (we hope) is perfect and there you are with family and friends. Just picture the scene, the lawn is looking wonderful, the garden just glorious in the late August sunshine and as you take a sip of 'English Country Garden' ... a most pleasing bank holiday cocktail, all is well with the world ... we certainly hope so. However, if the weather is not too good, please use your imagination !

To make this lovely drink here is what you do: 

INGREDIENTS
25ml gin
25ml St. Germain elderflower liqueur
2 springs of mint
1/2 a lime
Ice
Apple juice

INSTRUCTIONS
In a large highball glass, place 1 spring of mint and 1/4 of the lime in the bottom. Using the end of a rolling pin, bash the mint and lime together. Fill the glass up with ice and add the gin, elderflower liqueur and top up withe apple juice. Garnish with the other sprig of mint and lime wedge.

NOTES
If you don't have St. Germain elderflower liqueur use elderflower cordial. This is also delicious as a non-alcholic version using elderflower cordial and omitting the gin. Idea from here.

Now, of course you may prefer a glass of this

or this 

or even a cup of this

But I hope you can enjoy the weekend, wherever and whatever you're doing.

Now how about a nice low carb smoked salmon blini

and later a slice of low carb strawberry sponge cake 

sit down and enjoy the view

All the best Jan

David Gilmour - Rattle That Lock

New song from Dave Gilmour Pink Floyd guitarist and vocalist

Graham

Little Big Town - Good As Gone

Graham

Cuba Feliz - Lagrimas Negras

This for me is a fantastic video, what music is all about, the universal language. So laid back and yet urgent. I have never been to Cuba, but family and friends have, they loved the place and the people. I hear the fishing is fantastic. Time to get out there me thinks. A scene from the musical-documentary movie "Cuba Feliz", directed by Karim Dridi. Eddie

Pilot Speed - Alright

Saturday night is music night on this blog. Discovered this band while watching a Kevin Bacon movie yesterday Death Sentence and it put a hook in me. Eddie

Grilled Chicken & Blackberry Salad

As blackberries featured on the blog recently, I just thought I must share Martina's wonderful and simply delicious Grilled Chicken and Blackberry Salad. It is a stunning recipe, which you may wish to try out soon! Do please follow the link which I have given below and find out more about Martina and her lovely recipes.

Ingredients (makes 2 servings):
2 large chicken breasts, skinless (400g / 14.1 oz)
juice from ½ lemon
1 tsp thyme, fresh (or ½ tsp dried)
¼ cup extra virgin olive oil
2 small heads lettuce, I used little gem (200g / 7.1 oz)
½ cup artichoke hearts, canned
¼ cup kalamata (or other black) olives (30g / 1.1 oz)
¼ cup green olives (30g / 1.1 oz)
1 cup blackberries, fresh (150g / 5.1 oz)
1 tbsp blackberry vinegar or any other fruit vinegar,
¼ tsp salt or more to taste

Instructions:
1. Brush the chicken breasts with half of the olive oil, add lemon juice, thyme and season with salt. Leave for at least 30 minutes minutes to marinade.
Note: You can use any kind of cooking oil instead of olive oil (ghee, coconut oil, lard, etc.). Although marinating is optional, it is recommended.

2. Preheat the oven to 200 C / 400 F. Place the chicken breast in a baking dish and bake uncovered for 25-30 minutes. Remove from the oven and let it cool down. Slice into desired pieces.

3. Wash and place the lettuce into a salad spinner or drain using a paper towel. Fold into a serving bowl.

4. Drain the artichoke hearts and slice them into desired pieces. Add them to the bowl together with the sliced chicken.

5. Add drained kalamata (or other black) and green olives

6. Wash and drain the blackberries and add them to the bowl with the other ingredients.

7. Drizzle with the remaining extra virgin olive oil and fruit vinegar.

8. Enjoy!

Note:You can prepare the meat in advance and have it ready as a quick source of protein for your low-carb meals. When it's grilled, let it cool down, cut into desired pieces, place in an air-tight container and store up to 2 days (or freeze up to a month).

This lovely recipe idea is from Martina (pictured above). She lives in the UK, and has always been passionate about nutrition and healthy living. She started eating low-carb in 2011, shortly after she was diagnosed with Hashimoto’s hypothyroidism. Her recipes are all grain-free, sugar-free and gluten-free. She always opts for grass-fed beef and butter, raw hormone-free dairy and healthy fats like coconut oil. You can read more here

All the best Jan

How To Make Cancer Awareness Ribbon Sprinkles but don't eat them yourself !

"During the month of October, pink is everywhere. From jewelry to t-shirts to tattoos, there are endless ways for you to help raise Breast Cancer awareness. If you’re a baker, these homemade awareness ribbon sprinkles make it easy to use sweets to help bring awareness to this cause or another one close to your heart. I use mine during September to honor a special Ovarian Cancer survivor in my life." Taken from here.

Otto Warburg is considered one of the 20th century's leading biochemists. He was the sole recipient of the Nobel Prize in Physiology in 1931. In total, he was nominated for the award 47 times over the course of his career. He was awarded the Nobel prize for discovering Cancer, above all other diseases, has countless secondary causes. But, even for cancer, there is only one prime cause. Summarized in a few words, the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar.

Eddie

New World Order Dietitians

Here is a chance to see what goes on at a global Dietitians conference. A walk through the 16th International Congress of Dietetics located in Sydney Australia. I was astounded by the amount of sponsors from multinational corporations that support GMO foods. The goal of the international congress of dietetics is to standardise nutrition practice globally. Companies such as McDonalds, Mars, Nestle, Pepsi, Pfizer, Abbot, Kellogg's and Unilever are major partners with Dietetics associations globally. Hundreds of studies were presented none of which had anything to about the risks of GMO foods, BPA in foods or toxic pesticides.

Graham

UK Dietitians no fans of Dr. Aseem Malhotra

Long timers on the UK diabetes forum scene will no doubt remember the staunchly anti low carb dietitian known as Chris Cashin aka Ally5555. Low carbing diabetics faced scurvy, osteoporosis, bowel disorders and worse according to Cashin. Well the thick end of seven years on she is still defending the gospel according to the Eat Well Plate and kicking anyone who dares to criticise the failed dogma of the BDA and their ilk. Recently the dietitian I nick named sister scurvy was re tweeting BDA Chairperson Catherine Collins as you can see below. Some may remember my posts a few months ago referring to a twitter conversation I had with Collins, where she admitted the BDA have no dietary recommendations of their own. Evidently they just push the recommendations of Diabetes UK the diabetes charity.

If the BDA did not ooze such total arrogance, I might have some empathy for them, let's face it, what other so called 'professionals' have to live with such a high failure rate? Imagine a pilot that crashed his plane almost every-time he flies or a cab driver that junked his taxi three times a day. How would you answer that sort failure rate in your profession? How long would you last in your job, when the evidence of your total failure was there for all to see. Well, the BDA have some great get outs as Catherine told me in our conversation. "We can't stand over every patient watching what goes into there mouths" another great cop out is "the patient failed to comply" Do BDA dietitians comply with their own advice? if so, why are so many high profile BDA dietitians heavily over weight themselves. 

I reckon many failed patients do comply, they stick to the letter of the very poor advice of the Eat Well Plate and so called "healthy balanced diet" I call the diet of slow death for diabetics. Dr. Aseem Malhotra is becoming a well known voice of sanity and common sense around the world, and the dietitians are rubbishing him at every opportunity, clearly the likes of the ex "resident dietitian" has learnt nothing over the last seven years.

Eddie

F is for Friday !

For many, it may be a feeling of thank goodness it's Friday. For most in the UK it's a Bank Holiday Weekend. I say for most because there will still be those who have to work over the weekend.

For those fortunate to have today 'free' hope you have a great day. You may be taking time to get the house ready for some weekend visitors. Perhaps you've some shopping planned ... a visit, or perhaps a pleasant walk, or some fishing! 

If you are at work then maybe you can relate to this poem by Laura Hardstaff:

F is for Friday

F: is for Friday when all the fun begins,

R: is for Rest and a couple of sneaky gins!

I: is for Insatiable, our desire for this day never ends,

D: is for Dreaming about what fun the weekend sends,

A: is for Adventure and doing whatever one dares,

Y: is for You, no worries, work or cares.

Whatever you are doing this Friday - may I suggest a Friday dinner idea of a one stop fish dish !

One-pot fish with black olives & tomatoes

Ingredients:

Serves 4
(7g carb per serving)
175g black olives in oil, stones removed
1 large onion, roughly chopped
400g can chopped tomatoes
4 boneless white fish fillets such as Icelandic cod or hoki, each weighing about 175g/6oz

To serve:
chopped parsley
lemon wedges

Method:
1. Preheat the oven to fan 180C/conventional 200C/gas 6. Heat 1 tbsp of the oil from the olives in an ovenproof pan. Tip in the onion and stir well, leave to cook for a minute or two and then give it another good stir. Add the tomatoes and some salt and pepper. Bring to the boil, then add the olives.
2. Put the fish, skin side down, onto the sauce and drizzle over a splash more oil from the olive jar. Bake, uncovered, for 15 minutes until the fish is cooked. Sprinkle with chopped parsley and serve straight from the pan, with lemon wedges for squeezing over.

... and perhaps a nice bottle of chilled white wine to go with this dish?

Have a lovely Friday and a happy weekend.

All the best Jan

Newsflash: Aseem Molhatra getting the #LCHF message out on BBC1 !

Where do you want to get the Low Carb High Fat (LCHF) message out? Well, the UK's primary television channel would be super; and how would you ensure that it was articulated clearly for the masses? Well have the eloquent Aseem Malhotra deliver the goods !

Ivor Cummins AKA The Fat Emperor

Graham

Truffles : Low Carb and Sugar Free !

For adults only! Well these super tasting truffles do contain brandy ... so please keep them away from the children ! These low carb walnut and brandy truffles are simply delicious, a treat for us adults, why not make some and see why.

Sugar Free Walnut and Brandy Truffles

Ingredients:

Makes 20

250g / 9 oz regular cream cheese block (not spreadable)

100g/ 3.5 oz butter melted

4 tbs unsweetened dark cocoa powder 

¼ cup walnut pieces 

3 tbs granulated stevia, or sweetener of choice, to taste 

1-2 tbs brandy *see notes 

Instructions: 

1. Warm the cream cheese block to room temperature or in the microwave for 15 seconds, until it is soft enough to work with. 

2. Add the melted butter and mix through with a fork to ensure it is lump free and smooth. 

3. Add the cocoa powder, stevia and brandy. Mix until thoroughly combined. 

4. Gently stir through the tiny walnut pieces and refrigerate until firm enough to roll into balls. 

5. Roll a heaped teaspoon at a time and place each truffle on a plate. Place the plate into the fridge again for an hour or two for the truffles to really set firmly. 

6. Roll in cocoa powder if you like, or crushed walnuts, pistachios, pecans etc. 

Notes: 

*Brandy is optional and is intended for adults only. You can omit this entirely or you can add alcohol free brandy essence. 

NUTRITION INFORMATION: 

Serving size: 1 truffle Calories: 94 

Fat: 9.6g Carbohydrates: 1.3g Sugar: 0.5g Fibre: 0.5g Protein: 1.4g 

Idea for these delicious truffles from super star Libby at 'Ditch The Carbs' here

... recipes are just made for making, sharing and enjoying. 

All the best Jan

Blackberries - How to pick, store and cook them the low carb way

I have to agree with Hannah Williams, when she says, ... Few things sum up British summertime better than a scramble through a blackberry bush clutching an empty tub ready to fill! And, provided you're not trespassing on private property, blackberry picking is a great way of sourcing a cheap summer pud.

Crumbles and pies aside what can you do with the bountiful berry? Here are some top tips for handling all that free fruit...

Choose carefully

Like many things in life, the most successful blackberries will be ones that stand out from the crowd. They should be shiny and firm when you pick them though fruits do seem to vary in flavour from place to place. Seasoned blackberry hunters often have favourite bushes whose harvest they prefer to any neighbouring bush. As you can try before you 'buy' shop around to find what suits you, avoiding bushes by busy roads or fruit low enough to be 'watered' by passing dogs.

When to pick

Blackberries are normally at their best at the end of August to September. Legend has it any picked after the end of this month are best avoided as the devil is said to have peed on them. Not sure this is true but by October the damp weather will have certainly soiled many crops.

Where to pick

Grown in abundance in all manner of hedgerows across the country blackberries are not restricted to rural areas but regularly spotted along canal paths and across wasteland in towns and cities alike.

How to collect

Although it's hard to resist raiding each hedgerow try not to stack loads on top of each other or they'll bruise and squash before you get them home. Use a couple of containers if you want to pick lots of berries though it's always good to leave plenty for other pickers too.

Tip

When picking blackberries, or any small fruit, take a large plastic type milk jug with you, it is easier to hold on to the handle than hold a tub, the blackberries fit easily through the top. For children use a small milk jug as it will not weigh as much and it is easier for them to hold onto than a tub. When emptying, have patience as the berries will only come out one at a time, or, carefully cut the top of the jug and tip the berries out.

How to store

Try to keep them dry when storing and they should last for two to three days. If refrigerating let them come to room temperature before eating, as they'll taste much juicier that way. Don't worry if you've picked more than you can handle, blackberries are easily frozen and can be baked straight from the freezer with no need to defrost. Freeze on a tray in a single layer so they don't all squish together or puree them first then freeze the liquid in a bag or ice cube tray.

What to cook

Pies and crumbles are the obvious choice but blackberries also taste delicious served with savoury meats, or on their own with some double cream.

Article from Hannah here 

Looking for a low carb crumble / crisp topping try this ...

First Eliminate Sugar:

You can easily and significantly lower the carbohydrate content of your blackberry, or blueberry, crumble by removing all the sugar it contains. The sugar doesn't play any important role in this recipe, besides providing sweetness. Blackberries (Blueberries) are naturally sweet and do not need extra sugar. You can also make the topping without any added sugar, or you can use a sugar substitute to add a bit of sweetness without all the extra carbohydrates. Sucralose and stevia are good options for baking because they, unlike aspartame, tolerate high temperatures well. Eliminating the sugar alone will save you 38 to 50 grams of carbohydrates per serving.

Second Use Almond Meal:

For the topping of your blackberry, or blueberry, crumble you can replace in equal measure the regular all-purpose flour with almond meal. Almond meal can be purchased at many grocery stores in the health food section. Check the expiration date, however, because it can go rancid. To make sure it is fresh and to save money, make it yourself by grinding almonds in a food processor. Each cup of almond meal contains only 9 grams of net carbs, compared to the 95 grams found in regular wheat flour. (Replace the oats with coarsely chopped almonds for extra texture while keeping the carb content low.) These substitutions save you an extra 18 to 25 grams of carbohydrates per serving.

Low-Carb Blackberry or Blueberry Crumble

Without sugar and flour, your low-carb almond blackberry/blueberry crumble provides only 14 to 19 grams of carbohydrates per serving, a 78 percent decrease compared to the regular high-carb recipe. If you want to keep your carb intake even lower, split your serving with a friend and freeze leftovers for later to prevent temptation. Avoid serving your low-carb dessert with ice cream, since even sugar-free ice cream contains about 15 grams of carbohydrates per 1/2-cup serving. Instead, add creaminess by drizzling double / heavy cream, which does not contain any carbs, over your crumble.

Tips for Crumble from Aglaee here 

Will you be blackberry picking soon?

All the best Jan

Fad diets drive Aussies from grain in droves

AUSTRALIANS are eating 30 per cent fewer grains now compared to four years ago.

This was the key finding of a study into the attitudes and behaviours of Australians around grains and legumes.

The study, commissioned by the Grains and Legumes Nutrition Council, found young women (aged 19 to 30 years) are significantly limiting their consumption of grains and six per cent of all Australians do not consume grains at all.

The Council’s general manager Michelle Broom said the decline was due to the popularity of “fad diets”.

The popularity of low carb, high fat diet; the Paleo diet and a mainstream shift to gluten-free diets have seen consumers eat less bread, white pasta and noodles.

“Fad diet trends have resulted in widespread confusion about the benefits of eating core grain foods and legumes,” Ms Broom said.

“We need to educate people about the health consequences of cutting these nutritious foods out of their diets.”

The Council’s managing director Georgie Aley said her organisation, industry, health practitioners, food manufacturers and the media needed to work together to get consumers, especially women, back on track.

“We need consistent, substantiated messaging that effectively communicates the health benefits of grains and legumes to consumers,” Ms Aley said.

The study’s co-ordinator, Colmar Brunton research director Sarah Hyland, said recent controversies surrounding fad diets (including the disgraced cookbook from celebrity chef Pete Evans and the exposure of “wellness warrior” fraud Belle Gibson) made consumers more aware of the need for reliable health advice.

“We have an opportunity right now to communicate simple and scientifically-backed health messages and now is the time they will be listened to.”

http://www.theland.com.au/

Just what are the consequences of not eating grains ? after seven grainless years on a fad diet I don't have any problems.

Graham

English Breakfast Frittata

A clever twist on the full English breakfast. Packed with sausage, smoked bacon and soft button mushrooms, this 'English Breakfast Frittata' is just the perfect early morning dish, and so low in carbs, it's virtually no carb!

I know we feature quite a range of Frittata's on the blog, but can you have too much of a good thing? No, of course not! I saw this and thought another great low carb recipe idea to share - and it makes for an amazingly tasty start to the day.

Full English back on the menu ... well it's never left my menu plans. But read on, see what you think and perhaps try it out one morning, or lunchtime, or even supper time - a versatile recipe.

Ingredients:
Serves Four
2 outdoor-bred pork sausages
1 tbsp oil
3 smoked back bacon rashers fat trimmed cut into cubes
75 g button mushrooms sliced
62.5 g pkt (pomodorino) tomatoes halved
4 large (British) free-range eggs
12.5 g bunch fresh chives snipped

Method:
1. Squeeze the sausages out of their skins, and roll the sausage-meat into 12 bite-size balls.
2. Heat ½ tablespoon of the oil in a 20cm ovenproof frying pan. Add the sausage and fry all over for 1 minute, until browned and cooked through. Add the bacon and mushrooms and fry for a few minutes, until golden. Add the tomatoes for a further minute. Remove the mixture and set aside. Discard excess fat from the pan.
3. Whisk together the eggs and chives and season with freshly ground black pepper. Stir in 2/3 of the fried sausage mix. Preheat the grill to medium.
4. Heat the remaining oil in the frying pan over a medium heat. Add the egg mixture, tipping the pan so that it covers the base. Turn down the heat and scatter over the remaining sausage mixture. Cook for 8 minutes, or until almost set.
5. Place under a preheated grill, for 2-3 minutes, until the frittata is set and golden. Let cool slightly, then slide out of the pan, cut into wedges and serve.

Recipe idea from here

... and please don't forget a cup of tea to go with it !

All the best Jan

Dr Malcolm Kendrick: BBC Radio 2 iPlayer

 Dr Malcolm Kendrick talks health to Steve Wright about his book on health myths, 'Doctoring Data'

http://www.bbc.co.uk/programmes/p030p720

Graham

DCUK the forum of flog, low carb anti Sid Bonkers aka the enforcer fesses up !

After years of spouting only calorie control will lead to weight loss, and taking on low carbers at every opportunity, the Bonkers one has a moment of clarity. It is clear Sid lost a lot of weight by low carbing, watch how he tries to back peddle on today's revelations, and uses the old "I was miss-quoted" malarkey.

Sid at the flog today.

"Any way I cut my carbs down a little further than you to around 60g a day and was very strict and lost 4 stone over about 12 months"

"ps I managed to wean myself off insulin as the weight fell off and I lost my insulin resistance"

Low Carb High Fat (LCHF) : Back To Basics

This very interesting article was written by Julia McPhee, a fellow blogger,who lives in New Zealand, I think it's an interesting read - but what do you think?

"I think it’s time to get back to basics on low carb high fat (LCHF) dietary approach and clarify what it’s all about. The academics are fighting it out at policy level; there are several high profile chefs and foodies spreading the word at a public level, and good on them all. We need a multi-level approach to make changes to our health messages and to get the right messages to those that need them most.

But what about that person on the street. The 40 year old who despite listening to recommended public health messages for the past 20 years and following a low fat, high carb ‘healthy diet’ – has gained weight, has been diagnosed as pre-diabetic or has been put on medication for high cholesterol.

And now there’s a new kid on the block who says, “forget everything you have heard and believed for the last 30 years” and “eat more fat and less fruit”. “Stop eating those whole grains and cereals that we told you last year were healthy”.

I see it all the time; they roll their eyes and say to me “yes Julia but what’s next? What will you be telling us this time next year?”

I promise you that this is what I will be telling you this time next year:

Eat less sugar – full stop
Eat less processed foods
Eat more green leafy and above ground vegetables
Eat good quality fat – avocado, olive oil, butter, coconut oil
Eat meat and poultry (leave the fat and skin on), and seafood
Eat dairy products; cream, cheese, full cream milk, full fat unsweetened yoghurt etc
Cut bread, rice, pasta, cereals, and grains from your diet
Drink alcohol in moderation, but while actively trying to lose weight just give it a miss for a short time (believe me, you will survive)

But one more key point:

Eat only when you are hungry and stop when you are full

The high fat component of the LCHF eating plan will make you feel fuller faster and for longer. Interestingly we don’t need a clock to tell us when to eat. Neither do we need a specific sized plate to tell us how much to eat! Your brain and body will tell you when you have had enough. This is an instinctive way of eating; listen to your body signals."

... If you are unsure what to eat and what not to? Have a look on Julia's website and many other sites there is great information on the 'inter-web' ...

"But if you are:
Over 40 (or under for that matter)
Over weight (even just a little)
Tired a lot

Or if you:
Don’t sleep well
Are easily and often stressed
Know that you are not functioning at a level that is the best you can possibly be

Then just try this clean and instinctive way of eating.

You deserve to feel good, look good, and be great in all aspects of your life! "

Most words and above article from "Julia McPhee" here

How about trying this low carb meal?

Beef, slowly cooked with onions, carrots and cabbage - see recipe here  

Or this one Dijon Chicken With Mushrooms - find recipe here

Do hope you've found this of interest, sometimes it's good to go back to basics!

All the best Jan

Quote of the day.

've learned that anyone who cannot comprehend what is blatantly obvious, is usually being paid not to comprehend it.

Tim Noakes on twitter.

Sausage & courgette/zucchini kebabs

I always think kebabs make a change, and they can be eaten outside using a BBQ or even indoors by using the oven or grill! The grandchildren all like to help out in the kitchen from making Grandma a cup of tea ... they put the tea-bag in my special Grandma mug, and carefully pour the milk in, to making their own individual pizza toppings, cheese, tomatoes and pepperoni are favourites and of course the pizza base can be made the low carb way with cauliflower!

... but I digress, back to kebabs. These sausage and courgette kebabs are great for children and adults alike, but it is definitely a meal that children aged from say three can help out with. They can make their own dinner, have fun threading the skewers, but do take care and supervise, they love to watch and learn. Adults too can enjoy a sausage and courgette kebab or two - see what you think.

Tip, I always use the more meaty chipolata sausages those with at least 90% and above meat content.

Ingredients:
Makes 8 small skewers
2g carbs per serving

2 thin courgettes or 1 fat one, cut into quarters lengthways
½ red, yellow or orange pepper, cut into fat strips
3 chipolata sausages
8 cherry tomatoes
a little oil, for brushing

Instructions:

These have been given as if a child is helping so obviously amend to suit your circumstances ...
1. Ask your grown-up helper to turn the oven to 200C/ 180C fan/gas 6. Cut the courgette and pepper into chunks with a knife or scissors (or ask your grown-up).
2. Cut each sausage into 3 or 4 pieces with your scissors (or ask your grown-up to do this).
3. Push the wooden sticks through the cherry tomatoes, peppers, courgettes and pieces of sausage in any order, making sure the pointy end is facing away from you.
4. Brush your skewers with olive oil and put in a baking dish. Ask your grown-up helper to put them in the oven for 20 mins or until the veg are soft and the sausage cooked.

These can also be cooked on a BBQ or grill.

Serve simply with a salad or finger snacks such as celery, carrot or pepper sticks.

Recipe idea from here

All the best Jan