我们都被告知，我们应该建议我们的糖尿病患者吃更健康的饮食，这将有助于控制糖尿病及其并发症，其中包括眼睛问题。但是，健康的饮食究竟是什么，在新推出的概念中，脂肪是我们的朋友，而糖和碳水化合物最好避免吗？低碳水化合物，健康的脂肪饮食是一种吃本本提示的方法整个低脂肪食物的范式倒挂。这是20年来受到尊重的博士生公共卫生学者Grant Schofield教授推荐的一种方法。 Schofield教授的研究和实践是由真正的食物在我们的健康和福祉中扮演的中心地带，以及“帮助世界变化”，帮助人们“成为最好的”的驱动力。 教授书“肥胖”之一的一位作者之一，而亲切地称为“胖胖教授”Schofield教授，正在挑战广泛的脂肪恐惧症的最前沿，这些恐惧症促使我们吃了充足的饮食加工的，含有碳水化合物的食物。 我听说Schofield教授在2016年的皇后镇的雪景展望中，就代谢疾病和营养与眼睛的理论发表了讲话。在我家庭病史的糖尿病中，我认为自己处于危险之中，当时一直在研究生酮饮食。我已经转入低碳素，高脂肪的生活方式。听证教授Schofield亲自讲话激励了我的个人方向，并给了我的工具和信息，传递给我的糖尿病患者和危险的患者，帮助他们改善生活。
听到谢菲尔德教授不久之后，我再次与他联系。我想知道更多。我想问他关于营养，整体医疗保健以及我们作为初级卫生保健提供者的协会的问题。 毕竟，作为验光师，我们明白眼睛是身体其他部位的窗户。我们有幸检查唯一允许我们看到血管系统状态的器官，我们必须记住质疑我们所看到的体征和症状;是炎症，干眼病和睑炎炎的细菌不平衡或高血压，胆固醇和糖尿病等代谢疾病？当病人眼睛不健康的时候，他们的身体很可能是不健康的。 Schofield教授认为，对患者保健的整体方法很重要。 “目前的教学是如此的疾病导向，而且更为一体化的方法是必要的。我们不能只是修复病人;我们有道义上的义务来预防疾病和促进福祉，“他告诉我。 他解释说，现代代谢疾病的基础可以被认为是太多的血糖，代表高HbA1c或胰岛素分泌过多或两者兼有，加上“胰岛素抵抗是大自然的告诉你的方式，你不需要尽可能多的碳水化合物就像你以为你那样做的。“ 虽然现代代谢疾病可以用药物治疗，但他表示，即使在正常血糖的情况下，也可以使用稳定我们的血糖并防止胰岛素分泌过多的饮食，这样可以同样有效。在更大程度上，最近在“医学互联网研究杂志”发表的研究可能表明，正确的饮食可能不需要尽可能多的药物，如果有的话。 2 然而，由于人们在胰岛素敏感性水平和饮食中处理碳水化合物的能力不同，限制饮食碳水化合物的好处也会因不同的人而异。 Schofield教授建议，起始点是去除精制碳水化合物，因为这是最大的问题。这些应该用丰富的水果和蔬菜和可能的豆类的饮食来代替。要进一步，水果，蔬菜和豆类应该在季节。
黄斑变性饮食 从年龄相关性黄斑变性（AMD）的观点来看，Schofield教授规定的饮食的健康脂肪方面与AREDS2指南非常吻合;避免与AMD及其进展关系最高的高度精制的多不饱和油，并使用传统的脂肪和油，如我们目前流行的代谢疾病之前使用的橄榄，椰子，黄油和酥油。低碳水化合物，健康的脂肪饮食也促进食用坚果，种子和脂肪鱼;与AMD降低的风险相关的食物，以及保护性抗氧化剂的丰富来源。 关于补充问题，斯科菲尔德教授真的希望我们考虑到这些条件本身是否适合;然而，他承认，当有不同的证据出现时，难以对使用补品进行总体规则。 “就AMD而言，我们知道叶黄素和玉米黄质等抗氧化剂是保护性的，可以从低碳水化合物，健康的脂肪食物如鸡蛋，熟蔬菜，水果中获得足够的摄入量，在这种情况下锌，海鲜和肉类的每一天，没有使用补充剂，“Schofield教授告诉我。 “在冬季补充维生素D肯定是个很好的例子，没有理由怀疑。维生素B6是一种可以损害神经的补充剂，包括视力受损，如果不适当使用，这是医生知道的不足。“ 增加脂肪摄入的概念显然盯着心脏脂肪假说的桶，绝对不符合以前教授的食物金字塔 – 但是它也不完全符合心脏基金会的新食品“苹果”或“健康板”或“心脏“似乎只是一个小的洗牌方向。 Schofield教授告诉我，“我们需要做一些激动人心的事情，把食物金字塔倒过来，人们才能看到它。” 由于胆固醇和动脉粥样硬化的形式存在于心脏病的犯罪现场，所以认为脂肪已经被责备了，他指出，高碳水化合物也是如此，或者来自Be Pure Clinic的Ben Warren说：“碳水化合物是一种不必要的营养“。 3 幸运的是，去年的雪景将会记得Schofield教授的一个苏格兰绅士的故事，承认自己去医院保持维生素和液体，以治愈他的肥胖。绅士一年没有吃饭，幸免于难。他已经失去了所需的体重。
据Schofield教授介绍，心脏脂肪模型的真正基础就是这样;在碳水化合物和高胰岛素存在的情况下，身体优先使用葡萄糖作为燃料来源于脂肪，因此它在体内通常存在于脂肪中，通常在不理想的地方，如肝脏和内脏脂肪。 当我们用健康的脂肪代替我们的碳水化合物时，会发生显着的事情。由于胰岛素刺激胆固醇的合成，胰岛素从更稳定的血糖正常化导致胆固醇正常化。而且因为胰岛素刺激了盐和水的保留，所以低碳水化合物，健康的脂肪饮食常常减少或消除药物治疗高血压的要求。如果碳水化合物摄入量足够低，那么人们通常会将盐补充到他们的饮食中，比如那些基于生物饮食的食物。 令人兴奋的是，Schofield教授已经有越来越多的心脏病学家愿意测试碳水化合物，健康脂肪饮食的想法，作为帮助患者获得更健康心脏的旅程的一部分。 Schofield教授的意见可以在profgrant.com找到，他每周都会写一篇精心设计的文章。 Ryan O’Connor是新西兰Paterson Burn的验光师。他于2013年在奥克兰大学解剖学科学学士学位后，于2013年完成了奥克兰大学眼科学士学位。作为其科学学位的一部分，他在功能，生殖和神经解剖学，应用生理学，动物学和运动营养。一个敏锐的橄榄球运动员， 奥康纳先生对运动表演和营养感兴趣，并将他的努力推向体育视觉领域。这是他对Paterson Burn的主要儿科验光师之一的改善小孩生活的热情。
- McKenzie Amy L, Hallberg Sarah J, Creighton Brent C, Brittanie M Volk, Theresa M, Abner Marcy K, Glon Roberta M, McCarter James P, Volek Jeff S, Phinney Stephen D. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication, 2017, Use, and Weight in Type 2 Diabetes JMIR Diabetes 2017 | vol. 2 | iss. 1 | e5 | p.1
- 最低社会经济群体的比例约为两倍（8％ ）与最高的社会经济群体（3％）相比。3
- 澳大利亚与糖尿病性黄斑水肿相关的视力丧失总间接成本估计为每年20.7亿美元。糖尿病性黄斑水肿每人超过$ 28,000。4
- 2015/16年度关键成果年度更新：卫生部新西兰健康调查报告：网上发布：2016年12月15日，网上提供12/3/2017，health.govt.nz/publication/annual-update-key-results -2015-16 – 新中国健康调查
- 澳大利亚糖尿病数据来自澳大利亚政府，澳大利亚健康和福利研究所网站，其中获得了2014年度全国健康调查，“在线12/3/2017”，“http：//www.hh.gov.au / how-common-is-糖尿病
- 新西兰黄斑变性的社会经济成本，黄斑变性新西兰，2016年10月17日，德勤访问经济学执行，资料来源于12/3/2017，mdnz.org.nz/assets/Deloitte-MDNZ-Cost-of- AMD决赛，10月17日 – 2016.pdf
文章Ryan O’Connor | 26 June 2017 – mivision
The Fat Professor: Eye Health and Low Carb, Healthy Fat Diets
Professor Grant Schofield, affectionately known as The Fat Professor
We are all told that we should be advising our diabetic patients to eat a healthier diet, one that will help control their diabetes, and its complications, among them eye problems. But what exactly is a healthy diet and is there any truth in the newly proclaimed concept that fat is our friend, whereas sugar and carbohydrates are best avoided?
The low carb, healthy fat diet is an approach to eating that essentially tips the whole low fat food paradigm upside down. It’s an approach that is being recommended by Professor Grant Schofield, a respected PhD public health academic of 20 years.
Professor Schofield’s research and practice is driven by the central place that real food plays in our health and wellbeing, along with a desire to “help the world change” and help people “be the best they can be”.
One of three authors of the instructional book What The Fat?1 and affectionately known as The Fat Professor, Professor Schofield is at the forefront of challenging the widespread fat phobia that has pushed us to eat a diet full of processed, carb-laden food.
I heard Professor Schofield speak on the theory of metabolic disease and nutrition and the eye, at Queenstown’s Snow Vision Down Under in 2016. With diabetes in my family history, I consider myself at risk, and at that time had been looking into the benefits of the ketogenic diet. I have since moved onto a low carb, high fat lifestyle. Hearing Professor Schofield speak in person both inspired my personal direction and gave me the tools and information to pass on to my diabetic and at risk patients to help them improve their lives.
Eyes Tell the Story
Soon after I heard Professor Schofield speak, I made contact with him again. I wanted to know more. I wanted to ask him questions on the topics of nutrition, holistic health care and their associations for us as primary health care providers.
After all, as optometrists, we understand that the eyes are a window to the rest of the body. We have the privilege of examining the only organ that allows us to see the state of the vascular system and we must remember to question the signs and symptoms we see; is it inflammation, bacterial imbalances of dry eye disease and blepharitis or metabolic conditions such as hypertension, cholesterol and diabetes? When a patient is unhealthy in their eyes, they are likely to be unhealthy in their body.
Professor Schofield believes a holistic approach to patient healthcare is important. “Current teaching is so disease orientated and a more integrative approach is necessary. We can’t just fix sick people; we have an ethical duty to prevent illness and promote wellbeing,” he told me.
He explained that the basis of modern metabolic disease can be thought of as too much blood sugar, represented as high HbA1c or excessive insulin secretion, or both, adding “Insulin resistance is nature’s way of telling you, you didn’t need as many carbohydrates as you thought you did.”
While modern metabolic disease can be managed with medications, he said prescribing diets that stabilise our blood glucose and prevent an over secretion of insulin even in the presence of normal blood sugar, can be just as effective. To a greater extent, research published recently in Journal of Medical Internet Research has potentially shown that with the correct diet there may be no need for as much medication, if at all.2
However, because people differ in their levels of insulin sensitivity and their ability to handle carbohydrates in their diet, the benefits of restricting dietary carbohydrates will also differ between different people.
Professor Schofield recommends that the starting point then, is to remove refined carbohydrates because these are the biggest problem. These should be replaced with a diet rich in fruit and vegetables and possibly legumes. To take this a step further, the fruit, vegetables and legumes should be in season.
Macular Degeneration Diet
From an age-related macular degeneration (AMD) standpoint, the healthy fat aspect of Professor Schofield’s prescribed diet fits very well with the AREDS2 Guidelines; avoid highly refined polyunsaturated oils, which have the highest association with AMD and its progression, and use traditional fats and oils such as olive, coconut, butter and ghee which were used prior to our current epidemic of metabolic diseases. The low carbohydrate, healthy fat diet also promotes eating nuts, seeds and fatty fish; foods associated with a decreased risk of AMD and also a rich source of protective anti-oxidants.
On the topic of supplements, Professor Schofield really wants us to consider how appropriate they are for the condition itself; however he acknowledged the difficulty of putting a blanket rule on the use of supplements when there is such varying evidence out there. “In the case of AMD, we know that lutein and zeaxanthin and other antioxidants are protective, and it’s possible to get an adequate intake of these from low carbohydrate, healthy fat foods such as eggs, cooked vegetables, fruit, and, in the case of zinc, seafood and meat, every day of your life without using supplements,” Professor Schofield told me. “There’s definitely a good case for vitamin D supplementation in winter, no reason for scepticism there. Vitamin B6 is a supplement that can damage the nerves, including impaired vision, if used inappropriately, which is something that not enough doctors know.”
The concept of increased fat intake obviously stares down the barrel of the Heart Fat hypothesis and definitely does not align with the previously taught food pyramid – however neither does it fully align with the Heart Foundation’s new food ‘Apple’ or ‘Healthy Plate’ or ‘Heart’, which appears to only be a small shuffle in the right direction. “We’ll need to do something drastic like flip the food pyramid upside down, before people will be able to see it in perspective,” Professor Schofield told me.
Opining that fat has been given the blame because it is present at the crime scene of heart conditions in the form of cholesterol and atherosclerosis, he pointed out that so too are high carbohydrates… or as Ben Warren, from Be Pure Clinic says, “carbohydrates are an unessential nutrient”.3
Those lucky enough to be at last year’s Snow Vision will remember Professor Schofield’s tale of a Scottish gentleman admitting himself to hospital to be kept on vitamins and fluids in order to cure his obesity. The gentleman went just short of a year without food and survived. He was discharged having lost the desired amount of weight.
The Heart Fat Model
The true basis of the heart fat model, according to Professor Schofield, goes like this; in the presence of carbohydrates and high insulin, the body uses glucose as a fuel source preferentially over fat, thus it is stored as fat in the body, often in undesirable places like the liver and as visceral fat.
When we replace our carbohydrates with healthy fats, remarkable things happen. Because insulin stimulates the synthesis of cholesterol, a normalisation of insulin from a more stable blood sugar leads to a normalisation of cholesterol. And because insulin stimulates the retention of salts and water, a low carbohydrate, healthy fat diet often reduces or eliminates the requirement of medications to treat hypertension. Often people will need to supplement salt into their diet if their carbohydrate intake is low enough, such as those on the ketogenic diet.
It’s exciting to see that Professor Schofield has had more and more cardiologists willing to test the idea of a low carbohydrate, healthy fat diet as part of their journey to help patients achieve healthier hearts.
Professor Schofield’s opinions can be found at profgrant.com where he writes a well thought out article each week.
Ryan O’Connor is an optometrist with Paterson Burn in New Zealand. He completed his Bachelors Degree in Optometry from the University of Auckland in 2013, following a Bachelor of Science in Anatomy from the University of Otago in 2009. As part of his Science degree he sat papers in functional, reproductive and neuro anatomy, applied physiology, zoology and sports nutrition. A keen rugby player,
Mr. O’Connor takes an interest in sports performance and nutrition and drives his endeavours into the field of sports vision. This is complemented by his passion to improve the lives of young children as one of Paterson Burn’s key paediatric optometrists.
2. McKenzie Amy L, Hallberg Sarah J, Creighton Brent C, Brittanie M Volk, Theresa M, Abner Marcy K, Glon Roberta M, McCarter James P, Volek Jeff S, Phinney Stephen D. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication, 2017, Use, and Weight in Type 2 Diabetes JMIR Diabetes 2017 | vol. 2 | iss. 1 | e5 | p.1
Prevalence of Diabetes and Macular Degeneration
Diabetes and Diabetic Eye Disease
- In New Zealand, 6.5 per cent of the population above the age of 25 are affected by type 2 diabetes, with the prevalence among Pacific Islanders the highest at 14.5 per cent and Maori at 9.1 per cent.1
- In Australia, diabetes is the fastest growing chronic condition; increasing at a faster rate than other chronic diseases such as heart disease and cancer. All types of diabetes are increasing; an estimated 1 million Australian adults (5 per cent) had type 2 diabetes in 2014–15, according to self-reported data.2 Proportions were around twice as high in the lowest socioeconomic group (8 per cent) compared with the highest socioeconomic group (3 per cent).3
- Diabetes is also the leading cause of preventable blindness in Australia.4There are currently around 72,000 people in Australia with diabetic retinopathy, with approximately three in five experiencing poor sight.4 Diabetic retinopathy occurs in over 15 per cent of Australians with diabetes.
- The total indirect cost of vision loss associated with diabetic macular oedema in Australia is estimated to be $2.07 billion per annum. This is more than $28,000 per person with diabetic macular oedema.4
- Age related macular degeneration is the most common cause of blindness in New Zealand, contributing to 50 per cent of all blindness.5
- In Australia, one in seven people (1 million people) over the age of 50 have some evidence of macular degeneration.6
- Approximately 17 per cent of Australians with macular degeneration (170,000) experience vision impairment.
- Macular degeneration is the leading cause of legal blindness in Australia and like New Zealand, is responsible for 50 per cent of all cases of blindness.
1. Annual Update of Key Results 2015/16: New Zealand Health Survey, Ministry of Health, Published online: 15 December 2016, Sourced online 12/3/2017, health.govt.nz/publication/annual-update-key-results-2015-16-new-zealand-health-survey
2. Australian Diabetes Data sourced from the Australian Government, Australian Institute of Health and Welfare Website which sites the ABS 2014–15 National Health Survey, Sourced online 12/3/2017,.aihw.gov.au/how-common-is-diabetes
3. The Economic Impact of Diabetic Macular Oedema in Australia, Bayer Australia Ltd, April 2015, Performed by Deloitte Access Economics, Sourced online 12/3/2017, mdfoundation.com.au/resources/Final_report_Economic_Impact_of_DME_in_Australia.pdf
4. Socioeconomic cost of macular degeneration in New Zealand, Macular Degeneration New Zealand, 17 October 2016, Performed by Deloitte Access Economics, Sourced online 12/3/2017, mdnz.org.nz/assets/Deloitte-MDNZ-Cost-of-AMD-FINAL-17-Oct-2016.pdf
5. Macular Disease Foundation Australia Age Related Macular Degeneration information booklet, Macular Disease Foundation Australia Website, Sourced online 12/3/2017, www.mdfoundation.com.au/resources/1/factsheets/MD_Booklet_2013-10_Web.pdf
Article by Ryan O’Connor | 26 June 2017 – mivision