Origins and evolution of the Western diet: health implications for the 21st century

ABSTRACT

There is growing awareness that the profound changes in the envi- ronment (eg, in diet and other lifestyle conditions) that began with the introduction of agriculture and animal husbandry 􏰂10 000 y ago occurred too recently on an evolutionary time scale for the human genome to adjust. In conjunction with this discordance between our ancient, genetically determined biology and the nutritional, cultural, and activity patterns of contemporary Western populations, many of the so-called diseases of civilization have emerged. In particular, food staples and food-processing procedures introduced during the Neolithic and Industrial Periods have fundamentally altered 7 cru- cial nutritional characteristics of ancestral hominin diets: 1) glyce- mic load, 2) fatty acid composition, 3) macronutrient composition, 4) micronutrient density, 5) acid-base balance, 6) sodium-potassium ratio, and 7) fiber content. The evolutionary collision of our ancient genome with the nutritional qualities of recently introduced foods may underlie many of the chronic diseases of Western civilization. Am J Clin Nutr 2005;81:341–54.

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How To: Keep Healthy with Diabetes

This section is for everyone.



Overview

Meal Planning

Self-monitoring of Blood Glucose

Use of Insulin and Diabetes Medications

Foot Care

Urine Testing for Ketones

Annual Health Checks

You need to be confident about…

 

Overview

The Joslin Diabetes Centre have a check list so you can see what sort of things you need to know to look after yourself with diabetes. This list covers type one and type two diabetes. For each heading I will list what we have already covered on this course and what we will be covering in more depth in the Type One Section *

There is a considerable overlap between both types of diabetes. To start with most people with insulin dependent diabetes diagnosed in childhood or young adulthood are  not overweight or insulin resistant. As time goes on this may change so Type Ones would benefit from reading the earlier sections to see if any of it applies to them. The majority of the carb counting methods have also already been covered in the Metabolic and Type 2 section.

For type twos who start off on diet or oral medications they may find that after  a while this is no longer sufficient to maintain normal blood sugars. You may benefit by reading on to find out how to deal with insulin now or in the future.

If you don’t feel really confident about any of the things I have listed please take advantage of some of the books and internet resources in the help sections. It is important that you know what to do ahead of any emergency developing so please contact your diabetes support team for further personal training.

 

MEAL PLANNING

Your own meal plan
know how carbs, proteins* and fats affect the body
special foods and occasions
dining out
portion control
label reading
how to fit in treats*
alcohol*

 

SELF MONITORING OF BLOOD SUGAR

blood glucose goals
how to use the meter
monitoring schedule*
storing supplies*
interpreting blood glucose values and making decisions in diabetes treatment plan*

USE OF INSULIN AND DIABETES MEDICATIONS

Action and side effects of medication*
timing and schedule*
insulin injection techniques*
storage, refrigeration and disposal of supplies*
what to do if you miss a dose*

EXERCISE

What type, how long, how hard, how often and when.*
snacking adjustments*
preventing high and low blood sugars*

KNOWLEDGE OF HIGH AND LOW BLOOD GLUCOSE

Factors that cause high and low blood glucose*
symptoms*
how to treat*
when to call a healthcare provider*
how to prevent*

FOOT CARE

daily foot care*
emergency treatment for cuts, sores and abrasions.
how to do a proper foot exam*
proper footwear

URINE TESTING FOR KETONES

When and how to check for ketones*
What ketones mean*
When to call a doctor*

YOUR HEALTH TEAM WILL DO THESE ANNUAL CHECKS AND TESTS

A1C ( 2-4 times a year)*
kidney function*
cholesterol, ldl, hdl, triglycerides*
foot exam*
eye exam*
blood pressure*
general health check eg thyroid, tests for coeliac disease and anything relevant to you*

YOU NEED TO BE VERY CONFIDENT ABOUT…

Your own meal plan
The medication you are taking
Your glucose monitoring system
The treatment of high and low blood sugars
How to manage your sick days
Your risk factors for developing other health problems
Your foot care

 


Quick Quiz:
1. A test type twos should have done every six months is…
a Liver function and creatine kinase.
b Hbaic.
c Fasting lipids.
d Sex hormone binding globulin.

Have you got it?
1. You must have your hbaic checked every 3-6 months. If statins are being taken, fasting blood lipids, liver and creatine kinase levels may be taken episodically.

Where to Next?
Please all proceed to the How To: Safely Dispose of Needles and Other Sharps section.

 

How To: Keep Healthy with Type 1 Diabetes

This section is for everyone – who is still here!


DIAGNOSIS of TYPE ONE DIABETES

For most children or young people they will find out very quickly after diagnosis that they will need to be on injected insulin for life. Perhaps they will have had symptoms of weight loss, drinking a lot and passing urine a lot.  Others will have become very ill with diabetic ketoacidosis and will have been hospitalised.

More and more often younger people are being diagnosed with metabolic syndrome and type 2 diabetes. This is usually related to being overweight, sedentary and genetic influences.  Women with type 2, gestational or type one diabetes may find themselves being intensively treated with insulin during the planning or carriage of a pregnancy. Outwith pregnancy most people with type 2 diabetes will remain on diet and oral medications to control their diabetes. After about six years around half  of type 2 diabetics will have needed to add insulin to their medication regimes to maintain good control. Diabetics who use certain drugs to stimulate the pancreas to produce more endogenous insulin from their own pancreatic beta cells are more at risk of beta cell failure.

Type one diabetes results when the pancreas can no longer make enough insulin to prevent high blood sugars.  For early onset patients it is an autoimmune disease that used to be a death sentence.  Now that insulin is widely available for most people it is rarely as rapidly fatal. But until a real cure can be found and made available it can still feel like a life sentence.

Insulin is a drug that needs to be used very carefully.  It can rapidly lower blood sugars and cause hypoglycaemia which can cause death if it is very severe and is untreated. Lower levels of hypoglycaemia may not be obvious to drivers or their passengers and yet can cause impaired reaction times and judgement which can lead to accidents.  High blood sugars are less of a worry on the short term but on the long term damage accumulates that can severely affect the nerves, eyes, kidneys and heart.

Pancreatic beta cells start to die in tissue culture at sugar levels of 6.1 or higher. This is not a threshold effect and if blood sugar levels are brought below this level soon enough the cells can start to recover.

At the time of diagnosis and for up to decades afterwards type one diabetics still produce a small amount of insulin. The remaining beta cells are still subject to attack by autoimmune antibodies but can be nursed along for many years if high blood sugars can be avoided.

The more of your own pancreatic beta cells that are still active the easier it is to control your diabetes as the pancreas can still fine control sugar levels in a way that injections cannot. This is a major reason for all new diabetics to strive for normal blood sugars so they can prolong the “honeymoon” phase of diabetes.

Even the most rapidly effective injected insulins eg novorapid and humalog cannot replicate the immediately effective blood sugar lowering effect of the stored insulin from a normal pancreas beta cells. This means that blood sugars will be inappropriately high for at least some time after even small amounts of very fast releasing carbohydrates are eaten in eg bread or fruit. Over the long term these sugar spikes can add up to a lot of damage to body tissues.

We have already discussed what level of control you already have and what level of control may be optimal for certain groups of people in the Type Two Section. Please take a moment or two to review this.

This Type One section aims to give you more specific information on the use of insulin and other information to help you achieve the best health you can.


The insulin users section tends to lean heavily towards younger type ones. I will give some guidance about when older type twos can skip.

Quick Quiz:
1. For insulin users it is safe to go straight onto a low carb diet as long as you have…
a Thrown out all your crisps, breakfast cereals and biscuits.
b Bought a good low carb book to help you.
c Bought in plenty of meat, vegetables and olive oil.
d Planned out a gradual reduction of carbohydrates and appropriate reduction in your insulin.

2. Type One diabetics…
a Make plenty of their own insulin from beta cells in the pancreas.
b Can be sure there will be a cure within the next five years.
c Rely on carefully measured and timed amounts of injected insulin to keep well.
d Can eat whatever they like, when they like.

3. You are an insulin user going into hospital for a planned operation. You need to do three of these….
a Speak to an anaesthetist well before your operation to let them know how you manage your blood sugars.
b Speak to the dietician about your meal choices from the Healthy Diabetic section of the menu.
c Bring in your insulins, testing kit and any special foods or drinks you may need.
d Arrange for a friend to provide, transport, supplies and to liase with clinical staff.

4.Type ones can do three of these things…
a Get other autoimmune diseases.
b On first diagnosis go through a honeymoon period when pancreatic function improves for a period of time.
c Use inhaled insulin to control blood sugars.
d Die rapidly from severe hypoglycaemia.

5. Tests type ones should be having regularly include three of these…
a Amylase which is raised in pancreatitis.
b Thyroid function tests.
c Tissue transglutamase for coeliac disease.
d Albumin creatinine ratio which is a kidney test.

Have you got it?

1. D is correct. You MUST plan and change your diet and insulin doses GRADUALLY. This means more freqent blood sugar testing till you are stable on your new regime.

2. C is correct. If only we could be certain of a widely available and affordable cure within the next five years then we possibly could eat what we want, when we want without paying too much for the consequences. Unfortunately for the forseeable future most certainly DO have to live with the consequences so the tighter the control the better for most diabetics.

3. You need to do ACD. You don’t need to speak to the dietician. You decide yourself from the entire menu.

4. ABD are correct. Inhaled insulin is available now. It comes in 3 unit increments though and this is likely to make it less precise than is required for really tight blood sugar control for type ones. It may have a place for type twos who are still producing some of their own insulin.

5. Tests type ones should be having regularly include three of these…

Thyroid tests, coeliac tests, and kidney tests are all needed. Blood pressure, eye examination or retinal photography and foot examinations are other necessary tests.

Reference Info:

Where to Next?
Please proceed to the section How To: Deal with the Stress of a Newly Diagnosed Child section.

The Cure for Diabetes | Men’s Health

It’s a wonder no one has tried to have Mary Vernon’s medical license revoked. Since 1999, the 52-year-old family doctor has been treating diabetic patients in Lawrence, Kansas, with an approach that was abandoned by most physicians in the 1930s. Worse, this Depression-era remedy is the opposite of the current guidelines established by the American Diabetes Association, a nonprofit organization that spent nearly $51 million on research in 2005, and so should know a thing or two about how to handle diabetes.

Source: The Cure for Diabetes | Men’s Health