Current dietary recommendations state that there is insufficient evidence to prescribe an exact percentage of calories from carbohydrate, protein and fat for people with diabetes from the choice of a variety of popular diets currently available. Over the years, many a research has focused on the relative importance of the right proportion of carbohydrates and fat combination in a balanced diabetic diet. Jury is still out regarding the relative merits and demerits of a diabetic diet – low carbohydrate, high fat or low fat, high carbohydrate diet. Evidence from various studies suggest that low carbohydrate diets improve cardiovascular (CVD) risk through lowering HbA1c levels, improving blood pressure and body weight. There is also a positive effect on lipid profile and reversal of non-alcoholic fatty liver disease (NAFLD). Whilst there are some significant metabolic benefits of LCHF diet, it is accepted that there needs to be more long-term studies before it can be used in daily clinical practice.This chapter focuses on basic physiology and metabolism of carbohydrate and fat content in normal and diabetic patients and a review of the literature on these two diet combinations with current thoughts and evidence on this core issue affecting insulin utilization and metabolic profile.
Part of the book: Diabetes Food Plan
A combination of sub-therapeutic chelation and subsequent iron overload are regarded as the principal drivers of endocrine dysfunction in thalassaemia. The clinical presentation of endocrine complications and their timing of onset can be highly variable, in part due to population heterogeneity but also variation in chelation strategies. Endocrinopathies commonly associated with thalassaemia include: growth delay; pubertal delay; gonadal dysfunction; thyroid disorders; parathyroid and adrenal gland impairment; impaired bone metabolism; and type 2 diabetes mellitus. In this chapter we summarise the main presentations of endocrine disorder in thalassaemia, summarising their epidemiology, clinical presentation and pathophysiologic basis. Furthermore, we review screening, monitoring and treatment strategies, with particular regard to the UK Thalassaemia Society’s 2016 National Standards.
Part of the book: Human Blood Group Systems and Haemoglobinopathies