Kate Gibbons
The Times
Gerry Gajadharsingh writes:
This has been a great week for research challenging public health advice. Last week Britain’s National Obesity Forum last week urged people to ignore public health advice and “eat fat to get thin”. The group was criticized, by the establishment, for calling for people to reduce carbohydrates and stop counting calories. I guess if you have been saying something increasingly considered to be incorrect, for many years it will take them (the establishment and their public health advice) a few more yet to admit it.
This week was the turn of research criticizing the official Eat Well Guide for Diabetics. The study came about as a consequence of an online revolt by patients in which 120,000 people signed up to the “low-carb” diet plan launched by the forum diabetes.co.uk in a backlash against official advice.
Whilst it might make sense to many people (including me) that if you have a condition that doesn’t manage your blood sugar well (Type 111 Diabetes), reducing foods that contain sugar may help, but a statement from PHE said: “Our advice, agreed with Diabetes UK, is that people with diabetes should consume a diet consistent with the Eatwell Guide. The evidence considered by the Scientific Advisory Committee on Nutrition for its Carbohydrates and Health report does not support following a low-carbohydrate diet to prevent type 2 diabetes.”
I leave you to make your own conclusions!
Dr Wolf Funfack, set up Metabolic Balance in Germany in 2003 as a way of helping his Type 11 Diabetic Patients gain better control of their diabetes because so many of them were not responding well to their medications. I trained to offer this innovative individualised nutritional programme to selected patients in 2009. As well as helping Type 11 diabetic patients (there is a great case study in my iBook, The Health Equation – A Way of Life) many of my patients have found t it to be very beneficial in addressing many of their health concerns, including better weight management. The amount of money we as tax payers could save by helping people better manage their type 11 diabetes (never mind preventing it), could be enormous, given the actual cost of diabetic medications of a persons’ life time, or the cost of the co-morbidities and complications associated with it, high blood pressure, obesity, neuropathy etc.
A word of caution, patients’ often needs supervision to move away of a diet high in carbohydrates to choosing a diet lower in High Glycaemic Load carbohydrates (note GL is not GI, glycaemic index), ideally finding a clinician who is experienced in this.
I don’t like the term ‘Low Carbohydrates”. I even have some patients telling me they eat “no carbs”. This is simply not possible! AS always the devil is in the detail. If you want to find out more a great starting point will be to download my iBook from the Apple iTunes Store “The Health Equation- A Way of Life”.
70 per cent of participants experienced improvements to blood glucose after eating a diet low in starchy foods but high in protein and “good” saturated fats for ten weeks
The biggest pilot study of a low-carbohydrate diet to treat type 2 diabetes has shown that it may successfully control the condition.
A review of more than 80,000 people who ditched their low-fat, high-carbohydrate diet found that their blood-glucose levels dropped after ten weeks. The results have led doctors to call for an overhaul of official dietary guidelines.
The study came about as a consequence of an online revolt by patients in which 120,000 people signed up to the “low-carb” diet plan launched by the forum diabetes.co.uk in a backlash against official advice.
By rejecting guidelines and eating a diet low in starchy foods but high in protein and “good” saturated fats, such as olive oil and nuts, more than 80 per cent of the patients said that they had lost weight, with 10 per cent shedding 9kg (20lb) or more.
More than 70 per cent of participants experienced improvements to blood glucose, and a fifth said at the end of the ten-week plan that they no longer needed drugs to regulate blood glucose.
About 2.7 million people in Britain have type 2 diabetes, a condition that goes hand in hand with obesity. A further 750,000 people are thought to have undiagnosed symptoms. Costing more than £8.8 billion directly and indirectly each year, it is a defining issue for public health.
Frustrated doctors, nutritionists and diabetes specialists called for the “absurdly simplistic” guidelines, promoted by Public Health and the national charity Diabetes UK, to be rewritten. The results of the study, however, have not yet been replicated in a controlled and peer-reviewed trial.
A report by Britain’s National Obesity Forum last week urged people to ignore public health advice and “eat fat to get thin”. The group was criticised for calling for people to reduce carbohydrates and stop counting calories.
The majority of the 120,000 people who have signed up to the low-carb diet plan since November suffer from weight-related type 2 diabetes. More research needs to be done into whether restricting carbohydrates in type 1 patients of normal weight has a significant effect on glycemic control.
“The results from the low-carb plan have been impressive and this is a solution that is clearly working for people with type 2 diabetes,” Arjun Panesar, chief executive officer of diabetes.org.uk, said.
David Unwin, a family doctor and clinical expert in diabetes, is one of a growing number of clinicians treating patients with this diet. “For many years I followed the advice given by PHE and Diabetes UK,” he said. “It didn’t go well. They really struggled to lose weight, their blood glucose remained high and many relied on medication.”
A recent study of 18 of Dr Unwin’s patients resulted in an average weight loss of 8kg after cutting out carbohydrates; blood-glucose levels returned to “normal” in all but two.
“Many diabetics know not to put sugar in their tea but very few are aware that the toast they have at breakfast or rice at dinner may be wreaking havoc with their blood glucose. This is because when starchy carbohydrates like potato or pasta are broken down in the body by digestion the starch turns to sugar,” he said.
Some experts remain dubious about the direct link between carbohydrates and lower blood glucose.
“The robust evidence is that any diet which helps weight loss in diabetes will help improve patients metabolic levels since it is weight more than anything that drives diabetes development,” Naveed Sattar, professor of metabolic medicine at the University of Glasgow, said. “All diets work regardless of whether they are high-carbohydrate or low-carbohydrate, so long as folks stick to them.”
A spokeswoman from PHE said: “Our advice, agreed with Diabetes UK, is that people with diabetes should consume a diet consistent with the Eatwell Guide. The evidence considered by the Scientific Advisory Committee on Nutrition for its Carbohydrates and Health report does not support following a low-carbohydrate diet to prevent type 2 diabetes.”
Case Study
David Plant, 66, was diagnosed with type 2 diabetes in 2009 but ignored it for a long time.
“I had a wake-up call in a recent six-monthly check up,” he said.
“My HbA1c and triglyceride
“My GP was supportive of me adopting a low-carb lifestyle. In four months I’ve lost 14.5 kilos [32lb], taking me from a body mass index of 28 into a normal’ range of 23.4. I feel much better now; I’m nowhere near as tired or hungry as I was before. This isn’t a diet, it’s a change of lifestyle. It may seem slow at the time but you see results in just a few weeks.
“I found it frustrating at first, but in hindsight it was a lot to take on and has helped me maintain the lifestyle. At my original weight, walking uphill was a struggle. It’s a completely different story now; I’ve got lots more energy and motivation.”
Michele O’Sullivan, 49, a mother of three from Telford in Shropshire with type 2 diabetes, has lost more than 25kg on a low carbohydrate diet. She has managed to reverse her diabetes and says she “feels better than when [she] was 35”.
A former nurse, she battled for several years with pre-diabetes, which results in “crazy food binges” and dangerous spikes in blood pressure.
“No matter how hard I tried, my weight remained static,” she said. After three months on a low-carb diet her metformin dosage halved and now, two years later, she is medication free.
Eat Well guidelines
- Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates. Choose wholegrain where possible
- Eat at least five portions of a variety of fruit and vegetables a day
- Have some dairy or dairy alternatives (such as soya drinks and yoghurts). Choose lower-fats and lower-sugar options
- Eat some beans, pulses, fish, eggs, meat and other protein
Low-carb plan
- Replace carbohydrates with green vegetables and pulses, which should make up most of the plate
- Eat at least five portions fruit and vegetables a day
- Have a small portion of protein with most meals
- Consume dairy, such as full-fat milk and butter, in moderation
- Olive oil, nuts and other healthy saturated fats are welcome
- Avoid anything with added sugar