Understanding and adhering to your diabetes management plan can help stabilise your blood sugar as well as regulate your mood.

KEY HIGHLIGHTS

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Giloy has recently been in the news for COVID-19 immunity, and pose-COVID care. However, very few people are aware that the herb can also help in the management of COVID-19.

KEY HIGHLIGHTS

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Individuals with pre-existing conditions, such as type 2 diabetes, have a demonstrated higher risk for developing more severe cases of coronavirus disease 2019 (COVID-19) infection, leading to higher morbidity and mortality. A new study sheds light on improving outcomes for patients with type 2 diabetes who are infected with the virus, suggesting that a focus on blood glucose (BG) control may be key. 

For the study, which was published in Cell Metabolism, investigators performed a retrospective, multi-centered analysis of 7337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing type 2 diabetes.

The results showed that patients with type 2 diabetes required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than those without diabetes. Patients with diabetes registered a higher need for antibiotics, antifungal drugs, systemic corticosteroids, immunoglobin, anti-hypertensive drugs, and even vasoactive drugs, according to the data. Oxygen inhalation, noninvasive ventilation, and invasive ventilation was also more common in those with type 2 diabetes compared with those without.

However, the study showed that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared with individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization.

Patients from the well-controlled BR group also received less medical interventions, such as supplemental oxygen and/or ventilation, and had significantly lower incidences of lymphopenia, lower rates of increase counts of leukocyte and neutrophil, and elevated serum CRP and procalcitonin.

“We were surprised to see such favorable outcomes in well-controlled blood glucose group among patients with COVID-19 and pre-existing type 2 diabetes,” senior author Hongliang Li of Renmin Hospital of Wuhan University, said in a press release. “Considering that people with diabetes had much higher risk for death and various complications, and there are no specific drugs for COVID-19, our findings indicate that controlling blood glucose well may act as an effective auxiliary approach to improve the prognosis of patients with COVID-19 and pre-existing diabetes.”

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WASHINGTON: A ketogenic diet — which provides 99 per cent of calories from fat and protein — may produce health benefits in the short term, but negative effects after about a week, according to a study conducted in mice.

The study, published in the journal Nature Metabolism, suggests that the keto diet could, over limited time periods, improve human health by lowering diabetes risk and inflammation.

The keto diet has become increasingly popular as celebrities, including Gwyneth Paltrow, and Kim Kardashian, have touted it as a weight-loss regimen, the researchers noted.

The diet tricks the body into burning fat, said lead author Vishwa Deep Dixit from the Yale University in the US.

When the body’s glucose level is reduced due to the diet’s low carbohydrate content, the body acts as if it is in a starvation state — although it is not — and begins burning fats instead of carbohydrates.

This process in turn yields chemicals called ketone bodies as an alternative source of fuel.

When the body burns ketone bodies, tissue-protective gamma delta T-cells expand throughout the body.

This reduces diabetes risk and inflammation, and improves the body’s metabolism, said Dixit.

After a week on the keto diet, mice show a reduction in blood sugar levels and inflammation, he said.

However, when the body is in this “starving-not-starving” mode, fat storage is also happening simultaneously with fat breakdown, the researchers said.

When mice continue to eat the high-fat, low-carb diet beyond one week, they consume more fat than they can burn, and develop diabetes and obesity, the researchers said.

“They lose the protective gamma delta T-cells in the fat,” Dixit said.

Long-term clinical studies in humans are still necessary to validate the anecdotal claims of keto’s health benefits, the researchers noted.

“Before such a diet can be prescribed, a large clinical trial in controlled conditions is necessary to understand the mechanism behind metabolic and immunological benefits or any potential harm to individuals who are overweight and pre-diabetic,” Dixit said.

“Obesity and type 2 diabetes are lifestyle diseases. Diet allows people a way to be in control,” he said.

With the latest findings, researchers now better understand the mechanisms at work in bodies sustained on the keto diet, and why the diet may bring health benefits over limited time periods.

“Our findings highlight the interplay between metabolism and the immune system, and how it coordinates maintenance of healthy tissue function,” said Emily Goldberg, a postdoctoral fellow at Yale.

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Arecent survey of registered dietitians named the low-carbohydrate keto diet yet again as the most popular diet in the US. Powering this diet is fat, and loads of it — up to a hefty 90 per cent of one’s daily calories.

Its fans feed social media with before and after photos, crediting the diet for life-altering weight loss or other effects. They swirl butter into their coffee, load up on cheese and eat lonely burgers without its bestie, the bun.

The diet is hailed for dropping pounds, burning more calories, reducing hunger, managing diabetes, treating drug resistant epilepsy, improving blood pressure and cholesterol, as well as triglycerides, the major storage form of fat in the body. People have reported improved concentration, too.

What is a keto diet?

A “typical” ketogenic diet consists of at least 70 per cent of calories derived from fat, less than 10 per cent from carbs and less than 20 per cent from protein. That can mean chowing down on a lot of cheese, butter, eggs, nuts, salmon, bacon, olive oil, and non-starchy vegetables such as broccoli, cauliflower, greens and spinach. The keto diet is vastly different from the USDA dietary recommendations of 45 to 65 per cent of total calories to be from carbohydrates, 20 to 35 per cent from fat, and 10 to 35 per cent from protein.

The goal of the ketogenic diet is to enter a state of ketosis through fat metabolism. In a ketogenic state, the body uses primarily fat for energy instead of carbohydrates; with low levels of carbohydrate, fats can be converted into ketones to fuel the body.

For ketosis, a typical adult must consume less than 20 to 50 grams of net carbohydrates — total carbs minus fibre — each day. Crossing that threshold is easy: a thick slice of bread adds 21 carbohydrates, a medium apple 25, and a cup of milk 12. It’s not just bread and soda that are on the outs but high sugar fruit and starchy veggies like potatoes, as well as too much protein.

There are many ways to interpret the keto diet. Some people eat a salad with chicken, dressed in olive oil, while others feast on bacon washed down by diet soda, the kind of diet known as “dirty keto”. That’s eating anything, including processed foods, as long as your carbs are low enough and your fat high enough to achieve ketosis. The best diet is one that works for you, but if you want to try this, avoid trans fats such as margarine and limit saturated fat by consuming lean cuts of beef, skinless chicken breast and fatty fish like salmon. Reach for foods high in unsaturated fats such as avocado, nuts, seeds and olive oil.

Christopher Gardner, the lead author and a professor of medicine and nutrition scientist at Stanford Prevention Research Center, US, also says he sees one common misconception about keto: eating too much protein. Most amino acids in protein foods can be converted into glucose in the body, undermining efforts to keep carb intake low. “It drives me nuts that people don’t get it,” he said when he sees people eat, for instance, steak after steak.

Can I lose weight on it?

For the first two to six months, there’s evidence that a very low carbohydrate diet can help you lose more weight than the standard high carbohydrate, low fat diet, according to a new literature review of low-carb diets by the National Lipid Association.

“By 12 months, that advantage is essentially gone,” said Carol F. Kirkpatrick, director of US’s Idaho State University’s Wellness Center, and lead author of the new literature review. She said keto is best used to kick start a diet, before transitioning to a carb intake that you can adhere to for the longer term.

How long to see results?

For some, it’s the promised land of diets. Instead of cringing through carrot sticks, they can fill up on chorizo with scrambled eggs. Indeed, some evidence suggests that people feel less hungry while in ketosis, and have fewer cravings.

“That’s why it’s become so popular for the general population,” said Dr Mackenzie C. Cervenka, medical director of Johns Hopkins Hospital’s Adult Epilepsy Diet Center in the US. “Because once you are in ketosis, it’s easy to follow.” Usually, it takes between one to four days to enter the state, doctors say, but it depends on many factors like activity level: a runner, for example, may sprint there faster than a couch potato.

The keto diet appears to deliver fast results: The first pounds seem to slip off. That can be seductive but it’s likely water weight. Then, dietitians say, it’s back to energy in minus energy out. You can gain weight on any diet if you’re consuming 5,000 calories a day, according to Whitney Linsenmeyer, director of Saint Louis University’s Didactic Program in Dietetics.

“It’s not like it is going to magically alter your metabolism to where calories don’t matter,” she said. And when resuming the carbs, that water weight returns.

Does it help with diabetes?

Yes. “Carbohydrate is the biggest driver of blood sugar,” said Dr William Yancy, director of the Duke Diet and Fitness Center, who sees a lot of promise in the diet helping those with diabetes.

A new randomised clinical trial enrolled 263 adults with type 2 diabetes into group medical visits, with half receiving medication adjustment for better blood sugar control, and the others undergoing weight management counselling using a low carb diet. (All participants of the study had a BMI that fell within the range of overweight or obese.)

Both groups experienced lowered average blood sugar levels at the end of 48 weeks, according to findings in the Journal of the American Medical Association Internal Medicine. However, the weight management group on the low carb diet slimmed down more, required less medication and had fewer problematic low blood sugar episodes.

For those with type 2 diabetes, a low carb diet seems to improve average blood sugar levels better in the first year than the high carbohydrate, low fat diet. After that time, the review by the US National Lipid Association found that difference almost disappears — but with a very important benefit: the low carb participants were able to use less medication. “People like that because they don’t like to be on diabetes medicines,” Dr Yancy said.

Are there side effects?

At first some can experience some stomach issues and GI distress. “Ninety percent of calories from fat is probably going to be a shock to the system,” said Linsenmeyer.

It’s crucial, doctors say, to consult with a dietitian or physician, have cholesterol levels checked, and replenish the fluids and sodium lost by increased urination and the severe restriction of carbohydrates. If not, within two to four days of beginning the diet, that depletion may bring on “keto flu” — dizziness, poor sleep and fatigue.

“Carbohydrates have a lot of nutrients that can help us maintain our body function,” said Carla Prado, director of the University of Alberta’s Human Nutrition Research Unit, US. Some people experience “keto breath”, a halitosis likely caused by the production of acetone, one of the ketone bodies.

Possible side effects for patients with epilepsy starting the diet include constipation, vomiting, fatigue, hypoglycemia, worsening reflux and increased frequency of seizures. The US National Lipid Association review urges patients with lipid disorders (high cholesterol or triglycerides), a history of atherosclerotic cardiovascular disease (such as a heart attack or stroke), heart failure and kidney and liver disease to take caution if considering the diet. People on blood thinners should take extra care.

Whichever eating plan one chooses for 2020, certain recommendations are nearly universal: cut down on refined carbs and ultra-processed foods, and consume more whole foods, particularly non-starchy vegetables, such as broccoli, asparagus, and spinach.

“The ‘optimal diet’ lies somewhere between what has been proposed historically — the high carbohydrate, low fat diet — and the ketogenic diet,” said Dr Cervenka.

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Blood sugar control is one of the most important aspects of keeping diabetes under control. With more people with diabetes and pre-diabetes looking for strategies to help control blood sugar, new study suggests that ketone monoester drinks–a new food supplement–may help to do it.

“There is mounting evidence that a low carbohydrate ketogenic diet is very effective in controlling blood sugar and even reversing Type 2 diabetes,” said study lead author Jonathan Little, Associate Professor at University of British Columbia in Canada.

“We wanted to know what would happen if artificial ketones were given to those with obesity and at risk for Type 2 diabetes but who haven’t been dieting,” Little added.

Type 2 diabetes is a disease in which the body is unable to control blood sugar levels because of defects in functioning of a hormone called insulin.

“While Type 2 diabetes can be controlled with medications or injectable insulin, many people are looking to options that don’t require taking pills every day or that are less invasive,” he added.

According to the study published in the American Journal of Clinical Nutrition, Ketone supplements are proving fertile ground for research into Type 2 diabetes because ketones are the natural fuel source of the body when it’s in ketosis–the metabolic by-product of consuming a low carbohydrate, ketogenic diet.

To test the idea, the research team asked 15 people to consume a ketone drink after fasting overnight. After 30 minutes, they were then asked to drink a fluid containing 75 grams of sugar while blood samples were taken. “It turns out that the ketone drink seemed to launch participants into a sort of pseudo-ketogenic state where they were better able to control their blood sugar levels with no changes to their insulin,” Little explained.

“It demonstrates that these supplements may have real potential as a valuable tool for those with Type 2 diabetes,” he said.

“There are a number of problems that we still have to work out, including the fact that we still don’t know what the long-term effects of consuming ketones are,” he added.

“But for those that aren’t able to follow a strict and challenging ketogenic diet or for those that are looking for a new way to control blood sugars, this may be another strategy in helping to manage Type 2 diabetes,” Little concluded.

Other tips to keep diabetes under control

Diabetes management requires changes in lifestyle, timely intake of medicines and regular monitoring of blood sugar levels. Here are some effective ways to keep diabetes under control:

1. Keep your weight under control: Being overweight can be bad for management diabetes. Losing weight and maintaining a healthy weight can help in glucose tolerance and enable the body to use insulin in a better, more efficient way.
2. Quit smoking and alcohol: Diabetics need to stay way from sedentary lifestyle habits like drinking alcohol and smoking. Alcohol and smoking can together worsen diabetes.
3. Take less stress: Stress can increase your blood sugar levels. Stress management is an important part of controlling diabetes on a daily basis. Deep breathing, gardening, meditating, indulging in activities of your choice and listening to good music can help in reducing your stress.
4. Take care of your diet: Diet plays an important role in management of diabetes. Diabetics need to avoid high-carb, starchy foods and sugary foods as they result in rapid spike in blood sugar. High fibre foods like fresh fruits and vegetables, nuts and seeds, leafy green vegetables, fatty fish, cinnamon and turmeric amongst others are considered to be foods good for diabetics.
5. Stay physically active and exercise regularly: Regular exercise can help you lose weight, lower blood sugar levels and improve insulin sensitivity. Strength training is specifically important for people with diabetes as it improves body’s response to insulin and the way it uses blood sugar. 

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Ditching carbohydrates and eating lots of fat may give some protection against the flu. Feeding mice the so-called keto diet seems to boost certain immune cells, which may be responsible for the effect.

The keto diet forces the body to burn fat for energy, which can help with weight loss, and people may get flu-like symptoms known as the “keto flu” as their body adapts to so little carbohydrate. The keto diet has also been linked to improved heart health and control of blood sugar in diabetes, but much of the evidence is conflicting.

Akiko Iwasaki at Yale School of Medicine and colleagues previously found that the keto diet reduced inflammation in mice with gout. Because inflammation is common to both gout and flu, the team thought the keto diet could similarly deal with flu-related inflammation, which can severely damage the lungs.

To put this theory to the test, the team fed mice infected with influenza A – the most serious type of the virus – either a keto or standard diet for a week before infection. After four days, all seven of the mice fed a standard diet succumbed to the infection, compared to only five out of the 10 mice on the keto diet. These keto diet mice also didn’t lose as much weight, which is usually a clear sign of flu infection in animals.

The team found that the keto diet amped up the numbers of a specific type of T cell – key players in the body’s immune response – found in the lungs. Boosting these T cells dampened the sensitivity of cells lining the lungs to infection and increased mucus production.

It seems that this extra mucus is important for protecting the mice, says Iwasaki, because it traps the flu virus to stop it spreading. It still isn’t clear what these T cells do outside of this study though, she says.

Although mouse and human metabolisms differ, the finding could mean that people get a similar protection from influenza when on the keto diet.

“We already knew of a link between diet and immunity,” says John Tregoning at Imperial College London, who wasn’t involved in the work. Eating foods rich in vitamin C, for example, is known to strengthen our immune system. Switching to a keto diet may help boost the immune system so that it is better programmed to fight off the infection, says Tregoning.

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Childhood obesity is a complex health issue and its leads to several critical health problems. Children with obesity face four times the risk of developing type 2 diabetes compared to children with normal weight. Other Obesity-related health risks include metabolic syndrome, hypertension, coronary heart disease, bone problems, deranged lipid profile and obstructive sleep apnoea. Obesity has its adverse effects on health as well as the psychology of children. Moreover, it has certain long- term health effects.

Childhood Obesity: The Current Scenario

Children and adolescents who are obese in their childhood are most likely to be obese as adults. As in India, it is one of the fastest growing problems; prevention for it must be taken before hand for the children. The causes of excess weight gain in children are similar to those in adults, including factors such as a person’s behaviour and genetic makeup. Childhood obesity is a condition in which a child is significantly overweight for his or her age and height.

According to the Indian Journal of Endocrinology and Metabolism, nearly 20 % school children in India are obese. Methods to determine body fat directly are difficult. the diagnosis of obesity is often based on BMI. For children and adolescents, overweight and obesity are defined using age and sex specific normograms for body mass index (BMI). Children with BMI equal to or exceeding the age-gender-specific 95th percentile are defined obese.

In 2016, World Health Organisation’s (WHO) commission termed childhood obesity ‘an exploding nightmare’ as it finds 41 million under-fives overweight or obese. Many children are growing up in environments encouraging weight gain and obesity. According to the WHO Commission, the number of children under five who are overweight or obese has risen to 41 million, from 31 million in 1990. The statistics mean that 6.1% of under-fives were overweight or obese in 2014, compared with 4.8% in 1990. The number of overweight children in lower middle-income countries like India more than doubled over the same period, from 7.5 million to 15.5 million. Nearly 48% of all overweight and obese children aged under five lived in Asia, and 25% in Africa.

Obesity And Type 2 Diabetes In Children

There is an alarming rate of increase in the incidence of type 2 diabetes among children with obesity and those with a family history of the condition. Lower income and ethnic minority status are associated with both obesity and type 2 diabetes in children.

Children with type 2 diabetes do not achieve optimal glycaemic control, and are at high risk for later health complications. Obesity and type 2 diabetes represent significant public health issues. They impose a heavy burden on society because the condition is common and costly to treat. Studies indicate that children with type 2 diabetes are prone to develop serious diabetes-related health complications relatively early in adulthood, contributing to decreased life expectancy.

It is clearly recognized that type 2 diabetes is a progressive disease and the duration of the disease predicts complications and mortality. As such, it is reasonable to conclude that children with type 2 diabetes may be facing a grim future unless they seek comprehensive treatment for diabetes and obesity. Preventing our children and youth from getting diabetes and treating it aggressively once diagnosed should be a public health priority.

Screening Is Important

Overweight children who have a body weight greater than 120% of the ideal for height, and anyone who has family history of type 2 diabetes, hypertension or polycystic ovarian syndrome shouold be screened. Screening should begin at age 10 or at the onset of puberty whichever comes first. Screening should be done every other year. Childhood obesity, also known as paediatric obesity usually is self- diagnosable, as the weight of the child increases abnormally. Lab tests or imaging are often required for tracking the condition medically. Maintaining a healthy diet and physical activity levels are important for preventing obesity and consequent diseases.

Managing Childhood Obesity

Schools can play an important role in establishing an environment that supports healthful lifestyle habits to encourage healthy eating and regular physical activity. Schools have the opportunity to both educate students about these behaviours and provide opportunities for them to be practised. An effort should be made to increase the number of fruits and vegetables served during break time in schools.

Treatment of childhood obesity depends on the child’s age and existing medical conditions. Treatment includes changes in the diet and regular exercise. The goal for obesity treatment is to maintain healthy weight. Depending on a child’s existing health complications, treatment may involve a multidisciplinary team. The team will include the family physician, dietitian, counsellor or physical therapist and in some extensive or refractory cases bariatric surgery/ weight loss surgery can be considered.

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