Preventing type 2 Diabetes: Healthy Lifestyle Matters

Diabetes is one of the most serious chronic illnesses affecting around 4.2 million people worldwide. It is a clinical syndrome characterized by high blood glucose levels due to absolute or relative deficiency of insulin, this lack of insulin impairs the metabolism of carbohydrates, protein and fat. There are three types of diabetes

  • Type 1 diabetes
  • Type 2 diabetes
  • Gestational diabetes

Type 1 diabetes is caused by the immune system destroying pancreatic cells means not enough insulin to function normally, resulting in high blood glucose levels. While type 2 Diabetes is a condition in which our body produces insulin, but target cells do not respond to insulin and cannot use it properly. At first, the pancreas makes more insulin to overcome this high glucose level but eventually, it can’t keep up, and sugar build up in our body.

Causes and risk factors:

Insulin resistance is the hallmark of pre -diabetes and type 2 diabetes, lets understand what factor causes insulin resistance…

MODIFIABLE RISK FACTORS FOR TYPE 2 DIABETES

Understand your risks⬇️

➡️ OVERWEIGHT/OBESITY; Being overweight (BMI of 25-29.9), or affected by obesity (BMI of 30-39.9) or severe obesity (BMI of 40 or greater), greatly increases your risk of developing type 2 diabetes. The more excess weight you have, the more resistant your muscle and tissue cells become to your own insulin hormone.

➡️Sedentary Lifestyle
Inactivity and having excess weight go hand-in-hand with a diagnosis of type 2 diabetes. Insulin receptors are more in muscle cells as compared to fat cells, so an individual can decrease insulin resistance by exercising. Being more active also lowers blood sugar levels by helping insulin to be more effective.

➡️Unhealthy Eating Habits
Unhealthy eating has duel effects as it is a major contributor to obesity and also increase the risk of insulin resistance. A diet with too much fat, not enough fibre and too many simple carbohydrates all contribute to the development of type 2 diabetes.

➡️High Blood Pressure and High Cholesterol
In addition to causing damage to the cardiovascular system, untreated high blood pressure has been linked to the development of diabetes. High blood pressure and high cholesterol may increase the risk of developing heart diseases, stroke, and other complications of diabetes.

Smoking

There are several other factors which cannot be avoidable but play an important role in the pathogenesis of type 2 diabetes.

➡️History of Gestational Diabetes
. When pregnant, gestational diabetes generally lasts the duration of pregnancy and approximately 5 to 10 percent of females with gestational diabetes will continue to be affected by diabetes after delivery.

.➡️Family History and Genetics
Type 2 diabetes is also linked with genetics as suggested by #twinstudy. you are two to six times more likely to get type 2 diabetes if you have parent, siblings or child with diabetes.

➡️Increased Age
Age is an important factor for type 2 diabetes. As we age, the risk of type 2 diabetes becomes greater. Even if an elderly person is thin, they still may be predisposed to developing diabetes. The pancreas ages right along with us and doesn’t pump insulin as efficiently as it did when we were younger. As our cells age, they become more resistant to insulin as well.

Healthy habits for managing and reversing Pre -Diabetes;

Prediabetes or borderline diabetes is a condition in which blood sugar levels are raised but not high enough to labelled as diabetes. According to Diabetes.co.uk, around 7 million people in the UK are estimated to have prediabetes and thus have a high risk for developing type 2 diabetes. Pre -diabetes is now recognized as a reversible condition. By adopting healthy habits like making healthy changes in diet and regular physical activity, people with prediabetes can prevent the development of type 2 Diabetes.

Healthy diet; There is convincing evidence that diet rich in whole grains protect against diabetes as the bran and fibre in whole grain cause a slow rise in blood sugar. Avoid processed meat and red meat as they increases the risk of diabetes. Select polyunsaturated fats like olive oil, nuts, seeds, and try to eliminate trans fats (margarine, fried food).

Check your portions: Practicing portion control can help you lose weight and eat a healthy diet. Eating too much or too little of any of the major food group can be bad for your health. for more information about portion size visit, https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/portion-sizes

Be Active: Being physically active can lower your risk of developing diabetes. 30 minutes per day or 150 minutes per week physical activity is recommended, as it reduces the risk of getting obese and improves insulin resistance.

Lose weight if you are overweight or obese: Fat accumulation in the liver and pancreas affects how type 2 diabetes develops, and losing this fat can help put your diabetes into remission.

Reduce stress level as stress increases cortisol level which may interfere with glucose metabolism and increases blood glucose level.

Quit smoking: smokers are roughly 50% more likely to develop diabetes as compared to non -smokers.

take home message

Type 2 diabetes is preventable through lifestyle changes even if you are at high risk, It is very important to find out if you have prediabetes. If you are diagnosed with pre- diabetes,you should discuss a diabetes prevention plan with your doctor. There are alot of evidence -based information available on the following websites; https://www.nhs.uk/conditions/type-2-diabetes/food-and-keeping-active/

diabetes.org.uk

Gluten Free Diet: Fad or Necessity

Nowadays, a gluten free diet (GFD) has become a global trend, more and more people claim that they have some gluten related disorders but is it really true that gluten has turned into our enemy??. let’s see the whole picture.

Gluten is a group of protein found in wheat, barley and rye. Gluten acts as glue and hold food together. There are two common forms of gluten; gliadin which gives bread the ability to rise during baking and glutenins, which is responsible for dough’s elasticity.

Who actually need GFD

A gluten- free diet is the only treatment for patients with celiac disease and non celiac gluten sensitivity. Celiac disease is an autoimmune disorder that affects 1% of the population. The consumption of gluten from wheat or barley causes damage to intestinal villi causing the intestine to become inflamed results in the malabsorption of certain nutrients. Patients with celiac disease experienced symptoms including

  • Abdominal pain
  • Bloating/cramps
  • Diarrhoea/ constipation
  • Unexpected weight loss
  • Extra- intestinal symptoms (Dermatitis, Osteoprosis, Iron deficiency anaemia, and Infertility)

Gluten rich food

Gluten can be found in Wheat, barley, rye, malt,  couscous, kamut, spelt, semolina flour, packaged soups, sauces and condiments. Recent studies have clearly demonstrated that oats are nontoxic for patients with celiac disease; however, contamination of oat products with other prohibited flours during harvesting, milling, or processing of oat products is a concern.

GFD for healthy individuals

There is NO evidence to support that a gluten- free diet leads to weight loss. Some people choose to follow a gluten-free diet merely because it provides structure to eating healthier and adopting a healthy lifestyle. Eating gluten-free often may cause you to eat more whole foods such as fruits, vegetables, legumes, and lean meats. These diet changes are often healthier and lower in calories, and people may experience healthy weight loss. However, this weight loss can be achieved by simply limiting junk food, eating a balanced diet along with regular physical activity.

Gluten-free does not necessarily mean healthy because all gluten-free foods are not equally nutritious. Gluten- free products can be higher in calories, fats,and sugar in order to compensate for the texture and mouthfeel that gluten provides. A gluten-free diet can results in deficiencies of important nutrients, including B vitamins; folate, iron, thiamin, niacin, fibre, and riboflavin if not properly planned. Whole food bread and cereals are packed with B vitamins. Eating fiber rich foods are important, especially for breakfast, in order to get and maintain normal intestinal and bowel movement. Removing whole grains will add to digestive problems overall, not correct them.  It is possible to get more fibre from brown rice and fruit, which are gluten-free, but a person must be committed to eating enough of these foods on a daily basis to achieve a similar effect of foods rich in fibre like wheat bread and cereals.

TAKE HOME MESSAGE

The gluten- free diet is the primary treatment for celiac diseases and may help to improve symptoms in conditions related to gluten sensitivity. There is no evidence that gluten -free diet is an effective weight loss method. Diet and exercise are both important components of weight management and healthy lifestyle.

 

Mediterranean diet: Is it good for your health??

Mediterranean diet is considered the healthiest diet and widely recommended by physicians and nutritionist. This diet encourages nutrient-dense food and promotes plant-based food like vegetables, fruits, grains, nuts and healthy fats. The Mediterranean dietary pattern (MDP) also includes moderate consumption of fish and shellfish, white meat, eggs, and dairy products.

WHAT MAKES MEDITERRANEAN DIET(MD)

  • Wholegrains
  • Seafoods
  • vegetables and fruits
  • Legumes; lentils, chickpeas and beans
  • Nuts: almonds, hazelnuts, walnuts, pistachios
  • Herbs: rosemary, thyme and basil
  • Spices: nutmeg, cinnamon and saffron
  • Fish, poultry and minimal intake of red meat

Evidence for health benefits of Mediterranean diet

The Mediterranean Diet is associated with a lower incidence of mortality from all-causes, and is also related to lower incidence of cardiovascular diseases, type 2 diabetes, certain types of cancer, and neurodegenerative diseases.

The evidence so far accumulated suggests that adopting a Mediterranean diet may help prevent type 2 diabetes; moreover, a lower carbohydrate, Mediterranean-style diet seems good for HbA1c reduction in persons with established diabetes.

PHENOLIC COMPOUND

Mediterranean diet is rich in fruits and vegetables, which have been considered a good source of phenolic compounds. Berries, pomegranate, oliv oil, all contain variety of phenolic compounds. The potential benefits of olive oil for the prevention of type 2 diabetes have been confirmed in a meta-analysis of 29 prospective studies in which the highest olive oil dietary intake category showed a 16% reduction in the risk of type 2 diabetes. Thus, current evidence suggests that diets enriched with olive oil might prevent new-onset diabetes, an effect that, at least in part, could be attributed to the polyphenol content of oil.

HEALTHY FATS:

Mediterranean diet is very low in saturated fatty acids (SFA), and mostly fat comes from plant sources like olive oil and avocado, both are rich source of monounstaurated fatty acids (MUFA ). Ratio of MUFA to SFA is the key components for the health benefits of the MD. This diet also recomend frequent intake of nuts, which is best source of omegea 3 fatty acids, essential fatty acids that our body can not make. Fish are also important in mediterranean diet. Oily fish like sardine, mackerel, salmon and lake trout are rich in omega 3 fatty acids.

In a cohort study of 25,994 women in the United States, adherence to a Mediterranean diet was associated with a one-fourth relative risk reduction in cardiovascular disease, which was explained by reductions in inflammation, insulin resistance, body mass index, blood pressure and lipid profile (low -density lipoprotein and triglycerides).

FIBRE

There is strong evidence that consuming a fiber rich diet is associated with reduced risk of heart diseases, type2 diabetes, stroke and bowel cancer. Mediterranean diet is traditionally a diet rich in whole grains, fruits, and vegetables all are good sources of fiber.

Mediterranean Food pyramid

Take home message

The Mediterreanen diet is very similar to the government healthy recommendation, which is set out in the eating welll guide. Studies showed that longterm adherence to mediterranean diet is associated with better health outcomes. However, I must point out that the Mediterranean diet is not able to produce, by itself, the benefits listed above if you do not change at the same time other risk factors such as a reduced or absent physical activity, caloric intake in excess of the energy needs of our body.

References
(21) (PDF) The Mediterranean Diet: A History of Health. Available from: https://www.researchgate.net/publication/242018034_The_Mediterranean_Diet_A_History_of_Health

THYROID and DIET

The thyroid gland is an essential gland in our body that control all body functions, and healthy thyroid means a healthy body. The principal function ofthe thyroid gland is to produce T3 (triiodothyronine) and T4 (thyroxine). The hypothalamus and pituitary glands release thyrotropin- releasing hormone (TRH) and thyroid – stimulating hormone (TSH) respectively, and this stimulates the release of T3 and T4 directly from the thyroid gland. The hypothalamic-pituitary- thyroid axis is regulated by negative feedback. Thus, sufficient production or overproduction of T3 and T4 lead to reduced secretion of TRH and TSH. Thyroid hormones play a role in the regulation of metabolism, body temperature, digestion, cognition, muscle strength and cardiac contractility.

Primarily thyroid disease develops when thyroid gland produces too little or too much T3 and /or T4. BUT there is no specific food or dietary supplements that are helpful in treating thyroid disorder. There is no magic diet for a thyroid disorder, as claimed by some social media nutritionist. However, there are certain areas where our diet may be of relevance in the management of throid disease.

Micronutrients essential for healthy Thyroid

Iodine : Iodine is essential for the synthesis of T4 and particularly important in women who are pregnant as it is needed to ensure the development of a baby’s brain during pregnancy and early life. Iodine deficency results in enlarged goitre (thyroid swelling) and an underactive thyroid. However, in UK and other developed countries iodine deficiency is very rare. Sources of dietary iodine are fish, milk, seaweed and iodized salt. excessive intake also results in hypo or hyperthyroidism

If you are taking levothyroxine for hypothyroidism or for a goitre, there is no need to take iodine supplements

selenium: selenium is essential for a healthy thyroid, DNA synthesis, and also protect against infections and oxadative stress. Selenium is required for the enzyme which causes activation and deactivation of thyroid gland. In adults, the thyroid gland has the heighest concentration of selenium in the body. Adding food rich in selenium like Brazilian nuts, tuna, sardines, eggs, and legumes boots your selenium levels. The majority of data on selenium and throid disease are regardring chronic autoimmune throditis, and some studies suggested thast selenium supplement may be beneficial in this autoimmune thyroditis, however, still we ned lareg randomized trials to conclude this.

Zinc: Zinc is essential for activation of thyroid galand also regulate TSH production. Zinc deficiency is very rare in developed countries as it is abundant in many foofds like seafood, eggs, beans, poultry, nuts ( cashew and almonds).

Vitamin D : Vitamin D is required to activate thyroid hormone receptors, and insuffient Vitamin D impairs thyroid function . There are no large scale randomized trials showing VItamin D directly influence thyroid hormone level. Graves` disease is known to cause bone loss, which is cpmounded by Vitamin D deficiency. This bone loss can be regained by treatment and vitamin D supplementation before and after treatment.

Vitamin A : Vitamin A has been shown to regulate throid hormones metabolism and inhibit thyroid stimulating hormone via down regulation . Vitamin A deficency increases TSH secretion from pituitary gland and reduces iodine uptake by thyroid gland. Vitamin deficency is rare due to being in so many foods Animal source (Rertinol) is more potent as compared to plant derived form Carotenes.

Food to avoid

There is no food to avoid completely, eating balanced diet is important for a healthy thyroid. However there are some foods that should be eaten in moderation like

Brassicas (cabbage, cauliflower, kale etc) may contribute to the formation of goitre in some cases, but consumption would need to be very high before this is a real concern. In the UK, under normal dietary conditions, this is not normally a problem and the risk is very low.

Soya interferes with thyroxine absorption, therefore if you are taking thyroxine you should try to avoid soya, but numerous studied have found that consuming soya doesnot cause hypothyroidism in people with adequate iodine stores. If you wish to take soya, there should be as long a time interval as possible between eating the soya and taking the thyroxine.

Avoid products such as kelp, as they may interfere with thyroid function and wellbeing. Kelp is derived from seaweed and is naturally high in iodine. Because of this it is sometimes marketed as a ‘thyroid booster’ and can be purchased in dry preparations and tablets. As with iodine itself, it is of no health benefit to those with thyroid disease. 

TAKE- HOME -MESSAGE

A heart healthy diet that includes vegetables, fruits, lean protein, fibre, and omega 3 is paramount. If you still don’t feel well despite your medication, improving your diet and starting an exercise program may help.

Always consult your doctor, or pharmcist before taking any supplements or vitamins, as some can interfere with your throid function or your thyroid blood test.

Polyphenols; what they are, why you need them

Polyphenols are plant-derived dietary compounds that have been postulated to protect against certain chronic diseases such as cardiovascular diseases, neurogenerative diseases and and cancer.

what are polyphenols

Polyphenols are classified into different groups on the basis of their chemical structure. The main classes are phenolic acids, flavonoids, stilbenes, and lignans.

Despite extensive research, the exact mechanism of action of polyphenols in the human body remains unclear.It is suggested by research that gut mictrobiota modulate these polyphenols and transform them into physiological active compound that can be absorbed and have been linked with reducing risks of chronic diseases

Health benefit of polyphenols

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Glucose metabolism

Polyphenols regulate glucose homeostasis glucose as they increase insulin secretion. Additionally, studies show polyphenols inhibiting two enzymes vital for metabolizing glucose from dietary carbohydrate: α-amylase and α-glucosidase, slowing down glucose release and absorption and ultimately reducing high blood sugar following a meal. varios studies link intake of ployphenole rich diet to prevention of insulin resistance, metabolic syndrome, and type 2diabetes. Accordingly, individuals at risk of type 2 diabetes are encouraged to eat more plant foods, which of course are rich sources of polyphenols.

Heart diseases

Adding polyphenols in your diet may improve heart health. In many studies, regular consumption of cocoa, or flavanol extract of cocoa, is associated with reduced blood pressure and cholesterol. Cocoa, green tea, and black tea all contain Epicatechin, an imortant polyphenol which act at cellular level and imporve endothelial function and inhibit platlet aggregation, thus reduces the risk of heart diseases.

Cocoa and Cardiovascular Health | Circulation

Brain health

Polyphenols exhibit tremendous potential in treating and preventing neurodegenerative disease like Alzheimer disease, Parkinson and huntington disease. Metanalysis and epidemilogical studies strongly suggest that polyphenols rich diet improve cognitive functions in elderly people.

May protect again cancer

Polyphenolsact as antioxidants and anti inflammatory and have been reported to be efficaious in the prevention of cancer. Polyphenols can inibit the proliferation of prostrate, bladder, lung, gastrointestinal, breast and ovarian cancer.

Oral health

Polyphenols are actually present in the highest concentration in oral cavity, and it is believed that they may prevent dental caries formation. This effect is based on polyphenols’ antibacterial activity, but it can be also mediated by inhibition of enzymes glucosyltransferase B and C, responsible for the production of insoluble polysaccharides, that can form a plaque and contribute to adherence of oral bacteria to the dental surface.

Divers polyphenols, divers health benefit

  • Coffee (phenolic acids)
  • Tea (condensed tanninGrape (resveratrol)
  • Apple (flavonoid)
  • Berries (anthocyanins)
  • Buckwheat (Rutin, Quercetin)
  • Oat (Avenanthramides)
  • Alfalfa (Apigenin)
  • Beetroot (Betalains)
  • Various herbs

shall i take polyohenols supplement

Polyphenols rich supplemet confer additonal health benefit but high dose cause toxicity. However, the upper limit of plasma concentation of polyphenols before the elobration of advers effect is unkown. Morover, a considerable amount of evidence support the hypothesis that polyphenols can cause advers effect through their pro oxidative action.

Consumption of polyphenols as healthy dietary component is consistent with the advice to eat five or more potions of fruits and vegetable per day, but it is still unclear the exact dose of specific polyphenols that can be safely and beneficiially consumed.

Osteoporosis; the silent disease

20th October is the world osteoporosis, around 3 million people in the UK are affected by osteoporosis and 500,000 people receive hospital treatment for fragility fracture every year. In Europe, the disability due to osteoporosis is greater than that caused by cancer (except lung cancer). BUT what is osteoporosis

Osteoporosis means Porous bone. Bone is a living tissue that is constantly being broken down and replaced, we all have some degree of bone loss as we get older but osteoporosis occurs when this balance is disturbed and either body loses too much bone or makes too little new bones. Bones lost their density and become porous and fragile. Osteoporosis develops slowly over several years

osteoporosis affects women and men of all races but white and Asian women, especially older women who are past menopausal are at high risk.

Symptoms

osteoporosis is silent diseases as symptoms appear very late, often only diagnosed when a fall or sudden impact causes a bone to break.

  • Chronic back pain
  • Loss of height over time
  • Stooped or hunched posture
  • Limited mobility

what are risks

  • GENDER
  • ETHNICITY
  • FAMILY HISTORY
  • AGE
  • MENOPAUSE
  • LOW BODY WEIGHT
  • PREVIOUS FRACTURES
  • MEDICAL CONDITION; Early menopause, thyroid disorders
  • MEDICATIONS; Glucocorticoids, Antacids

HOW TO PREVENT OSTEOPOROSIS

Osteoporosis is preventable by adopting healthy lifestyle guidelines. Nutrition, physical activity, weight, smoking cessation, avoiding heavy alcohol drinking can improve bone health.

Eat well for bone health

  • Well balanced diet consist of all food groups play a critical role in building and maintaining good bone health at every stage of life. There are certain vitamins like vitamin D and K play an important role in preventing osteoporosis. similarly, minerals like calcium, magnesium, phosphorous and copper are important for bone health.
  • Building strong bones begin in childhood and are essential to the prevention of osteoporosis. Good nutrition with plenty of calcium rich food like milk and dairy products or other calcium rich sources helps children to achieve their highest possible peak bone mass.

Recent research has found that olive oil, soybeans, blueberries, and food rich in omega 3 fatty acids are like fish oil, and flax seeds may have bone boosting benefits.

EXERCISE

Regular physical activity like aerobic exercises aimed at 30-45 minutes per day or 150 minutes every week helps in preventing osteoporosis.

Studies show that weight bearing exercises such as weight training, walking, hiking, jogging, climbing stairs and playing tennis over a period of time can improve bone density even build a new bone.

WHAT TO AVOID FOR GOOD BONE HEALTH

There are certain foods that should be consumed in moderation like soda, caffeine, saturated fats, salt and alcohol. They have no direct effect on bone health but they impair calcium absorption and reduce bone density.

smoking and bone health;

several studies found smoking as risk factor for osteoporosis and bone fracture.How smoking affects bone health, still unclear that decrease in bone density is due to smokng itself or to other risk factors common among smokers. For example women who smoke also tend to have early menopause than nono smokers and in many cases people who smoke are less physical active, drink more alcohol and poor diet as compared to non smoker.

Osteoporosis is not an invietable part of ageing; it is preventable.So it is vital that all of us, of all ages, start taking care of our bones now , before it is too late. love your bones protect your fracture

FODMAPs and their link with IBS

FODMAP is not a single entity, but a group of an acronym that stands for fermented, oligo, di, monosaccharides and polyols. FODMAPs are found in a variety of fruits, vegetables, milk and wheat.

HOW FODMAP WORKS;

FODMAP may exacerbate IBS symptoms through a various mechanism such as ;

OSMOTIC OVERLOAD; Poor absorption of FODMAP causes osmotic overload and distention of small intestine and abdominal symptoms.

BACTERIAL FERMENTATION; FODMAPs are rapidly absorbed by colonic bacteria and produce colonic distention due to gas production associated with abdominal pain and bloating.

FODMAPs are not bad for everyone, in normal healthy individuals they have important physiological effects like; they increase stool bulk, enhance calcium absorption and modulate immune function. They selectively stimulate the growth of Bifidobacterium a species of good bacteria.

FODMAPs and the irritable bowel syndrome (IBS)

IBS is a chronic functional disorder of the intestine, the most common symptoms are abdominal pain, bloating and altered bowel movements.The global prevalence of IBS is around 12% and is more common in women.

Treatment of IBS consist of pharmacological and non pharmacological measures. Among the non pharmacological options; stress reduction, dietary modifications ( restriction of certain food (FODMAP) and cognitive behaviour therapy are the most important.

LOW FODMAP DIET

In recent years, there is a growing body of research which support low FODMAP diet for the management of IBS, studies have shown that it can help up to 70-85% of patients with IBS achieve relief of their symptoms. it is now included in NICE guidelines as a second line intervention for IBS.

Following a low fodmap diet may helpful in alleviating symptoms of IBS like

  • Abdominal pain
  • Bloating
  • Altered bowel movement
  • Gas

There is no evidence that low FODMAP diet works for non digestive symptoms that are associated with IBS, such as headache and skin or joint problems.

Phases of low FODMAP diet

It is three phased elimination diet, first phase is the restriction phase in which high FODMAP food should be completely avoided. This phase lasts for 2-6 weeks. Second phase is reintroduction in which food with high FODMAP reintroduced but one at a time. This will enable you to identify which FODMAP you are sensitive too. This stage can take several months to complete and ideally should be completed under the guidance of a dietitian. Personalized stage the third phase is a combination of phase 1 and phase 2 and involves the long term, modified FODMAP diet. For more information regarding a high FODMAP food list https://www.monashfodmap.com/about-fodmap-and-ibs/high-and-low-fodmap-foods/

WHAT IS DOWNSIDES OF LOW FODMAP.

There is short term risk associated with insufficient protein, dietary fibre, B group vitamins and calcium intake.

Low levels of prebiotics;

Prebiotics are indigestible carbohydrates that are resistant to gastric acid and fermented by bacteria present in the large intestine. Prebiotics predominately found in food containing Fructans and Galacto-oligosaccharides.The low FODMAP diet restricts the intake of many high prebiotic (high FODMAP) foods and prolong restriction of high FODMAP can alter gut microbiome diversity. Studies have shown low levels of total bacterial abundance and reduced level of bifidobacterium following a low FODMAP diet. This is why re-introduction phase is very important as it allows you to have more variety in your diet but also maintain a healthy gut.

Calcium in low FODMAP diet;

The restriction of lactose containing dairy products may enhance the tendency to poor calcium availability since these items are primary source of calcium and promoting effect of lactose on calcium absorption is lost.

Lactose or dairy free calcium sources are; Kale, lactose free plant based milk fortified with calcium, hard cheese, firm tofu.

TAKE HOME MESSAGE

Low fodmap diet is considered as a second line treatment option for patients with IBS as recommended by NICE guidelines. This diet should not be used without specialized dietary advice from a registered professional. Vegan or vegetarian are at increased risk of protein deficiency due to limited plant protein sources however well constructed meal plans by registered dietitians may reduce possible nutritional deficiencies.

Non Alcoholic fatty liver disease (NAFLD) and lifestyle interventions

We know that obesity is a risk factor for several non communicable diseases, it can lead to diabetes and other metabolic conditions, but there is less awareness that obesity can lead to serious liver disease.It is estimated up to 1 in every 3 people in the UK has early stages of NAFLD, where there are small amounts of fat in their liver.

Non-alcoholic fatty liver disease is the accumulation of triglycerides in the liver cell and this buildup is independent of alcohol consumption. It is a spectrum of disorder ranging from less severe steatosis (fatty liver) to more severe non-alcoholic steatohepatitis (NASH), where the liver has become inflamed; this is estimated to affect up to 5% of the UK population. Fibrosis and cirrhosis develop at later stages and lead to liver failure and sometimes liver carcinoma.

what causes NAFLD

  • The exact cause of NAFLD remains unclear, however, it is linked with genetic and environmental factors like
  • 1.Obesity
  • 2.Diabetes
  • 3.Hyperlipidemia
  • 4.Women with PCOS5.
  • 5.Sedentary lifestyle

Treatment and prevention

There is no specific pharmacological treatment for NFALD. However, various medicines can be useful in managing the problems associated with the condition like;medications for high cholesterol, high blood pressure and Insulin sanitizers.

Life style modifications;

There is a strong consensus that lifestyle interventions such as diet, physical activity and weight reduction can help in preventing and reduces the progression of the disease. A metanalysis of 23 trials shows that lifestyle modification including weight loss and physically activity consistently reduced liver fat and improved histopathology.

WELL BALANCED DIET; Diet consists of vegetables and fruits with less processed carbohydrates. Low Glycemic index carbohydrates with more fibre content also reduce insulin resistance which is directly linked with NAFLD. Low caloric diet intake ( 3-6 months) either low carbohydrates or low fat diet results in weight loss and improved lipid profile.

Intake of polyunsaturated fats especially omega 3 fatty acids reduces the risk of NAFLD. Mediterianean diet is a best source of mono unsaturated fatty acids( MUFA) like n– oleic acid (olives, nuts, avocado), which play an important role in the metabolic profile of human metabolism. MUFA has been demonstrated a beneficial effect on lipid profile bt decreasing  plasma triacylglycerol and very low density lipoprotein (VLDL) cholesterol concentrations and modestly increasing high density lipoprotein (HDL) cholesterol without adversely affecting low density lipoprotein (LDL) cholesterol concentrations. 

Soft drinks are leading cause of added sugars in the world and different observational studies report a positive association between soft drink consumption and NAFLD. Soft drinks like cola drinks contain caramel coloring, which is rich in advanced glycation end products (AGEs) that may increase insulin resistance and inflammation.

Observational studies have demonstrated a favourable impact of coffee intake on health and in particular a protective effect from the metabolic syndrome. Coffee contain polyphenols chlorogenic acid which acts as antoxidants, anti inflammatory and reduces the risks of developing NAFLD and cardiovascular diseases.

Regular physical activity: There is a dose-response relationship between NAFLD and physical activity (both prevalence and disease severity,  therefore, the more physical activity performed throughout the day, the better! Aim to do at least 150 minutes/week of physical activity like walking or cycling. Increasing daily walking has also been shown to improve fat oxidation and is a way of increasing physical activity levels at no cost and without additional equipment. Aerobic and resistance exercises both improves NAFLD. A systematic review (24 exercise-only studies) revealed that exercise produced a 20–30% relative reduction in hepatic steatosis, independent of weight loss in NAFLD patients.

weight reduction: Based on available data, patients should optimally achieve a 5%-10% weight reduction. A prospective study with 7 years of follow up emphasized that even a modest weight change of 3–5 kg is an independent predictor for the development and remission of NAFLD, regardless of baseline body mass index (BMI).

TAKE-HOME MESSAGE

Lifestyle interventions can be highly effective in treating NAFLD across the disease spectrum and offer a holistic way of managing not only liver health, but also cardiovascular and metabolic health. Patients often feel difficult to achieve and implement these modifications, however with proper and individualized support suffient long term changes can be possible.

always set Smart, Meaurable, Achievable, Relevant, Timely goals

is irritable bowel syndrome lifelong??

Irritable bowel syndrome (IBS) is not as simple as just having an unhappy gut, its not all in our head either. IBS not only manifest as painful gut but it also affects patients confidence, body image and mental health.

Irritable bowel syndrome (IBS) is the most common chronic functional disease of the digestive system. Around 20% of the world population is affected by this order. Women are around 2 to 3 times more likely to be diagnosed with IBS and 4 to 5 times more likely to seek specialty care for it than men.

A variety of gastrointestinal and extraintestinal factors are likely to influence the manifestation of IBS. Dysregulation of the brain-gut axis, gastrointestinal infection, low-grade infiltration and activation of mast cells in the intestinal mucosa with consequent release of bioactive substances, and altered serotonin metabolism are the emerging factors of IBS pathogenesis.

sex hormones like estrogen and progesterone affect motor and sensory function of GIT and triggfer IBS symptoms in women before or during mensturation.

Figure adapted from “THE LANCET gastroenterology and hepatology

SYMPTOMS OF IBS

The most common symptoms of IBS are abdominal pain, bloating, altered bowel movements diarrhea or constipation. Some people may experience both constipationa and diarrhea at different time. IBS is also associated with psychological disorders like anxiety and depression, gastroesophageal reflux and genitourinary infections. women with IBS may be at risk of developing endometriosis or having a hystercetomy.

TREATMENT

Only symptomatic treatment is available for IBS, the choice of drug treatment depends on the nature and severity of the symptoms. Many drug treatment options for IBS are available over-the-counter. According to NICE guidelines, Antispasmodic drugs (such as alverine citratemebeverine hydrochloride and peppermint oil) can be taken in addition to dietary and lifestyle changes. A laxative (excluding lactulose as it may cause bloating) can be used to treat constipation.

Antidepressants like amitriptyline and citalopram can be used as a second line of treatment  in patients who have not responded to antispasmodics, anti-motility drugs, or laxatives. A selective serotonin reuptake inhibitor may be considered in those who do not respond to a tricyclic antidepressant [unlicensed indication]

LIFESTYLE INTERVENTIONS

DIET

Diet plays an important role in IBS management as it controls symptoms, but it does not necessarily target the underlying cause. so if you eliminate the foods that trigger your symptoms it improves your IBS symptoms but, when trigger foods are reintroduced, often symptoms also return. In IBS management, the way you eat and what you eat both have an important impact on gut symptoms.

  • Reduce caffiene intake;limit tea and coffee to not more than three cups a day.
  • limit alcohol and fizzy drinks
  • Reduce intake of resistant starch, fatty foods
  • Drink plenty of water
  • Try Probiotics;Yoghurt and some drinkss and supplemets such as tablets, capsules or sachets.

Fibre in IBS; Fibre is double edge sword in IBS as for some it is a blessing and for other IBS patients, it can worsen their symptoms. When considering fibre, it is important to look at both the quantity and the type of fibre (insoluble or soluble), as too little or too much fibre can trigger IBS symptoms.

Quality of fibre also matters. soluble fibre and insoluble fibre behave very differently when they reach the digestive system. If an increase in dietary fibre is required always to prefer soluble fibre as they dissolve in water and remove excess fluid and that how they are good in IBS with diarrhea.

 Intake of insoluble fibre (e.g. bran) and ‘resistant starch’ should be reduced or discouraged as they may exacerbate symptoms.

  • Psyllium; It is a unique soluble fibre that has a dual function, it softens the hard stools and also helps in IBS with diarrhea by thickening up loose stool.it may also improve bloating and incomplete evacuation.
  • Flaxseed; Flaxseed is good for IBS with constipation. aways start with low quantity like half tablespoon (6g) per day and then gradually increase up to 2 tablespoons. The seeds are either swallowed whole with water or soft food such as yogurt, or they are ground up and sprinkled on food
  • Peppermint oil /tea; There is a growing body of evidence that supports the efficacy of peppermint oil in IBS. It is a natural solution for IBS with minimal side effects. Peppermint oil is antispasmodic and relax intense intestine and reduce abdominal pain.

FODMAP

There is a group of carbohydrates found in different foods which causes IBS symptoms as they are poorly absorbed in the small intestine. FODMAP is a term used for these foods. f=fermented,o=oligosaccharide,d= disaccharides, m=monosacchrides,p= polyols. these are present in the stonefruits, legumes, lactose-containing foods, and artificial sweeteners might exacerbate symptoms in a subgroup of patients due to their fermentation and osmotic
effects.

  • BACTERIAL FERMENTATION; Gut bacteria in the large intestine ferment this indigestible fodmap and gives off-gas. This gas distends the stomach, causing bloating, wind, constipation and explosive stool.
  • OSMOTIC OVERLOAD; FODMAP can draw water in from the body into the small bowel and increasing the pressure over the intestinal wall causing diarrhea or some experience hard stool followed by watery stools.

Low FODMAP diet ; Low fodmap diet is a sceond line approach for IBS patients. It improves IBS symptoms in around 70% of patients however, this diet is not for a lifetime and should be introduced under the supervision of qualified professionals. For more about low fodmap diet, which food are included, phases of this diet, visit this website. https://www.monashfodmap.com/

NON DIET APRROACH

Move YOUR BODY;

Physical activities boost mood and also good for the gut muscles. Low-intensity exercises like walking, swimming, cycling, light jogging can help reduce stress and control IBS symptoms.

STRESS MANAGEMENT

IBS is considered a disorder of gut and brain and any kind of stress, physical or psychological have a direct effect on the symptoms of IBS as evident by data. Relaxation and other stress-reduction techniques could bring a sense of wellbeing and have an impact on the severity of IBS symptoms.

COGNITIVE BEHAVIOURAL THERAPY (CBT); There is increasing evidence for the efficacy of CBT in alleviating the physical and psychological symptoms of IBS.

SLEEP HYGIENE;

Sleep disturbance is very common among IBS patients. studies show positive association between sleep deprivation and worse gut symptoms. Poor bad night sleep results in bad IBS day symptoms. Sleep quality and duration equally important, but one in three adult do not get quality sleep.

take home message;

IBS is a chronic disorder ofthe digestive system but for the majority of patient, it is frustrating and its effect on the quality of life make it a disease with high cost. Current medical tratment for IBS, only targets the symptoms of this disorder. IBS can be managed by identifying what triggers the symptoms, which food is good for IBS. Non diet approach like physical activity, relaxing tecniques all show promising results in alleviating IBS sypmtoms.IBS symptoms varies from person to person so personalized interventions are important.

The shoe that fits one person pinches another; there is no recepie for living that suits all

Iodine;an overlooked micronutrient

Iodine, one of the most important micronutrient required at all stages of life. Iodine is essential for the synthesis of Thyroid hormone, triidothyronine (T3 )and thyroxine (T4) which regulates body metabolism. Thyroid hormones receptors are presents in almost every cell of the body, so they are important regulators of many physiological processes includes brain development, growth, metabolism and cardiac function. Iodine plays a vital role in brain development during early pregnacy till childhood. Many brain structures and systems appear to be affected with iodine deficiency, including areas such as the hippocampus, microstructures such as myelin, and neurotransmitters.

25 -30mg of iodine present in a healthy body, 80% of which is stored in the thyroid gland. The non hormonal iodine is found in a variety of body tissues including mammary glands, eye, gastric mucosa, cervix and salivary glands.

How much Iodine Do we Need

In the UK, the recommended daily intake of iodine for a healthy adult (male and female) is140 microgram and there is no specific recommendation for pregnant and breastfeeding women. As during pregnancy, iodine requirement increases so the British Dietetic Association (BDA) suggested 200 microgramm of iodine per day for pregnant and breastfeeding women.

dietary sources of iodine

Milk and dairy products fish and eggs are a major source of iodine. In the UK, milk and dairy products provide as much as 34% of iodine intake. Fortified milk is recommended for those who are using non dairy milk alternative. however, a study conducted by the University of surry revealed that only a few plant based milk brands in UK are fortified with iodine.

Fruits and vegetables also contain iodine but the amount varies depending on the iodine content of the soil, fertilizers use up and irrigation practice. The table below produced by BDA shows the iodine content of food in the UK.

Some vegetables impair absorption of iodine like cruciferous vegetables (broccoli, cauliflower, cabbage and soya) and cause swelling of the thyroid gland (goitre) due to low levels of thyroid hormones. However, normal consumption of cruciferous vegetable does not appear to increase the risk of hypothyroidism unless accompanied by iodine deficiency. 

iodine deficiency

  • Pregnant and lactating women; The iodine requirement in pregnant women is 50% higher as compared to non preganant women as; maternal iodine production increases by 50% in eraly pregnancy.At this stage fetal thyroid is not fully active so, additional iodine is rquired for fetus toproduce its own thyroid hormones.
  • vegetarian /vegans
  • People with food allergies; milk or fish allergies
  • Lactose intolerance

Globally, iodine deficiency is a serious public health issue and it is estimated that around 2 billion people all over the world are iodine deficient. iodine deficiency leads to hypothyroidism which causes impair neurodevelopment in early childhood.

It is claimed by WHO that iodine deficiency is the most significant preventable cause of brain damage and mental retardation. Severe iodine deficiency during pregnancy causes Endemic cretenism( congenital hypothyroidism) in the newborn which is marked by gross mental retardation, deaf mutism, short stature.

iodine deficiency causes a spectrum of disorders in different age groups collectively known as iodine deficiency disorders ( DIDs). The effects of IDD in humans at different stages of life are presented in the following pyramid.

Iodine deficiency can be corrected by adding iodine to dietary media like salt, oil, water, sauces etc. The methods of proven value for mass use are iodized salt and iodized oil. To this end, fortification of salt with iodine has been identified and considered to be the most suitable method of fortification.

universal iodized salt is recommended intervention by WHO for iodine deficiency however, in the UK there is no iodized fortification program and most sale salts are not fortified. it is better to meet iodine requirement through diet.

TAKE HOME MESSAGE;

Iodine is essential for thyroid hormone production and its deficiency may impair body metabolism and brain development.

The best way to meet your daily iodine requirement is eating a healthy well balanced diet. People with different dietary choices like vegan and vegetraian are increased risk of developing iodine deficiency.

vegans should check their iodine levels and in case of iodine deficiency, consume iodine supplements but always consult GP, dietitian or nutritionist before using iodine supplements.

Strong evidence is still needed to conclude the efficacy of iodine supplementation in mild to moderate iodine deficient women on the cognitive function of their children.

Avoid seaweed based supplements as they may cause iodine intoxication.