Jane Feinmann first published in HEALTHINSIGHTUK
How much longer can the charity Diabetes UK continue to provide advice on diet to the UK’s 3.9 million people with type 2 diabetes that is based on the discredited Seven Countries Study carried out by Ancel Keys back in the 1950/1960s? The urgency of this question cannot be overstated.
On the one hand, type 2 diabetes is almost certainly the most poorly managed chronic disorder of modern times. Two out of three people with the disorder fail to control their blood glucose despite GPs handing out diabetic medication amounting to 10 per cent of the NHS drugs budget.
The long-term consequences of this failure are staggering and tragic – both financially and at an individual level.
Every year, 80 per cent of the £10bn that the NHS spends on diabetes is used to treat the consequences of poorly controlled blood sugar: kidney and heart failure, increased risk of heart attack and stroke as well as blindness and nerve damage. Each week surgeons carry out more than 100 diabetes-related amputations – with 24,000 deaths every year because people with type 2 diabetes are not able to control their blood glucose.
A policy based on a discredited study
At the same time, there is virtually universal acceptance that type 2 diabetes is the classic life-style disorder where what you eat makes a crucial difference.
So why does Diabetes UK (with the support of both Nice and NHS Choices) persist in sticking to a recommendation that everyone with type 2 diabetes should continue to consume ‘a normal’ healthy diet’ – ie.one that’s low in fat and with plenty of daily starchy carbohydrates including bread, rice and pasta, based on the now discredited 1950/1960s Keys study.
Sure – as Diabetes UK continually points out – not everyone with type 2 diabetes is obese: some indeed are ‘skinny’. But eight out of ten people with the disorder have a BMI above 30 which suggests that a key factor is diet – with new evidence showing why there is no single BMI linked to type 2 diabetes.
‘We now know that individuals have different levels of tolerate to fat within the liver and pancreas,’ explains Professor Roy Taylor of Newcastle University’s Diabetes Research Group. ‘Only when a person has more fat than they can cope with does type 2 diabetes develop. What’s more, we now know that when they successfully lose weight and go below their personal fat threshold, their diabetes will disappear,’ he explains.
Trying to hold back the tide of evidence
The last two or three years has seen a growing pile of highly persuasive evidence showing the benefits of weight loss for people with type 2 diabetes who switch to a low carb diet. Last year, the journal Diabetologia published a study of 19 patients with type 2 diabetes at the Southport surgery of Dr David Unwin, a GP and diabetes specialist.
All the patients lost an average of 8.65kg (19lb) over seven months on a low-carb, high-fat diet, reducing their blood glucose levels by nearly a quarter. Later this year, Dr Unwin is set to publish a further study of 69 patients with non-alcoholic fatty liver disease, a precursor of type 2 diabetes as well as heart disease, showing a 46 per cent improvement in liver blood tests, and therefore a reduced risk of high blood glucose levels after an average of 13 months on a low-carb high-fat diet. .
What’s more common sense supports the low carb protocol, according to diabetes specialist, Dr David Cavan, author of Reverse Your Diabetes. ‘We know that type 2 diabetes develops when blood glucose rises above a certain level – and whether it’s sugar, rice, bread or potatoes, these carbohydrates rapidly turn into glucose in your bloodstream,’ he says.
His patients and many others are able to control blood glucose by becoming more active and switching to a low carb diet. Indeed under his influence, around 280,000 people with diabetes have signed up to the online forum, diabetes.co.uk where they are able to swap tips on low carb meals and provide comradely support to each other as they’re forced to ignore the advice from their GP or diabetes nurse.
Desperate patients forced onto dangerous diet
When I wrote about this dilemma in the Daily Mail recently, the piece triggered over 200 responses from readers caught in this invidious position.
Mary Megan from London was ‘stunned’ last year when her GP ‘recommended eating carbohydrates as part of a ‘healthy balanced diet’ when I know for a fact from having tested my blood sugar over the years that carbohydrates are the exact cause of my high blood sugar.’
Bob from Sudbury, Suffolk has lost the sight in one eye and suffered kidney failure and nerve damage after being diagnosed with type 2 diabetes 12 years ago but given ‘little to no advice ‘. Sari from Hampshire says her mother ended up with a huge weight problem because her diabetic nurse insisted ‘you are getting it wrong by not eating enough carbs and that is the main cause of your problem.’ Poppy’s daughter in law was told she ‘must eat carbohydrates to use her insulin’.
It’s not just the UK where people with type 2 diabetes are confused.
Earlier this summer, the Academy of Nutrition and Dietetics, representing 90,000 US dietitians, ‘turned its back on decades of dietary dogma’ with a report to ‘de-emphasise saturated fat as a nutrient of concern’ while ‘recognising the strongest evidence that a reduction in intake of carbohydrates and added sugars will improve the health of the American public’.
Nurse told to stop making diabetics well again
Yet at almost exactly the same time, pro-low-carb dietitian Jennifer Elliott was expelled from the Dietitians Association of Australia because of her recommendation to lower carbohydrate diets to people with type 2 diabetes. When she turned up for work at Southern New South Wales health district, she was sacked – and a warning was issued to dietitians that ‘nutritional advice to clients must not include a low carbohydrate diet’. Elliott says she had no choice but to refuse to comply with this advice: ‘Can you imagine having to tell a client with diabetes, who has lowered his blood glucose levels, lost weight and come off all diabetes medications by reducing his carb intake, that he now has to start eating more carbs because SNSW Health says so !? she explains.
‘It’s not easy to be a dietitian in Australia advocating carbohydrate restriction, but even worse to be a person with diabetes in the SNSW Health district where you are denied the choice of a low-carbohydrate diet,’ she says on her website babyboomersandbellies.com.
Here too, it seems as though the health establishment is prepared to prevaricate indefinitely. Last month, Dr Aseem Malhotra, clinical associate to the Academy of Royal Colleges repeated a challenge to the charity Diabetes UK to explain why it continues to recommend ‘carbohydrates known to promote fat storage and hunger’ to a group of people most of whom urgently need to lose weight.
‘Given that type 2 diabetes is a condition related to an intolerance to metabolise carbohydrates, it is puzzling why Diabetes UK recommends as part of a “healthy balanced diet” the consumption of plenty of starchy carbohydrates and modest amounts of sugary food and drinks including cakes and biscuits,’ he said.
An inspirational doctor who is helping diabetics
In a response on its website to the Mail article, Diabetes UK acknowledges that there is indeed ‘evidence that low carbohydrate diets can be effective and control blood glucose’. But the statement by its clinical advisor, Douglas Twenefour, adds the extraordinary assertion that ‘a healthy balanced diet’ (ie with plenty of carbohydrates) ‘is easiest to understand and will benefit the majority of people with diabetes’.
It’s an assertion which assumes there can be no change to the current culture where refined carbohydrates are widely promoted and easily and cheaply available - a bit like a lung cancer charity saying that giving up smoking is a good idea but that it’s too difficult to get message across.
Making lifestyle changes to control blood sugar isn’t easy but it’s possible provided people are given detailed information – as the online community, diabetes.co.uk has shown. Dr Unwin has described how, as a committed, informed GP, he has been able to help patients with type 2 diabetes to lose weight and gain control over the blood sugar with a low carb diet – at the same time saving £20,000 per year in prescription costs – an important factor bearing in mind that Diabetes UK has recently warned that type 2 diabetes will bankrupt the NHS.
As for those who can’t imagine an end to advertising and product placement of refined carbs, they should consider the impact of smoking cessation policies on both health and culture over the past five decades.
For the sake of Mary, Bob and Sari’s mum and the three million other people diagnosed with type 2 diabetes in the UK, we need Diabetes UK to bring about a tipping point on carbs advice.
Jane Feinmann is an award-winning medical journalist with a special interest in investigating safe and effective healthcare. She belongs to Imperial College Health Partners’ Patient Safety Champion Network. Her website is janefeinmann.com.
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