Sadly Noy Pullen passed away in February 2023, we look at all she achieved with the DSA project: Agents For Change.

When did Agents for Change start?

Agents for Change (A4C) began in 2007. The World Diabetes Foundation (WDF) began financially supporting Agents for Change in 2008.

In June 2015, Martin Wolf Andersen and Susanne Olejas from WDF Denmark, attended Agents for Change seminars in Western Cape and North West Province during a field visit.

Aim and the mission of A4C

Diabetes is a huge problem in South Africa (SA) and worldwide. There are over four million people diagnosed with diabetes in SA. The International Diabetes Federation reports that 50% of people with diabetes are undiagnosed worldwide.

Lack of trained healthcare providers in diabetes in SA is the most critical issue impeding the delivery of high-quality diabetes care. The aim of A4C is to train healthcare providers and other healthcare practitioners in diabetes in all provinces, including rural areas.

The programme creates awareness about the importance of lifestyle change when living with diabetes and reducing the risk of getting it.  Participants attend intensive two-day workshops, six months apart, where they learn about diabetes, how to manage it and prevent complications. They are also taught communication skills so that they can empower people living with diabetes for self-management. To do this, they are encouraged to change their own behaviour for better health.

In 2006, Noy Pullen relocated to Cape Town from Johannesburg where she met Buyelwa Majikela-Dlangamandla who was then a diabetes educator at Groote Schuur Hospital. They worked together on this project (A4C) through DSA since 2007 until January 2022.

Noy was also the editor of Diabetes Focus for many years. She had interest in diabetes and helping people as she had a family member with diabetes.

What are the greatest achievements for A4C?

The greatest achievements of A4C were training more than 2 000 healthcare providers. The majority of participants managed to change their own lifestyle, such as eating healthily, losing weight and doing physical activity.

Some of them started vegetable gardens. A4C supported them by providing them with tools, such as seeds, skipping ropes, measuring tapes, information booklets, etc.

During all trainings, A4C did practical food demonstrations, and everybody helped. Many said they thought that healthy eating was boring, but said they enjoyed the food during training and changed the way they prepared food at their homes.

A4C was recognised by the South African Department of Health and the trained healthcare workers reached more than 100 thousand people in the country.

What was Noy Pullen known best for?

Noy loved colour. Although she had a teaching qualification, she stopped teaching many years ago. She was also a make-up artist. Noy was an excellent article writer, interviewing people and writing their stories. She was a spiritual person who loved her family and was good at uniting them. She was a coach and teacher and encouraged people to be themselves and do their best.

How did she impact A4C?

A4C would never be the same without Noy. Her guidance helped and encouraged Buyelwa to use the guiding style of teaching rather than the old way of directive teaching. Noy had great influence and encouraged Buyelwa to write a diabetes book. She was accurate with bookkeeping and writing up of reports including financial reports to the sponsors.

A4C project stopped

Unfortunately, due to the sponsor stopping their financial support of A4C, the last A4C training was in January 2022.

Farewell Noy and farewell A4C; may your soul rest in eternal peace.

References

Agents for change WDF08-378 (project description)

Agents for change WDF11-590 (project description)

Agents for change WDF14-876 (project description)

Agents for Change: champions in the fight against diabetes in South Africa (Diabetes Voice, June 2009 | Volume 54 | Issue 2) http://www.idf.org/sites/default/files/attachments/2009_2_Pullen.pdf

HRH Strategy for the Health Sector: 2012 to 2017 (pdf) (http://www.ahp.org.za/files/1896/HRH%20Strategy%202012%20to%202017.pdf)

Mel Fourie explains the mechanisms of gut health in relation to Type 2 diabetes and what happens in your body when you eat nutrient-dense foods compared to empty calories.

Did you know that sugar consumption has gone from twenty teaspoons a year to twenty two teaspoons a day? When we primarily eat foods containing high sugar, dangerous trans fats, and low fibre, your body doesn’t know how to utilise these anti-biological nutrients which cause metabolic dysfunction and weight gain due to the proliferation of inflammatory gut bacteria. Your gut health (flora) becomes toxic spiralling your microbiome into dysbiosis, a term meaning imbalance.

Blood glucose imbalances, mood swings, weight gain, and sleep disturbances are just some of the many side effects that can happen when your dietary choices contain harmful ingredients.

At its very core, Type 2 diabetes can be understood as a disease caused by too much insulin, which your body secretes when you eat too much sugar.

Solving the problem – the quality of the food

Knowledge is power and presenting the problem this way is incredibly profound because the solution becomes immediately obvious. You can lower your insulin levels by reducing your dietary intake of sugar and refined carbohydrates thus improving your gut health.

This leads me to sharing a rather bold statement, that obesity and diabetes can’t be cured in a doctor’s office alone. The journey to healing diabetes begins on the farm, in the supermarkets, in the restaurants, in your kitchens, on your plates, and in your gut.

Depending on the quality of the food, it will have profoundly different effects. If you have, for example, broccoli or your favourite soda, they’re both carbohydrates, but they have very different effects in your gut and microbiome, as well as your biological responses.

Broccoli vs soda

To illustrate how this works, let’s follow a sequence of biological responses that occur as broccoli and soda enters your body.

Soda

Let’s begin with a few gulps of soda. Your gut quickly absorbs the fructose and glucose. The glucose spikes your blood glucose, starting a domino effect of high insulin and a cascade of hormonal responses that kicks bad biochemistry into gear. The high insulin increases storage of belly fat, increases inflammation, raises triglycerides, lowers HDL, raises blood pressure, lowers testosterone in men, and may contribute to infertility in women. Your appetite is increased because of insulin’s effect on your brain chemistry. The insulin blocks your appetite-control hormone leptin. You become more leptin resistant, so the brain never gets the I’m full signal. Instead, it thinks you are starving.

Your pleasure-based reward centre is triggered, driving you to consume more sugar fuelling a sugar addiction. The fructose makes things worse. It goes right to your liver, where it starts manufacturing fat, which triggers more insulin resistance and causes chronically elevated blood insulin levels, driving your body to store everything you eat as dangerous belly fat.

You may also get a fatty liver, which generates more inflammation. Chronic inflammation causes more weight gain leading to obesity. Anything that causes inflammation will worsen insulin resistance. Another problem with fructose is that it doesn’t send informational feedback to the brain, signalling that a load of calories just hit the body. Nor does it reduce ghrelin, the appetite hormone that is usually reduced when you eat real food. Now you can see just how easily your favourite soda can create biochemical chaos.

Broccoli

Let’s look at the digestive pathway of broccoli. As with your favourite soda, broccoli is made up primarily (although not entirely) of carbohydrates.

To clarify what that means, because the varying characteristics of carbohydrates will factor significantly into the contrast, carbohydrates are plant-based compounds comprised of carbon, hydrogen, and oxygen. They come in many varieties, but they are all technically sugars or starches, which convert to sugar in the body.

The important difference is in how they affect your blood glucose. High-fibre, low-sugar carbohydrates such as broccoli are slowly digested and don’t lead to blood glucose and insulin spikes, while table sugar is a quickly digested carbohydrate that spikes your blood glucose. Therein lies the difference.

Slow carbohydrates like broccoli heal rather than harm. When you eat broccoli there is no blood glucose or insulin spike, no risk of fatty liver, and no hormonal chaos. Your stomach distends sending signals to your brain that you are full. There is no triggering of the addiction reward centre in the brain. You also get many extra benefits that optimise metabolism, lower cholesterol, reduce inflammation, and boost detoxification.

The phytonutrients in broccoli boost your liver’s ability to detoxify environmental chemicals, and the flavonoid kaempferol is a powerful anti-inflammatory. Broccoli also contains high levels of vitamin C and folate, which protect against cancer. The glucosinolates and sulphorophanes in broccoli change the expression of your genes to help balance your sex hormones, reducing the risk of breast and other cancers.

This rather simple illustration clearly demonstrates that good nutrition is a fundamental cornerstone of well-being and gut health. When you shift your diet, you change your biology, so choose to eat well.

But what does it mean to eat well for good gut health?

Basically to eat whole foods in their most natural form, including all the colours of the rainbow every single day to ensure you are getting plenty of beneficial phytochemicals and antioxidants to support whole-body health.

• You can start by adding more veggies to every meal. Try incorporating high-fibre vegetables like broccoli, cauliflower, kale, peppers, and spinach.
• Substitute sugar-laden treats with low-glycaemic fruits like blueberries, cherries, kiwi, and raspberries.
• Add healthy fats like avocados, olives, extra virgin olive oil, organic coconut oil and cold pressed hemp seed oil.
• For those who choose to eat animal products, move away from industrially-raised meat products and start sourcing grass-finished or free-range meats and eggs as well as wild caught fish and seafood.
• Add a few anti-inflammatory nuts and seeds and incorporate a diversity of healing herbs and spices.

Exercise – the most powerful medicine

Did you know that exercise might be the most powerful medicine to manage blood glucose levels and make your cells more insulin sensitive? Walking, yoga, Tai Chi, or similar more gentle forms of exercise are great ways to start.

Final thought

Obesity and Type 2 diabetes are closely related, and generally, increased weight increases the risk of disease. The correlation is not perfect but, nevertheless, maintaining an ideal weight, eating nutrient dense foods, and taking care of your gut flora are the first steps to prevention.

• Broccoli vs Soda illustration adapted from The Blood Sugar Solution.

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Lynette Lacock looks at the impact of sports drinks on blood glucose levels in people with diabetes and offers healthier alternatives.

The origin of sports drinks

Sports drinks have been around since the early 1900s. One of the first commercially successful drink was Lucozade which was launched in the UK in 1927. Originally it was sold by a pharmaceutical company and primarily marketed to sick people. Today we have a large variety of sports drinks marketed to healthy active people. In fact, globally it is a (USD) $26 billion industry.

These drinks are designed to replace fluids and electrolytes that are lost while exercising. They mostly contain water, sugar (carbohydrate), minerals, electrolytes, vitamins and some also include caffeine.

What do they do for you?

During periods of intense exercise, you lose water and electrolytes.  Both of these are essential for your muscles to work properly. When you exercise for long periods of time, your body turns carbohydrates into glucose that your body uses as fuel. If your glycogen (glucose) storage gets low, you will become tired and not be able to perform optimally.

Using energy drinks can help hydrate you and provide your body with an energy source. However, these drinks contain an average of nine teaspoons of sugar per helping. So, if you have diabetes, this high amount of sugar can cause your blood glucose to spike.

Do you need the added caffeine?

Many energy drinks on the market contain caffeine as well as carbohydrates and electrolytes. The reason behind this is that caffeine has been shown to stimulate your brain by increasing focus, concentration and reaction time. The goal being to enhance your sporting performance.

The amount of added caffeine may be well-tolerated by a healthy adult but can spike blood glucose levels in someone with diabetes. The caffeine causes your blood glucose to rise followed by a spike in blood insulin levels. Caffeine can stay in your system for up to six hours prolonging this response in the body and causing havoc with your glucose metabolism.

Consuming sugary drinks with caffeine on a regular basis can put you at an increased metabolic risk and excessive caffeine should be avoided altogether in children, adolescents and people living with diabetes.

Do people with diabetes need sports drinks when they exercise?

As you exercise, your body becomes more dehydrated and blood glucose rises as your bloodstream becomes more concentrated. Adding carbohydrates will elevate your blood glucose even more.

If your drink also contains caffeine, it will make your blood glucose level rise even higher, requiring more insulin to bring your blood glucose levels back to normal. Overall, consuming these drinks when you have diabetes makes regulating your blood glucose very difficult.

So, to answer the question: no, people living with diabetes don’t need to consume sports drinks when they exercise. You need to look for a healthier alternative that hydrates and replaces electrolytes.

First and foremost, you must stay hydrated by drinking enough water. If you are exercising in the heat and sweating for more than one hour, you may want to replace lost electrolytes as well.

Everyone’s blood glucose reacts differently to various types of exercise and to monitor yourself effectively you need to be drinking sugar-free and caffeine-free drinks. Always check with your doctor before starting a new exercise regime and follow the tips below to see how your body reacts to the increased activity.

Monitoring tips when exercising

• Check your blood glucose before, during and after exercising.
• The first couple times you start a new exercise, check your blood glucose two, four and six hours after exercising because it can cause your blood glucose to drop, requiring you to eat more or lower your evening insulin dose.
• Keep a carbohydrate snack on hand in case you experience a hypoglycaemia attack while you are exercising.
• Drink plenty of water to remain hydrated while you exercise.

Healthy alternative drinks for people with diabetes

Sports drinks companies have already come out with sugar-free and low sugar alternatives. For example, Energade Light and Powerade Zero contain little or no extra sugar or caffeine but still contain electrolytes.

Unfortunately, most contain artificial sweeteners which don’t raise your blood glucose but do have other risk factors.  If you want to avoid artificial sweeteners, there are healthier alternatives. You could drink some of the following:

• Unsweetened coconut milk (contains electrolytes).
• Unsweetened fruit juices diluted with water (contains electrolytes).
• Vegetable juice (contains electrolytes).
• Kombucha (contains electrolytes).
• Unsweetened tea.

You could also eat something that contains electrolytes and drink water. For example, a banana has electrolytes and you stay hydrated by drinking water.

There are other healthy sugar-free alternatives on the market. Ask your doctor or pharmacist which one is best for you.

References

https://diabetes.org/healthy-living/fitness/sports-drinks-impact-on-glucose-blood-sugar#:~:text=Caffeine%20(sometimes)%3A%20Many%20of,spike%20your%20blood%20sugar%20significantly.

https://www.nhs.uk/conditions/type-1-diabetes/living-with-type-1-diabetes/exercise-and-sport/

https://endocrinenews.endocrine.org/energy-drinks-cause-blood-glucose-insulin-levels-to-spike-and-hinder-blood-sugar-control-in-teens/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995988/

https://www.eatingwell.com/article/8009374/best-and-worst-hydration-drinks-for-people-with-diabetes/

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Diabetes nurse educator, Christine Manga, answers the burning question: how accurate are blood glucose meters?

Blood glucose meters are an essential and convenient tool for people living with diabetes to manage their condition. These small devices allow you to measure your blood glucose levels quickly and accurately whilst on the go.

However, some people are concerned about the accuracy of these glucose meters. This is a valid concern as inaccurate readings can lead to incorrect treatment decisions, which can have serious consequences.

Trialled and tested

The accuracy of blood glucose meters has improved significantly in recent years. The accuracy of these devices is tested by regulatory bodies such as the Food and Drug Administration (FDA) in the United States before they are approved for use by the public.

Over and above this, manufacturers are also required to meet certain accuracy standards. The International Organisation for Standardisation (ISO) has established a standard for blood glucose meter accuracy which requires readings fall within 15% of a laboratory reference value. This explains why glucose readings can differ even when taken at the same time but on different fingers. Using two different meters will also yield different results due to the 15% allowance.

Blood glucose meters are generally considered to be accurate. Some meters come with a control solution that have a known glucose concentration, which you can use to test your meter’s accuracy. Newer meters don’t come with this.

Maintenance and use of the blood glucose meter

The accuracy of a blood glucose meter depends on several factors, most of which the user has control over. Included here are maintenance and use of the meter.

• Check expiry date of strips, expired strips can give inaccurate results.
• Use the meter according to the manufacturer’s instructions.
• Close the strip container securely each time as moisture/humidity can damage the strips.
• Avoid exposing strips and meters to extreme temperatures such as leaving them in a hot car or keeping them in a fridge.
• Wash and dry hands properly before testing. Contamination from food and hand creams among other things can alter glucose readings.
• Hands should be warm when testing, if they are cold, more pressure is applied to obtain the blood drop, getting some interstitial fluid (ISF) that can lead to unreliable readings.
• Dehydration can affect readings, try to drink enough fluid every day.
• Use a sufficient size blood drop, too little blood may give inaccurate results.
• Do not share your meter.

Glucose sensor vs finger-prick readings

For people who wear glucose sensors, they may notice a substantial difference between their finger prick and sensor readings. This is not due to inaccuracy of either device.

Sensor glucose and capillary blood glucose are different because they measure glucose levels using different body fluids. Sensor glucose readings come from interstitial fluid (ISF), which is the fluid that surrounds the cells under the skin.

Finger-prick blood glucose readings come from the blood that flows in the small blood vessels near the surface of the skin. There is a delay between the glucose levels in the blood and the ISF because glucose first enters the bloodstream from the digestion of food, and then diffuses into the ISF. This delay can be up to five minutes.

Therefore, sensor glucose and finger-prick blood glucose readings may not always match, especially when glucose levels are changing rapidly, such as after eating, exercising, or taking insulin. This is normal and expected.

The difference in sensor and blood glucose doesn’t matter if you understand why they may not always match and how to use them correctly. Sensor glucose readings can give you a more complete picture of your glucose trends and patterns over time as they test your glucose every 60 seconds, while capillary blood glucose readings can give you a more precise measurement of your glucose level at a specific moment.

Ask for advice

If you are concerned about the accuracy of your readings, you should talk to your doctor or diabetes educator for advice. They can help you choose a meter and test strips and teach you how to use them correctly.

As another option, you can do a finger-prick test on your meter at the same time as you have blood drawn in a lab and compare the results. They should be within 15% of each other.

Blood glucose meters are fantastic devices that assist in day-to-day management of diabetes. They have without a doubt evolved over time.

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Dr Louise Johnson explains the connection of hair loss in people living with diabetes.

The average human normally sheds 50 to 100 hairs per day according to The American Academy of Dermatology. Losing hair is part of the hair lifecycle. As one hair is shed, another replaces it. The hair follicle is a complex mini organ that produces hair from terminal differentiated cells called keratinocytes. On average, a human has between 2 and 5 million hair follicles of which 100 000 are on the scalp. But there is a difference between shedding hair and hair loss.

The hair follicle

The growth of the hair follicle can be divided into three phases:

1. Anagen (growth)

Anagen growth is the active phase in which the hair follicle takes on its onion shape and works to produce the hair fibre. This phase lasts between two and six years. During this phase, rapid cell division occurs in the hair bulb. In addition, new hairs begin to protrude from the scalp.

2. Catagen (transition)

Catagen is a transitional phase that last two to four weeks.

3. Telogen (rest)

This phase last three to five months and is the resting phase.

Hair loss

Excessive hair shedding can occur during times of stress or after pregnancy. This is not the same as hair loss which is referred to as alopecia, occurs when something stops the hair from growing. This falls into three categories:

1. Androgenetic alopecia
2. Alopecia areata
3. Telogen effluvium

Androgenetic alopecia

This is characterised by male pattern baldness and can happen to both males and females due to hormonal changes. The incidence varies across races, but its prevalence increases with age, visibly affecting 57% of women and 73.5% of men who are at least 80 years old.²

Alopecia areata

This develops when the immune system attacks the hair follicle and can be associated to Type 1 diabetes since it’s an autoimmune disease.

Telogen effluvium

This is due to a response to stress.

Is hair loss a symptom of diabetes?

Hair loss can occur in both Type 1 and Type 2 diabetes. In Type 1 diabetes there are often other autoimmune diseases associated. Alopecia areata is one where antibodies attack the hair follicle which leads to hair loss. Hashimoto thyroiditis is another autoimmune disease which causes dry skin and hair loss due to an underactive thyroid gland.

In Type 2 diabetes, cortisol levels (stress hormone) can be high due to insulin resistance. Excess cortisol can disrupt the hair follicle leading to hair loss.

In a 2019 study¹, it was shown that in Type 2 diabetes of African origin were associated with increased risk of central scalp hair loss. There may be a genetic factor to central hair loss.

Clinicians should also screen women with central scalp hair loss for Type 2 diabetes if they are not yet diagnosed. Whether successful treatment of Type 2 diabetes might protect African women from central scalp hair loss remains to be determined.

In long-standing diabetes, both Type 1 and Type 2, there is often microvascular (small vessel) damage which leads to impaired blood flow to the affected area as well as less nutrients and oxygen. This can be seen in eye, kidney, feet and hair. Typically seen in patients with peripheral neuropathy (lower leg loss of sensation due to nerve damage), the hair growth on the lower leg is reduced or absent.

Medication can also contribute to it. In patients taking metformin it’s important to monitor the vitamin B12 and folate levels. This can be diminished which would cause impaired hair growth.

Management of hair loss in diabetes

1. Good glucose control is important. Make sure that your average blood glucose (HbA1c) is below 7% or the target that your healthcare practitioner suggests.
2. Healthy eating, exercise and stay hydrated.
3. Make sure your thyroid levels, vitamin B12 and folic acid levels are normal. Also remember to check iron levels since iron carry red cells and oxygen. If not replace as needed.
4. Get enough sleep.
5. Be gentle when washing and brushing your hair.
6. Seek medical help early.
7. In cases where it interferes with quality of life, a wig or hair prosthesis should be considered until the hair grows back.

References

1. Coogan P.F. Traci n et. al. “Association of type 2 diabetes with central scalp hair loss in a large cohort of African American women” Int. Jour of women’s dermatology, 5(2019) p 261 – 266
2. Gan DCC, Sinclair RD “Prevalence of male and female pattern hair loss in Maryborough.” J Investig Dermatol Symp Proc. 2005;10(3)184-9

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The connection between nutrition and mental health is quite technical. Nonetheless, the fact remains that a healthy diet equals a healthy mind. Dietitian, Ilze Roth, tells us more.

“The food you eat can be either the safest and most powerful form of medicine or the slowest form of poison.” – Ann Wigmore

Food provides the nutrients responsible for the energy and essential substances upon which all growth and development, as natural processes indicating progression, and survival depend.¹

The traditional definition of nutrition from the study of nutrients in food and the body was extended in literature to include the “study of human behaviour related to food.” Researchers further affirm that nutritional components unrefutably influence certain health conditions, either positively or negatively, based on the diet-behaviour association.²

Scientific evidence across dietary- and nutrition-related research clearly indicates that the intake of food invariably influences the physiological functioning of the body, based on the underlying nutritional status of the individual.²

Importance of nutrition for brain functioning

The brain, as part of the central nervous system, is one of the smallest, yet most complex organs of the human body systems. It regulates your behaviour, perceptions, memories and is responsible for initiating all voluntary movements. The brain is the most metabolically active organ.³ Therefore, it relies on dietary intake for sufficient energy and is highly susceptible to dietary insufficiencies which may negatively impact the structure and function thereof.⁴

Dietary patterns either deficient or excessive in essential nutrients, negatively affects brain function and as a consequence mental health and behaviour.⁵

Dietary intake provides nutrients essential for various physiological functions including cell propagation, synthesis of DNA, metabolising hormones and neurotransmitter and are important elements of enzyme systems in the brain.^6,2

Nutrition impacts brain function through creating stronger or weaker connections between neurons (known as synaptic plasticity) and influencing the hippocampus which regulates memory.⁷

The link between the gut and the brain

A study⁸ explains that the gut and brain link is established by the vagus nerve that originates in the brain stem and travels through the body to the gut, connecting it with the central nervous system. The vagus nerve untangles within the gut and penetrates the gut wall, which is essential in the digestion of food. This intricate connection is imperative to ensure bidirectional communication between the brain and the gut.

Through the gut-brain axis, it’s now possible to understand the impact of nutritional abnormalities on the brain’s functioning as your dietary intake is sensed by the neurons in your gut, sending messages to the brain to alarm the brain.⁷

Effect of poor nutrition on the brain

A Mahan and Raymond study⁸ defines human nutrition as “processes whereby cells, tissue, organs and the body as a whole obtain and use necessary substances to maintain their structural and functional integrity.”

Within this context, optimum nutrition can be determined by diet quality, measured by recording food patterns based on their alignment with national dietary guidelines and how diverse the variety of healthy choices is within core food groups or equivalent international groupings.¹⁰

Dietary patterns deficient in necessary nutrients, increases the risk of developing non-communicable diseases (NCD).¹¹ A diet high in refined carbohydrates, saturated fat and salt can lead to deterioration in mental capacity and also influence behaviour and increased prevalence of NCDs.^4,12

Enjoy a variety of foods

In South Africa, the Food Based Dietary Guidelines addresses poor diet quality and ensure optimum nutrition, physical and mental development, lowered NCD risk, health and well-being through all stages of life.¹³ The guideline Enjoy a variety of foods promotes dietary diversity as part of a healthy diet, to prevent NCDs.⁵

A balanced diet is central to support physical health, with scientific evidence propagating the Mediterranean diet as a good model. Evidence from interventional human studies indicates benefits of plant-based diets on individuals, suffering specifically from lifestyle-related diseases, including obesity, Type 2 diabetes, and inflammation.¹³ It’s therefore believed that a similar diet will be advantageous for optimal development and functioning of the brain.¹⁴

Research shows that the typical Western diet (WD) where the dietary pattern resembles a poor-quality calorie-dense diet, laden with saturated fat, refined sugars, sodium, increased consumption of fast foods, and a low intake of vegetables, resulting in low levels of folate, fibre, and omega 3 fatty acids.^14,15

Multiple physical and psychological disorders are related to the persistent intake of a WD.¹⁶ According to the World Health Organization (WHO), 74% of all deaths globally are attributed to NCDs, including those associated with aging and diseases caused or influenced by the consumption of a WD, such as Type 2 diabetes, overweight, obesity, and cardiovascular diseases.¹⁷

The result of these dietary behaviours is not limited to increased prevalence of NCDs, but also deterioration in mental capacity.¹² Furthermore, obesity and overweight are independent risk factors for stroke, mild cognitive impairment, and dementias, such as Alzheimer’s disease and vascular dementia.¹⁸

Healthy diet, healthy mind

As mentioned previously, researchers recognise the MeD as an eating pattern with the ability to protect against diabetes and to prevent heart disease. The common features include the consumption of nutrient-dense foods, especially encouraging greater amounts of fruit and vegetables, whole grains and omega-3 rich fish, lean meat, low-fat dairy products, nuts and legumes as well as the use of olive oil, canola oil and seed oils.²

Further to the MeD, the Dietary Approach to Stop Hypertension (DASH) diet has similar features and these two dietary approaches were fused to devise the MIND diet (an acronym that stands for the MeD-DASH intervention for neurodegenerative delay).

Recent research suggests that this approach assists in the effective reversing and protection against cognitive decline, thereby (also) reducing the risk of Alzheimer’s dementia.⁸

The MIND diet

The MIND diet highlights the following 10 groups of foods to include at regular intervals:

• Whole grains
• Green leafy vegetables
• Other vegetables (carrots, peppers and broccoli)
• Nuts
• Berries
• Beans or legumes
• Fish
• Poultry
• Limited wine
• Olive oil

In addition, the MIND diet emphasises five unhealthy food groups that should be minimised in your conquest to optimise brain functioning. These include:

• Pastries and sweets
• Red meat / processed meats
• Cheese
• Fried or fast food
• Margarine

A graphic representation of the MIND diet and the portions and intervals at which the suggested food groups should be taken:¹⁹

Figure 1: Graphic representation of the MIND diet.

Conclusion

The improvement of poor-quality diets to combat cognitive decline and optimise brain functioning are thus reliant on the unified and synergistic nature of the diversity of single nutrients which transmutes into healthy dietary patterns.¹⁵

Behaviour change is a process and only possible through holistic and interdisciplinary nutritional interventions, considering the factors that influence dietary choice.^13,15

References

1. Ahmad, F., Hasan, H., Abdelhady, S., Fakih, W., Osman, N., Shaito, A., & Kobeissy, F. 2021. Healthy meal, happy brain: how diet affects brain functioning. Frontiers for Young Minds. [Online]. Available: https://kids.frontiersin.org/articles/10.3389/frym.2021.578214#:~:text=Proper%2C%20healthy%20nutrition%20can%20benefit,number%20of%20connections%20between%20neurons. [2 May 2023]
2. Associate Parliamentary Food and Health Forum. 2008. The links betweeen and behavior. The influence of nutrition on mental health, London: The Associate Parliamentary Food and Health Forum. [Online]. Available: https://www.globalwellnessinstitute.org/wp-content/uploads/2018/04/FHF.pdf  [20 August 2020]
3. Benton, A. 2010. The influence of dietary status on the cognitive performance of children. Molecular Nutrition and Food Research, 54(4): 457-470. [Online].Available: https://onlinelibrary.wiley.com/doi/full/10.1002/mnfr.200900158 [16 August 2020]
4. Haapala, E.A., Eloranta, A.M., Venäläinen, T., Jalkanen, H., Poikkeus, A.M., Ahonen, T., Lindi, V. & Lakka, T.A. 2016. Diet quality and academic achievement – A prospective study among primary school children. European Journal of Nutrition, 56(7): 2299-2308. [Online]. Available: doi:10.1007/s00394-016-1270-5 [5 November 2020]
5. Hassan, Z.A., Schattner, P. and Mazza, D. 2006. Doing a pilot study: Why it is essential? Malaysian Family Physicians, 1(2-3): 70-73. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4453116/  [2 November 2021].
6. Kontis, V., Mathers, C., Rehm, J., Stevens, G.A., Shield, K.D, Bonita, R., Riley, L.M., Poznvak, V., Beaglehole, R. and Ezzati, M. 2014. Contribution of six risk factors to achieving the 25×25non-communicable disease mortality reduction target: a modelling study. The Lancet, August, 384: 427. [Online]. Available:https://www.thelancet.com/action/showPdf?pii=S0140-6736%2814%2960616-4 [28 March 2018]
7. Kroner, Z. 2009. The relationship between Alzheimer’s Disease and Diabetes: Type 3 Diabetes. Alternative Medicine Review, 14(4):375. [Online]. Available: https://altmedrev.com/wp-content/uploads/2019/02/v14-4-373.pdf [4 March 2023]
8. Mahan, L. & Raymond, J. 2017. Krause’s food and the nutrition care procecss. 14th ed. Missouri: Elsevier.
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