204. Scientific Advisory Committee on Nutrition (SACN) Report on “Carbohydrates and Health”

In December I wrote to my MP, Julian Smith expressing my concern about the failure of the current UK policy on Type 2 Diabetes (T2D). I pointed out that the recommendation to reduce fat and increase carbohydrates was not working and that many people had discovered that it made their condition worse. By contrast, there is convincing evidence and numerous case studies which demonstrate that a diet which is low in carbohydrates and high in healthy fats (LCHF) is an extremely effective treatment for T2D.

I quoted the experience of Ian Day who made the following comment on one of my blogs:

“I was diagnosed Type 2 Diabetes in 2,000 at age 61. I was advised to eat the NHS “healthy diet” with plenty of starchy carbs, low fat, sugar and salt. I was also advised that however well I complied, diabetes was progressive and would lead to problems with eyes, kidneys and possible stroke and heart disease.

It’s inevitable – the nature of the disease.

Sure enough the disease progressed – reduced kidney function, beginning of retina bleeds, chronic tiredness and severe crippling peripheral neuropathy.

In May 2008, with advice from Fergus on the www.diabetes.co.uk/forum I gave up all the obvious carbs.

My blood sugars immediately improved and within 3 months I was out of pain and able to play tennis again.

Now, after 7 1/2 years on a low carb, high fat diet I am well, with NO diabetes complications.

I would not DARE revert to the NHS/Diabetes UK “healthy” diet. It’s poison.”(emphasis added)

The complete letter can be accessed here (1).

The letter was forwarded to Jane Ellison who is the Minister for Public Health. Here is an extract from her reply:

“With regard to low carbohydrate diets, the Scientific Advisory Committee on Nutrition (SACN) has published its report “Carbohydrates and Health” in July. In that report, SACN considered evidence from a wide range of prospective studies and randomized controlled trials that investigated the relation between consumption of carbohydrates and various health outcomes. The evidence considered by SACN for this report does not support the suggestion that consuming a diet low in carbohydrates and high in fats would reduce the risk of type 2 diabetes, but found that greater consumption of sugar sweetened beverages is associated with increased risk.”

Clearly the Minister is totally reliant on the SACN report so it is worth considering some of the aspects which relate to T2D in it.

One of the issues in the terms of reference was to review:

“the evidence on dietary carbohydrate and cardio-metabolic health (including cardiovascular disease, insulin resistance, glycaemic response and obesity)”

Insulin resistance is (IR) the key to understanding T2D. However the report pays little attention to this concept and it is not mentioned at all in the conclusions and recommendations. Unbelievably I can find no reference to the highly significant work of Gerald Reaven who is known as the

“Father of Insulin Resistance.”

He and his research team established the importance of IR in human disease especially in T2D. But he also demonstrated that it has a crucial role in those who do not have T2D with respect to various other parameters which include triglycerides (TG), low HDL-C, hyperuricemia, decreased LDL-C particle diameter, salt sensitivity, essential hypertension and increased sympathetic nervous system activity.

As long ago as 1988 Reaven delivered the Banting lecture in which he proposed his concept of Syndrome X which has subsequently been described as the Metabolic Syndrome (MetS) (2). Here is how he describes his ideas:

“The common feature of the proposed syndrome is insulin resistance, and all other changes are likely to be secondary to this basic abnormality. All five of the proposed consequences of insulin resistance have been shown to increase the risk of coronary artery disease (CAD), and the fact that all of them may not necessarily be seen in the same individual should not minimize their importance. Based on these considerations, it seems fair to make the suggestion that resistance to insulin-stimulated glucose uptake may play a crucial role in determining who will and who will not develop CAD.”

Reaven identified the crucial role of insulin/IR in the development of many different diseases. We now understand that if there is excessive consumption of sugar and carbohydrates this will result in a build-up of glucose in the blood.

Consequently there has to be an increase in the secretion of insulin by the pancreas in order to direct the glucose to the liver and convert it into fat which is then stored. The effect of this is to ensure that the concentration of glucose in the blood remains under control. However if the high intake of sugar and carbohydrates persists, IR will occur in various organs including the liver and pancreas. As this continues to get worse the pancreas responds with even more insulin. It is possible to maintain control of the blood glucose in this way for up to about 10 years. Eventually a point is reached where the pancreas fails and is no longer able to meet the demand for insulin. This is when the blood glucose starts to rise. If blood glucose measurements are done, then T2D will be diagnosed. Even if T2D does not develop, the IR which is caused by the high level of insulin (hyperinsulinaemia) constitutes a serious risk in its own right, which may result in a range of different chronic diseases.

Reaven has explained that essentially there are two scenarios. In one the pancreas is damaged to such an extent that it is unable to produce sufficient insulin to maintain control of the blood glucose which means that T2D is the result. Hence it is highly likely that retinopathy, nephropathy and neuropathy will develop. In the other, the pancreas continues to produce sufficient insulin to control the glucose in the blood BUT the high concentration of insulin (compensatory hyperinsulinaemia) causes a different set of diseases. These include hypertension, stroke, polycystic ovary syndrome (PCOS), non-alcoholic fatty liver disease (NAFLD), cancer, sleep apnea. Cardiovascular Disease (CVD) is common to both pathways. From the perspective of the individual, the first warning signs are likely to be when the blood glucose starts to rise. However it is clear that the even without any increase in blood glucose, if the insulin levels are raised this constitutes a genuine increase in the risks of developing many different diseases.

Basically all this develops from the fact that the requirement for insulin has been stimulated by the high quantity of glucose in the blood. This in turn is a direct result of the amount in the diet. So the obvious answer is to alter the diet by reducing the amount of sugar and carbohydrates. There are hundreds of individuals who can confirm this not to mention many different research studies.

Conclusion

In the light of this, the recommendation of the SACN report that the population average intake of carbohydrates should be 50% of the energy consumed is surprising to say the least. The committee has totally failed to appreciate the relevance and crucial importance of IR. Consequently it has not confronted the key contemporary public health issue which is the persistent steady increase in the incidence of T2D. It is therefore somewhat disingenuous of Minister Ellison to use the SACN report to dismiss my concerns about T2D and how the disease can be tackled.

It is quite staggering the SACN review has failed to address these issues. We can only assume that the members who prepared the report are ignorant of the information. The fact that such key issues have not been addressed means that the SACN report is fundamentally flawed and is utterly useless as contribution to public health policy formulation.

Other features of this SACN report has been subject to criticism by Zoë Harcombe (3).

 

REFERENCES

  1. http://vernerwheelock.com/?p=921
  2. G Reaven (1988) Diabetes 37 (12) pp 1595-1607
  3. http://www.zoeharcombe.com/2015/07/sacn-report-carbohydrates-health/

203. Dietary Guidelines for Americans: Another Fine Mess!

The cornerstone of the original dietary guidelines was the recommendation to reduce the intake of saturated fat (SFA). This in turn led to the advice to increase the consumption of complex carbohydrates and the polyunsaturated fat (PUFA). The fundamental basis was the so-called “cholesterol theory” which was that the risk of developing heart disease was associated with the levels of total cholesterol (TC) and LDL-Cholesterol (LDL-C) in the blood. The case against SFA was that it pushed up these 2 parameters and therefore lowering it would reduce the risk. Similarly it was argued that the risk would also be reduced by increasing the consumption of PUFA because of its effect on TC and LDL-C.

It is obvious to anyone who examines the evidence in a dispassionate way that it is full of holes. In particular:

  • Because the emphasis has been completely focussed on heart disease, the implications for other diseases/conditions have been neglected. The only logical approach is to concentrate on all causes of illness/death. The best indicator of progress (or the lack of it) is all-cause mortality (ACM).
  • It emerges that when this is done, the highest death rates are for those with low values of TC and LDL-C. It is quite amazing that in men there is no increase in death rates at high values and surprise, surprise, in older women, which is when most deaths occur, the greatest life expectancy is in those with the highest values (1).
  • There has been a failure to recognise the role of the different individual SFAs which vary in their effects on TC and LDL-C. Many of them are important nutrients in their own right (2).
  • Similarly there has been no appreciation that increasing the omega-6 PUFAs can be extremely detrimental because of increased inflammation which can lead to many different diseases including cancer and heart disease (3).
  • It is virtually certain that the recommendation to increase the consumption of carbohydrates is one of the critical factors which has contributed to increase in the incidence of type 2 diabetes (T2D).

Despite these rather inconvenient facts, the recently approved Dietary Guidelines for Americans (4) continues to point the finger at SFA.

Here is the actual recommendation:

“Limit calories from added sugars and saturated fats and reduce sodium intake. Consume an eating pattern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns.”

The scientific basis was developed by an Advisory Committee which reported earlier in 2015 (5) and relied heavily on a report prepared jointly by a Task Force of the American College of Cardiology and the American Heart Association entitled:

“2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk”

It is unbelievable that once again there has been heavy reliance on evidence which is restricted to heart disease. In fact the report specifically states that the objective is:

“to develop clinical practice guidelines for assessment of cardiovascular risk, lifestyle modifications to reduce cardiovascular risk, management of blood cholesterol in adults, and management of overweight and obesity in adults.”

Furthermore:

“Outcomes of interest not covered in this evidence review were the following risk factors: diabetes mellitus (diabetes)-and obesity-related measurements, incident diabetes metabolic syndrome, high-sensitivity C-reactive protein, and other inflammatory markers.” (emphasis added)

The fact that T2D, which is probably the most important public health issue at the present time, has been omitted simply beggars belief.

Reverting back to the report itself, it is evident that the “cholesterol theory” remains one of the pillars of the strategy. Even though there is overwhelming evidence that low TC and low LDL-C is associated with high ACM, the AHA/ACC continues to regard any treatment that lowers these values as beneficial with respect to heart disease. It accepts that many people in the USA would benefit from lowering their LDL-C and are advised to:

  • Aim for a dietary pattern that achieves 5% to 6% of calories from saturated fat.
  • Consume a dietary pattern that emphasizes intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats.

Essentially this advice has finished up in the approved Dietary Guidelines. What this means is that the vilification of the SFA continues.

Missed opportunity

There is no doubt that the original American guidelines did enormous damage because they advised a reduction in fat/SFA that helped to increase the consumption of carbohydrates, which is one of the major reasons why T2D is currently such a huge problem. It is a global issue because so many countries took the lead from the USA in the development of national nutrition policies. We have now reached a point where the only effective means of combatting the T2D crisis is to take policy initiatives which will result in a substantial reduction in the consumption of sugar and other carbohydrates. While there is growing recognition that sugar intake should be controlled, there will be little progress until it is accepted that there has to be a corresponding increase in the consumption of healthy fats which includes SFA.

The fact that the USA continues to advocate a sharp reduction in SFA is a set-back which flies in the face of overwhelming evidence.

On the other hand there are many positive signs and there is growing awareness that a fundamental re-think is required in official policies around the world.

Perhaps the most impressive proof comes from Sweden where the national diet has been changing in accordance to these concepts. In fact there was recently a shortage of butter! The incidence of obesity is beginning to decline and I have it on very good authority that T2D is also starting to decline.

 

Source: http://www.dietdoctor.com/wp-content/uploads/2015/05/obesity-sweden.jpg

Policy failure

The adoption of the US guidelines is just one more example of the inadequacy of policy formulation, which happens in so many countries. It is proving to be extremely difficult to achieve fundamental shifts in concepts. This is probably because governments invariably rely on the establishment “experts”.  Most of these have built up their reputations by helping to devise the current strategies. It is quite an eye-opener to discover that so many of the leaders in the medical profession in the USA and elsewhere still apparently believe in the “cholesterol theory” and are quite unaware of (or chooses to ignore) the evidence which destroys its credibility.

A closely related aspect is the ineptness of politicians to exert control and who seem to be incapable of challenging the validity of the advice presented by the medical/health professionals. But that is a story for another day.

 

 

REFERENCES

  1. http://vernerwheelock.com/?p=838
  2. http://vernerwheelock.com/?p=155
  3. http://vernerwheelock.com/?p=153
  4. http://health.gov/dietaryguidelines/2015/guidelines/executive-summary/
  5. http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf
  6. http://circ.ahajournals.org/content/129/25_suppl_2/S76.long

 

202. Have the benefits of Vitamin D been overhyped?

Professor Tim Spector of King’s College, London has just written an article in which he says he has changed his mind about advocating the supplementation of a number of vitamins, including Vitamin D (1). First of all, he must be applauded for having the courage and integrity to admit in public that he has been wrong in the past. One of the plagues of the modern day is that far too many scientists and other health professionals refuse to accept that their pet theories are no longer valid. As a consequence they regard any criticism as a personal attack and continue to defend their position long after it has lost all credibility. So it follows that the arguments used by Tim Spector have to be taken seriously.

His doubts were raised by 2 recent papers on the effect of Vitamin D supplementation on the number of falls and on the incidence of fractures in older people (2, 3). It was found that those who were given 60,000 International Units (IUs) per month had more falls than those who were given 24,000 IUs.

Vitamin D status is assessed by the concentration of the 25-OH derivative (25(OH) D) in the blood. In order to put these results into perspective this aspect needs to be considered. The subjects in this trial were given a large dose once every month. One group was given 24,000 IUs once a month and another was given 60,000 IUs per month. It was found that those with blood levels of 110 nmol/L-240 nmol/L 25 (OH) D had the highest incidence of falls. It must be stressed that these doses are relatively high. Furthermore one large dose every month is different from having the same total amount in smaller doses taken daily. None of those who were being given 24,000 IUs had blood levels which were this high.

In the USA the Institute of Medicine (IoM) has recommended that a blood level of 50 nmol/L 25(OH) D for 97.5% of the population should be the objective. It concluded that this could be achieved if the intake was 600 IU per day. Clearly this is way below the level which was associated with the falls in the above study.

However what is highly relevant is that 2 authors of the paper quoted above, Prof. Heike A. Bischoff-Ferrari of Zurich University and Prof. Walter C. Willett of Harvard, were concerned that with respect to bone health the recommended serum levels of 25(OH) D were too low (4). They noted that:

  • A threshold of 50 nmol/l (20 ng/ml) for the 25(OH) D concentration was insufficient to achieve a reduction in the incidence of falls or fractures in treatment groups.
  • Furthermore, in the very large population-based NHANES analysis, bone density increased with higher 25(OH)D levels far beyond 50 nmol/l (20 ng/ml) in younger and older adults suggesting that the IOM threshold recommendation is too low for optimal bone health in adults.
  • The International Osteoporosis Federation had recommended that the Vitamin D intake should be 800 to 1000 IU for people aged 60 years and over in order to achieve a serum 25 (OH) D level of 75 nmol/L. This was considered optimum for the limitation of falls and fractures.

They go on to comment:

“The IOM conclusion that intakes of vitamin D are adequate for most of the US population assumes that lack of randomized trials means lack of benefit, which seems illogical.”

One wonders what their view would be of the recommendation of the Scientific Advisory Committee on Nutrition (SACN) in the UK which has decided that 25 nmol/L 25(OH) D would be suitable for the population of the UK and the Recommended Nutrient Intake (RNI) should be 400 IU per day. This appears to be unbelievably complacent and is only half the value which the IoM advises.

Tim Spector’s doubts were reinforced by an “umbrella review” in the BMJ which was based on over 250 reviews/meta-analyses (6). This concluded that there is highly convincing evidence for a clear role of Vitamin D does not exist for any outcome, but associations with a selection of outcomes are probable. In other words, the researchers were unable to find any convincing evidence, especially randomised controlled trials (RCTs) which proved conclusively that there was a definite improvement in those individuals who had an increased intake of the vitamin.

As usual, readers were able to respond to this article and many of them had reservations about the conclusions and significance of this paper. The points made include the following:

  • Many of the studies cited did not take precautions to ensure that those with an adequate supply of Vitamin D were excluded. Clearly such participants would not be expected to respond positively.
  • Inadequate numbers in some of the trials.
  • Failure to have a high enough dose of Vitamin D.
  • Failure to allow for the role of other minerals and vitamins including Vitamin A, Vitamin K2, calcium and magnesium.
  • The tissue damage related to a specific aspect if ill-health may not be reversible and therefore not effect would be detected.

One of the respondents noted that one of the co-authors of the umbrella review, John Ioannidis, has concluded in an earlier paper such reviews should be regarded as:

 “subjective and suboptimal”,

“limited by the data in the primary studies” and the process of

 “patching together pre-existing reviews”.

This means that they are open to subjective interpretations based on the authors’ opinions. The respondent, Simon Spedding, commented that:

“The reason Vitamin D meta-analyses and reviews fail to produce useful results is thought to be biological flaws in primary studies… These flaws lead to null results as the intervention does not change the Vitamin D status; however these flaws may be overlooked when evaluating the research for Vitamin D and other nutrients…”

Furthermore:

“The review authors… describe flaws as “difficulties in relation to RCTs” such as “low dose vitamin D supplementation”, “large differences in baseline plasma concentrations of 25-hydroxyvitamin D” and “contamination with private use of vitamin D” in the randomised controlled trials that might be “inadequate to raise the body’s vitamin D concentrations enough to show a difference between the arms of a trial”…Whilst this umbrella review… recognised these “difficulties” or biological flaws in their primary studies, the authors choose not to compare meta-analyses of flawed and unflawed primary studies.”

Despite these concerns raised by Tim Spector the fact remains that there is compelling evidence from a variety of different sources and disciplines which indicates that in many people there is an insufficiency of Vitamin D. Therefore it would be beneficial for them to increase their intake.

The findings that there is an increased incidence of falls reported in the study are likely to be genuine but closer examination shows that the blood levels in those affected are very much higher than in the vast majority of the general population. It is possible that the single high dose causes particular problems in the group of older people. Undoubtedly such high levels in the blood should be avoided and it is important to discover why that occurred in this investigation. Nevertheless there is absolutely no doubt that in many people the Vitamin D status is far too low and nowhere near that reported in the study. There is no question that current official recommendations in the UK, which are only 50% of those in the USA, are totally inadequate. But there are also valid reasons for believing that the USA recommendation should be increased.

So while I respect Tim Spector for his honesty and integrity, I suspect that he has failed to appreciate the weaknesses in the papers which have caused him to change his mind. It also appears that he has discounted the excellent work of a number of key players, such as Michael Holick (6), who have made valuable contributions to our understanding of the crucial role of Vitamin D in the body.

REFERENCES

  1. http://theconversation.com/the-sun-goes-down-on-vitamin-d-why-i-changed-my-mind-about-this-celebrated-supplement-52725
  2. S R Cummings et al (2016) http://archinte.jamanetwork.com/article.aspx?articleid=2478893
  3. H A Bischoff-Ferrari et al (2016) http://archinte.jamanetwork.com/article.aspx?articleid=2478897
  4. http://www.hsph.harvard.edu/nutritionsource/vitamin-d-fracture-prevention/
  5. E Theodoratou (2014) http://www.bmj.com/content/348/bmj.g2035
  6. M F Holick (2010) “The Vitamin D Solution: A 3-Step Strategy to Cure Our Most Common Health Problems” Plume (Penguin) New York

201. Let those with Diabetes Speak for Themselves

In this blog, I will highlight the views and experience of those who have succeeded in coping effectively with their condition. Invariably this has been achieved by reducing consumption of sugar and carbohydrates and replacing them with healthy fats (LCHF). Usually this has been in direct conflict with the advice from the official sources.

In September 2015, the American Diabetes Association posted the following question on Facebook:

“What was your most recent blood glucose reading?” (1).

There were over 800 responses, many of which were highly critical. Here is a selection:

  • Carolyn Fisher 81
  • “Because I DON’T follow the ADA’s advice! The ADA diet given to me by a diabetic educator told me to eat 165 grms of carbs per day and she “had to follow the ADA guidelines”. Your advice is killing people! Do you see all these comments? All of us that have normalized our BS’s from the knowledge of Dr. Richard K. Bernstein, MD and are succeeding in achieving great blood glucose control. He should be the Head Medical Director of the ADA if your mission is really to help people. Wake UP!”
  • Andrea Athey
  • “My fasting bs was 105. I’m following low carb high fat diet. I’ve been grain and sugar free for three months. Previously, may average fasting glucose was 160. This was when I was following the ADA recommended diet given to me by a diabetic nurse. What are you guys doing? Trying to kill us?
  • Catherine Chandra Watkins 77
  • “Before lunch (I’m a T2). How do I achieve that? I use low-carb, high-fat eating and intermittent fasting to reach actual normal blood glucose readings. And I have more energy and brain power running on ketone bodies than on glucose. I don’t understand, ADA, why you tell people who can’t tolerate carbohydrates–a nonessential macronutrient–to eat that which will cause them severe problems. I totally don’t get it. LCHF is completely sustainable and satisfying, once you are in ketosis and the carb cravings stop. And I’ve lost 70 pounds painlessly. Why do you continue to tell diabetics to poison themselves? ?? ???”
  • Maria Jerry James
  • “On Dec 8 2014, I left my Dr in tears. My a1c was 8.9, my vision was terrible with multiple hemorrhages, I was taking Lantus 50 u twice a day, at least 5 shots of R 10 u per my ss, I also took 2000mg Metformin, 8 mg Glimerpride, a stomach and a bp pill as well, and I was morbid obese. I came home and found a fb group called Reversing Diabetes, who had put tons of hours of research in Low Carb High Fat way of eating. I loved the numbers this bunch was having so I thought what the heck. Within the first month I was off all insulin and most of the meds. Today, I am med free!! My a1c is 5.0, I have lost 60 lb, my eyes are clear, and my labs are wonderful. Take the bull by the horns people, stop feeding this disease. I lost my 64 yr old aunt to this disease, not because her bs was high, but because she took so much insulin to keep it normal.”
  • Debra McElyea Rainey
  • “The ADA diet is responsible for the deaths and maiming of many diabetics. If you want to live with diabetes and be healthy, low carb is the only way.”
  • Vikki Rostoll-Olivier
  • “I have been a Type 1 diabetic for 28 years, and am now 31. After all those years following the death sentence ADA diet, I eventually lost the sight in my left eye due to Retinopathy. Who I actually have to blame is the ADA, but they don’t care. They are not the one who has lost sight. Thank goodness for Dr Bernstein, as I now have sugars that are 4, and almost never go over 8 after a meal. The ADA diet is a death sentence!!!”

The NHS Choices provides information on a range of health-related topics. One of these is entitled:

“The truth about carbs”

by dietitian Sian Porter (2). I did a blog about in October 2014 (3). In particular I repeated a number of comments on the article which were critical of the points in it. Here are some examples:

  • “Have the NHS been infiltrated by certain members of the food lobby or are they really this ignorant?   No wonder this country has an obesity crisis!”
  • “Dreadful article. Old 70’s health myths dressed up as common sense advice. I do not understand how this is allowed to be put out as public information from the NHS.”
  • “Hello Sian, I am concerned that you are pushing the low fat dogma despite the relentless science and research that shows that the dogma is nonsense. The NHS has a public duty to admit low fat calorie obsession is a dead end. You do not deal with hormones, metabolism and gut health. Food quality and healthy metabolism are key to health, not carbs. Please stop defending the mistakes of the past.”
  • “This commentary is full of inaccuracy, fallacy, opinion, and error.”
  • “I have been low carb for over a year. Result ; lower triglycerides, ldl static, hdl increased, fasting blood sugar lowered, energy levels increased. Oh and not to mention two and a half stone lighter. I eat lots of saturated fat and enjoy it. Am i constipated? No. You need to examine the huge and growing scientific evidence on low carb high fat diets.”

In the light of the very damning comments I would have expected there would have been some attempt to answer them. But instead the comments have been removed. However it is still possible to award a rating on a 5-star scale. The result: 666 out of 925 were for a single star!

In August 2015, there was an article in the BMJ in which Dr David Unwin and Dr Simon Tobin reported on how one of their patients had successfully achieved weight loss and effectively overcome his Type 2 Diabetes (T2D) by cutting out sugar and reducing carbohydrates in his diet (4). As a result he was able to stop all 4 drugs he had been taking and the paper made a plea for a concerted effort to reduce the amount drugs being prescribed. This obviously struck a chord with many people who responded with their views and experience. Here is a selection:

  • Katherine H Aull. PhD student
  • “I was put on a low carb, high fat diet due to neurological complaints. I am now off all medications and remain asymptomatic, so long as I follow the diet. Further, I lost 15kg and am now effortlessly maintaining a weight I hadn’t been since primary school. I eat heroic doses of saturated fat, salt, and cholesterol, with absolutely no whole grains. Yet my blood cholesterol is normal, with a total: HDL ratio under 2.4.”
  • Debbie Wright-Theriault, Hair Replacement Specialist/ADE (associate diabetes educator)
  • “I’m a 49 year old type 1…I cannot understand the current recommendations in my country by the ADA on giving 30-60 carbs per meal. It’s a proven, scientific fact that carbs raise glucose….and high glucose causes an entire slew of complications such as blindness, loss of limbs to neuropathy and kidney failure…so why recommend eating so many carbs?? I eat 30 grams or less of carbohydrate per day and all those are from non starchy veggies. I am well nourished, never hungry and my last 5 A1C’s have been in the 4’s. ..with the last one 4.8..why is this way not prescribed to patients? I eat delicious foods made with almond flour instead of wheat flour…with no sugars and no unhealthy ingredients…they are easy to make, recipes are readily available online and in cookbooks…..so why the high carb recommendations? It’s akin to telling a child with a peanut allergy to continue to eat peanuts and just keep the epi pen handy. With the high carb recommendations of the ADA, people have to inject massive amounts of insulin and still have no control over roller coaster blood sugars…is that healthy? I think not. Please…someone…review these current guidelines that are slowly killing people and start saving lives!!”
  • Angela M Erickson, Registered Nurse
  • “I absolutely agree with the recommendation given for carbs being a bad idea. I have been type 1 for over 22 years. A couple years back I had many beginning complications. High cholesterol, numb areas in my feet, hormone imbalances, and an irregular heart rhythm to name a few. I decided to adopt Dr. Bernstein’s protocol. I now eat 30g of leafy green carbs a day, or less. I have an a1c of 4.9. I’ve regained the feeling in my feet…my PCOS has resolved, and I finally have hope for the future. I just wish someone on my medical team had come to me with carb restriction as an option, long ago.”
  • Sarah J Hallberg, Physician
  • “As an obesity medicine physician who uses low carb high fats diets in all of my patients I cheer the publication of this article. Nowhere in medical school or after is the concept of taking someone OFF medications discussed. Why should we? Patients are supposed to just get sicker, right? This attitude is not only pervasive but more important WRONG. They get sicker only when they are taught to eat a diet that makes them sicker. Unfortunately, this is the low fat diet pushed by all so called “patient advocacy groups” such as the American Diabetes Association. When taught to eat a whole foods low carb high fat diet patients do get better and “deprescribing” is a daily occurrence in our clinic. We need to stop using medicine to treat food! Doing this requires teaching the patients why and not just telling them what to do. The idea that patients don’t want to or are not capable of change is not true if you teach them to do something where they can actually see change.”
  • Paul E Buchanan, Director, Team Blood GlucoseI undertook a period of intense study and learnt all I could about the action of insulin, learning that taught me to completely disregard the standard model of care offered to people with diabetes in the UK, to disregard the published advice of the leading charities that work in diabetes in the UK and to adopt a low carb, high fat lifestyle.Within 6 months I had completed my first Olympic Distance Triathlon.Reducing insulin use and modifying behaviour is critical to a long-term and successful management of type 1 diabetes.”
  • I then founded teambloodglucose.com to help other people with diabetes learn how to live more active lives with diabetes. We now have a formal partnership with Imperial College, London. We conduct in the field research and publish peer-reviewed articles and papers on activity and diabetes.
  • Within three months I had reduced my HbA1c to 5%, self-taught carb counting and worked out all of the ratios I needed to manage my diabetes.
  • “In response to a diagnosis of Type 1 Diabetes at the age of 44 with a fasting HbA1c of 13.6% I was initially mis-diagnosed with Type 2 Diabetes. Some weeks later I was re-classified as Type 1 and prescribed insulin. I was given no training nor offered any education as “it will take eighteen months or so for you to stop ‘honeymooning’ and there is no point in trying to work out any ratios or tech you to carb count as it won’t help'”. In response to the question about how I should manage by glycaemic control with an ambition to complete the London Marathon I was advised to do nothing more strenuous than a gentle walk once a day as there was no telling what exercise might do to my blood glucose levels. This was in 2012.

The Low Carb Diabetic website provides guidance and information for those suffering from either T1D or T2D based on a diet which has a low carbohydrate content (5). Many of the contributors have followed the advice with great success. Here are some of the stories:

  • Janet
  • “I had no real advice on diagnosis, just told to ‘eat a healthy diet’. I have a friend who has been type 2 for a long time and I knew you were supposed to check your blood sugar. I asked for a meter and was told I would be given one by the diabetic nurse when I saw her eventually. Meanwhile I did some reading online, was devastated to find out the implications of uncontrolled diabetes and felt my life was over. However I was lucky that within less than a week I had found this site and also Fergus who I emailed about his lowcarb bread. That was the beginning of hope for a healthier future for me. I cut out carbs drastically, when I got my meter I found that just one piece of Burgen bread sent my blood sugar to double figures, as did one weetabix and a drizzle of milk. That was it; I knew that there had to be something odd about the standard dietary advice if I wanted to get good bs control.My GP says that he can’t remember a diabetic in the practice with such a low hba1c for a long time, but is very evasive when I ask about the madness of the standard dietary advice, and I am just told the famous mantra….’If it works for you…’ If it works for me why not for others? I know that ‘we are all different’ but the present dietary advice to eat lots of carbs, particularly when many are also told not to test is madness, testing is essential for everyone, only then do you find out what you can or can’t eat.”
  • At my first hba1c, after 2 months of strict lowcarbing, it was at 7.2, I know it would have been much higher if it had been taken at diagnosis. My hba1c has since dropped gradually, my latest being 5.4. My bloods are good, kidneys perfect, my hdl cholesterol is 48% and triglycerides are 0.5. I eat cream, butter and cheese etc. I have also lost more than 4 stones in weight. I feel much better and look it too. People always ask how I did it and can’t believe it sadly when I say I don’t eat many carbs but I do eat fat. I was always a keen cook and after initial despair at what was I going to eat, I now relish the challenge of adapting recipes and inventing new dishes which fit into my new lifestyle.
  • “My diabetes was diagnosed by chance in 2009, when my GP asked me to have a fasting blood test due to raised BP. This came back at 7.1, I was asked to have another one which came back at 9. I have since found out that another blood test in 2006 showed a fasting level of 6.6, but for some reason I was never informed I was pre-diabetic. Knowing what I know now my sugars would have been running wild during that time. I had been overweight for many years but always active, people often said I should have been skinny as I was always busy, but at the time of diagnosis I weighed more than 16 stone and whatever I did, it didn’t seem to shift. I also ate lots of fruit; sometimes seven pieces a day, granary bread, pasta and rice, plus fruit juice. I was literally welcoming diabetes but didn’t know it at the time, had I known I was pre-diabetic I might have done some research and avoided becoming a fully paid up member of the club no one wants to join. Just before diagnosis I remember having a really ‘carby’ day when I felt so sleepy and my feet were burning, as if on fire, couldn’t get rid of it for over a day, I am sure these were the effects of very high sugars. Looking back I often felt sleepy after lots of carbs, but put it down to a demanding job and life.”

 

    • Kate
    • “My name is Kate, a lively 63 years young, living in Cornwall with my husband and dogs, lots of family and grandchildren close by. My Mother, who sadly died in June this year, aged 92 had Diabetes Type 2, was not overweight and until Alzheimer’s changed her life, was fit and healthy. I have always been aware that because my Mothers Mum, my maternal grandmother also had Diabetes, it was not unlikely that I would also develop it at some stage. I have always prepared healthy food but admit to maybe enjoying my food too much!
    • I have also suffered from high BP throughout my adult life, another legacy from Mother, plus Hyper Cholesterolemia, same source, which means that without help, my body does not deal with cholesterol efficiently and so it lays stored, I have been taking statins for some years now and generally have no ill effects, I also take Atenolol and Ace Inhibitors for an erratic BP. Three years ago, a routine blood test showed elevated levels of sugar and so I took a Glucose Intolerance test, the results showing Pre Diabetes. I was given very little advice, just handed a booklet to read, no tea and sympathy! Because at that time, I didn’t know any better, I followed the advice in the booklet, eat plenty of starchy carbs, which I did and soon noticed the weight gain!My family has a history of glaucoma and I have an annual eye check to ensure my eye pressure hasn’t increased. My job involves working with children with a visual impairment and I am well aware of how precious sight is. Interestingly my eye pressure had risen the year before diagnosis, but after 3 months low carbing it had dropped and earlier this month when I saw my optician he couldn’t believe how much further it had gone down. I told him that I was convinced that it had gone up due to high blood sugars and that it was now much improved due to good bs control, which he thoroughly agreed with, another bonus.
    • Who knows what is around the corner, but all I can say is that at the moment life is good, I am healthier than I have been in years and have made some wonderful friends who I am convinced have helped to save my life.”
    • I spoke to my Doctor who said not to worry, carry on doing what I was doing, so carry on I did! We then moved house and had to change Doctors and shortly afterwards, my new Doctor ordered blood tests to check on my liver function due to the statins, the results showed a high blood sugar and so the test was repeated two weeks later, the BG was even higher this time and an HbA1c showed 8.8, definitely Diabetes! I was devastated, I felt betrayed and angry and from that moment on, I decided to take charge of my own disease and destiny, embarking on a read, read and more read programme, it soon made perfect sense that the carbs were the culprit! My newly appointed Diabetes nurse was aghast at my new regime of low carbing, “On your own head be it” were her words! Pretty soon, she had to eat her words as the BG began to fall without the help of medication and although I wasn’t grossly overweight, my body became toned and healthy at a near perfect 9 stones. The HbA1c result after 8 months was 5.7 and at this juncture, the nurse no longer had an argument, indeed she began to ask me about my regime, taking notes whilst I sang the praises of low carbing, what sweet irony!! It’s no use being bitter, I try to be resolute and embrace my new way of life even though there are the odd times I come close to falling off the wagon, but so far I am clinging on for dear life!
    • Fergus2000:
    • “I have had type 1 diabetes for 27 years. For the first 20 of those I had gradually worsening health – increasing blood glucose, insulin use, hypoglycemia attacks and weight. I followed an approved diet based around starchy carbohydrates and low in fat. In 2000 I began trying to reverse my decline by restricting carbohydrates in my diet and replacing them with more meat, fish, vegetables, eggs, dairy foods and nuts, although I received no encouragement from my doctors in using this approach. The results have been remarkable2000: HbA1c 7.6%, BMI 29, HDL 1.7, LDL 2.4, triglyceride 0.7, daily insulin use ~80 units

      2008: HbA1c 4.7%, BMI 22, HDL 3.1, LDL 1.8, triglyceride 0.5, daily insulin use ~ 20 units

      I have always tried to look after myself, staying physically active and working hard. I have never consciously reduced my calorie intake. I believe all diabetics should be made aware of the potential benefits of such a diet before deciding how to deal with their condition.”

 

  • In December I wrote to my MP who forwarded the letter to Ministers in the UK Department of Health (6).

Here is a quote from the reply by Public Health Minister Jane Ellison:

“With regard to low carbohydrate diets, the Scientific Advisory Committee on Nutrition (SACN) published its report “Carbohydrates and Health” in July. In its report, SACN considered evidence from a wide range of prospective studies and randomised controlled trials that investigated the relation between consumption of carbohydrates and various health outcomes. The evidence considered by SACN for the report does not support the suggestion that consuming a diet low in carbohydrate and high in fat would reduce type 2 diabetes, but found that greater consumption of sugar-sweetened beverages is associated with increased risk.”

It is obvious this is a direct contradiction with the experience of those I have featured above. Essentially she is implying that all those who claim to have successfully treated T2D with LCHF are liars and charlatans. This Minister is incapable of making any kind of independent assessment for herself and is probably putty in the hands of her advisers who will never admit they have been wrong as long as they can get away with it.

If you are concerned and agree with me that the current policy is a disaster and causing many to suffer and die prematurely please present your views to Jane Ellison and her boss Jeremy Hunt.

Her email is jane.ellison.mp@parliament.uk

Tweet Jane Ellison MP@JaneEllison

If she is bombarded with letters, emails and Tweets then maybe the message will eventually get through.

 

REFERENCES

  1. https://www.facebook.com/AmericanDiabetesAssociation/posts/10153140618374033
  2. http://www.nhs.uk/livewell/loseweight/pages/the-truth-about-carbs.aspx
  3. http://vernerwheelock.com/?p=614
  4. http://www.bmj.com/content/351/bmj.h4023.full?ijkey=AN2nBwW6h3wuQJK&keytype=ref
  5. http://www.lowcarbdiabetic.co.uk/
  6. http://vernerwheelock.com/?p=921 

200. Never Mind the Cholesterol it’s the Insulin

I have now been blogging for 3 years and this is Number 200! Although it has been hard work it has been an amazing experience. In particular, through the medium Twitter I have made contact with many different people from all over the planet. I greatly appreciate the interaction with so many individuals, who are doing excellent work and have fascinating stories to tell. Some like Jen Elliott in Australia and Tim Noakes in South Africa are having to fight battles to defend their professional integrity at considerable personal cost. It is important to understand that they at the forefront of a campaign for a more rational strategy to prevent and treat disease which will mean significant improvements in health and well-being for everyone.

So a great big THANK YOU to all those who responded to my blogs and tweets in any way over the past few years. It is a very special occassion when the opportunity arises to meet you in person for the first time. The usual introductions are superfluous because it is like a re-union with an old friend! The highlight of 2015 for me was the visit to Cape Town for the Low Carb Summit in February. Cape Town is a wonderful city. The event itself was a tremendous occasion and a unique opportunity to meet many of those from all over the world who in their own way are helping to promote a sound approach to nutrition and health. It was striking how many individuals, working away on their own, had reached essentially the same conclusions about the faults in the official dietary guidelines and the steps needed to correct them.

In this post I will tackle one of the original issues which has had a huge influence, namely the cholesterol theory. Despite all the knowledge and information which conclusively demonstrates that blood cholesterol (TC) is not a risk factor for heart disease or anything else, the authorities persist with the myth, spending enormous resources on testing and scaring the living daylights out of many people. (Blog 179 gives a brief run down on how things have gone badly wrong) (1). As an example, the evidence shows that those with the lowest TC and LDL-cholesterol (LDL-C) have the highest all-cause mortality (ACM). For women, those with the highest TC have the greatest life expectancy). The position is rather like when the police arrest the wrong person for a murder which means that the genuine killer remains on the loose. In this context, it is my contention that the focus of attention should be on insulin. Of course insulin plays a number of key roles in the body but if these are disrupted then this can lead to a range of different forms of disease and ill-health.

Essentially what happens is that when the body is subjected to a threat such as an infection, injury or toxic material, there is a response by the immune system to deal with it. Invariably this includes changes which result in insulin resistance (IR). This means that the sensitivity to insulin has been reduced and therefore the amount of insulin required to achieve a given effect has been increased. This can be illustrated by describing how Type 2 Diabetes (T2D) develops. The initial cause is invariably consumption of excessive amounts of sugar and carbohydrates which results in a build-up of glucose in the blood. This triggers an increase in the secretion of insulin by the pancreas in order to direct the glucose to the liver and convert it into fat which is then stored. The effect of this is to ensure that the concentration of glucose in the blood remains under control. However if the high intake of sugar and carbohydrates persists, IR will occur in various organs including the liver and pancreas. As this continues to get worse the pancreas responds with even more insulin. It is possible to maintain control of the blood glucose in this way for up to about 10 years. Eventually a point is reached where the pancreas fails and is no longer able to meet the demand for insulin. This is when the blood glucose starts to rise. If blood glucose measurements are done, then T2D will be diagnosed. Even if T2D does not develop, the IR which is caused by the high level of insulin (hyperinsulinaemia) constitutes a serious risk in its own right, which may result in a range of different chronic diseases/conditions. The relationships have been explained by Gerald Reaven and are shown in a figure which is available at

http://www.cell.com/action/showFullTextImages?pii=S1550-4131%2804%2900007-5

To access this it will be necessary to copy this link and paste into your browser. It is a nuisance but probably worth the trouble if you are interested.

Essentially there are two scenarios. In one the pancreas is damaged to such an extent that it is unable to produce sufficient insulin to maintain control of the blood glucose which means that T2D is the result. Hence it is highly likely that retinopathy, nephropathy and neuropathy will develop. In the other, the pancreas continues to produce sufficient insulin to control the glucose in the blood BUT the high concentration of insulin (compensatory hyperinsulinaemia) causes a different set of diseases. These include hypertension,, stroke, polycystic ovary syndrome (PCOS), non-alcoholic fatty liver disease (NAFLD), cancer sleep apnea. Cardiovascular Disease (CVD) is common to both pathways. From the perspective of the individual, the first warning signs are likely to be when the blood glucose starts to rise. However it is clear that the even without any increase in blood glucose, if the insulin levels are raised this constitutes a genuine increase in the risks of developing many different diseases.

Between 1988 and 1995, 208 healthy volunteers (98 males and 110 females) were monitored for a period of at least 6 years on average (3). During this time, 40 clinical endpoints were identified in 37 of the participants, which consisted of 12 with high blood pressure, 9 with cancer, 7 with CHD, and 5 with T2D, 3 of which also had high blood pressure, and 4 with stroke. There were 6 deaths. Based on the insulin suppression test which is a recognised reliable estimate of IR, the subjects were divided into 3 groups (high, medium and low IR). The male/female ratios and the proportion of smokers were similar in each group. The most impressive finding is that none of the clinical endpoints were recorded in the group with the lowest IR but that there were 28 in the group with the highest IR. This left 12 in the middle range group. There were no deaths in the low IR group, 2 (infection and cancer) in the middle group and 4 (2 CVD and 2 cancer-related) in the high IR group. These results are absolutely remarkable. 

It is important to appreciate that although this is not absolute proof that there is cause and effect, there are sound theoretical reasons why it makes very good sense. These have been elucidated in many papers by Gerald Reaven (See eg 2). Ask yourself which group would you prefer to be in? I know what my answer would be and I would also be much more concerned about an IR that was relatively high than with a high value for my cholesterol! Despite the convincing evidence that IR is almost certainly at the root of many of the common killer diseases, there is little attention paid to it by the medical/health professions or by the policy makers. In the light of the information presented above anyone with a high IR would probably be interested to have that information and would be open to advice on how to lower it. It would make very good sense to switch resources from cholesterol to IR. It is unlikely that this will happen in the short term. Nevertheless for anyone who wishes to act on this information, it would be logical to adjust the habitual diet by reducing the content of sugar and carbohydrates. Effectively this is a sound basis for the Low Carb High Fat (LCHF) which is considered in greater depth in this blog (4).

Murphy’s Law

Unfortunately the news just gets worse. There are other factors which contribute to the IR so this is probably one of the best examples of Murphy’s Law (where everything possible goes wrong) that I have encountered.

  • Insufficient Vitamin D. There is convincing evidence that Vitamin D plays a critical role in many of the steps which contribute to the development of IR (5). These include the efficient functioning of the immune system and the production of insulin by the pancreas. There are several studies which show that IR is reduced by supplementation with Vitamin D. However in order to achieve a positive result it is necessary to use much higher amounts that recommended in official guidelines.
  • Omega-6 and omega-3 polyunsaturated fatty acids (PUFAs). The emphasis in the recommendations to increase the intake of PUFAs in order to reduce TC levels has resulted in an increase in the ratio of omega-6:omega-3 in many countries to the range of 15-30 or possibly even more. Ideally the ratio should be 1 and no more than 4. Omega-6s are pro-inflammatory while omega-3s are anti-inflammatory. It has been shown that increasing the intake of omega-3s in middle-aged men was associated with greater insulin sensitivity and a more favourable metabolic profile (6). The tertile (third) with highest omega-3 index had insulin sensitivity that was 43% greater than the two lower tertiles. It was also found that this group had improved ?-cell function which meant that the ability of the pancreas to secrete insulin had been increased. Because of the pro-inflammatory characteristics of the omega-6s it follows that a relatively high intake in the diet will increase the IR (7).
  • Reduction in salt intake. There is growing concern that those who attempt to follow the current recommendations on sodium intake may actually cause some damage to their health. Experimental investigations have shown that volunteers on a low sodium intake (20 mmol/day) had an IR which was considerably higher than those who had a much higher intake (200 mmol/day) (8). There was a 4–5 fold increase in serum aldosterone and also an increase in plasma noradrenaline concentration in those in the low salt group compared with the high-salt one. It was suggested that this may have contributed to the differences in insulin sensitivity following the adjustment in dietary sodium intake. These results were effectively conformed in a study involving much larger numbers a few years later (9).
  • It has been established that statins increase the risks of developing T2D. Recent studies have shown that certain statins trigger a series of steps which result in increased IR (10). A recent evaluation of statins concluded that the benefits were limited to a few extra days of life (11). Based on this information, it is difficult to understand why anyone would agree to using these drugs. However I do accept that a rather different case is presented by the pharmaceutical industry and its supporters.

Conclusion

We now have a very convincing and comprehensive case to focus on the role of insulin as a crucial factor in avoiding many of the common chronic disease which are prevalent and having a reasonably healthy existence. The occasional need to increase the amount of insulin secreted is a perfectly normal response to cope with variations in the quality and quantity of food which is consumed. However when the habitual diet persistently contains excessive amounts of sugar and other carbohydrates, the system is overloaded and eventually breaks down. In reality the system is extremely robust because it can cope with abuse for several years before serious problems arise. It could be argued that protocols should be introduced so there is a programme to test for high levels of insulin. But the procedures are relatively complex and expensive to deliver. On the other hand if the population generally could be advised and persuaded to reduce the consumption of sugar and carbohydrates, there would be widespread improvement in public health and the effects would be evident relatively quickly. Although I have not really touched on the subject of obesity here, there is overwhelming evidence that it is the consumption of so much sugar and carbohydrates which is the primary cause of the so-called obesity crisis. A diet based on low carbohydrate intake is therefore the way to tackle this issue. The big problem is the inertia and even hostility to any policy initiative along these lines. In fact it is ironic that several of the other aspects of official advice are also contributing to the present appalling standards of public health. On a more positive note, it is a “no-brainer” for individuals and their families to take the initiative themselves. It is not all that difficult and the benefits will become apparent in a very short time. For more information on the practicalities just follow the lead given by progressive doctors like Dr David Unwin in Stockport or Dr Rangan Chatterjee who made the excellent TV programmes “Doctor in the House” broadcast recently on BBC TV. Details are shown in these 2 blogs (12, 13).

  1. http://vernerwheelock.com/?p=838
  2. G M Reaven (2005) Cell Metabolism 1 (1) pp 9-14
  3. F S Facchini et al (2001) The Journal of Clinical Endocrinology & Metabolism 86 (8) pp 3574-3578
  4. http://vernerwheelock.com/?p=886
  5. C-C Sung et al (2012) Journal of Biomedicine and Biotechnology Article 634195, 11 pages http://dx.doi.org/10.1155/2012/634195
  6. B B Albert et al (2014) Scientific Reports 4 Article number: 6697 doi:10.1038/srep06697
  7. E Patterson et al (2012) Journal of Nutrition and Metabolism Article ID 53946, 16 pages http://dx.doi.org/10.1155/2012/539426
  8. R R Townsend et (2007) Clinical Science 113 (2) pp 141-148
  9. R Garg et al (2011) Metabolism 60 (7) pp 965-968
  10. B D Henriksbo et al (2014) Diabetes 63 (11) pp3742-3747
  11. M L Kristensen et (2015) BMJ Open 9 (5) pp1-5
  12. http://vernerwheelock.com/?p=915
  13. http://vernerwheelock.com/?p=912

 

199.Time for a New Policy on Diabetes (Letter to Julian Smith MP for Skipton and Ripon)

This letter was sent to my MP just before Christmas.

Hello Julian,

One of my followers, Ian Day, has just posted this comment on my blog:

 

“I was diagnosed Type 2 Diabetes in 2,000 at age 61. I was advised to eat the NHS “healthy diet” with plenty of starchy carbs, low fat, sugar and salt. I was also advised that however well I complied, diabetes was progressive and would lead to problems with eyes, kidneys and possible stroke and heart disease.

It’s inevitable – the nature of the disease.

Sure enough the disease progressed – reduced kidney function, beginning of retina bleeds, chronic tiredness and severe crippling peripheral neuropathy.

In May 2008, with advice from Fergus on the www.diabetes.co.uk/forum I gave up all the obvious carbs.

My blood sugars immediately improved and within 3 months I was out of pain and able to play tennis again.

Now, after 7 1/2 years on a low carb, high fat diet I am well, with NO diabetes complications.

I would not DARE revert to the NHS/Diabetes UK “healthy” diet. It’s poison.”

 

I can assure you that this is by no means an isolated case. There are literally hundreds if not thousands who have had a very similar experience. Some examples can be found on this website (1). The reaction of many individuals to the conventional advice can be gauged from these links (2, 3, 4).

May I remind you that in May I wrote to you and amongst other things I pointed out that:

“Type 2 Diabetes (T2D) can be controlled and in many people actually cured. This is done by removing the cause which is excessive consumption of sugar and carbohydrates, which result in so much glucose in the blood that the body is unable to cope. Unfortunately the official dietary recommendations are in direct conflict with this strategy which includes:

  • ‘’Starchy foods such as potatoes, bread, cereals, rice, pasta should make up about one third of the food you eat’’.

 

The basis of successful treatment of T2D is to replace the carbohydrates with fat, especially saturated fat, such as butter. Again this is contrary to the current official advice which is that:

  • ‘’Eating too much fat can make us more likely to put on weight, because foods which are high in energy (calories). Being overweight raises our risk of serious health problems such as heart disease, type 2 diabetes and high blood pressure’’

 

We now know that this is totally wrong and that it is the high intake of carbohydrates which causes weight gain.

So the irony is that those who comply with current guidelines are only making things worse!”

The many case histories which I refer to here demonstrate conclusively that the last statement is regrettably true.

In my letter to you I also made this comment:

“I believe it is essential that ministers exert control. If it is left to civil servants to draft a reply I have no doubt my views will be brushed aside. At this stage I am not advocating a new policy, although I am convinced the case is very powerful. What I would hope to see is a thorough evaluation of these relatively new ideas and concepts. I believe this will only happen if new people are brought in to provide information and advice. I have absolutely no doubt that the majority of those already involved will have a built-in hostility to them for the simple reason that acceptance means admitting they have been wrong in the past. Unfortunately most people find this very difficult to do.

This is a genuine challenge to the politicians.”

You passed my information to the Minister and the reply from Jane Ellison stated:

“Preventing diabetes and promoting the best possible care for people with diabetes is of great concern to the Government. The NHS Five Year Forward View set out a commitment to implement the National Diabetes Prevention Programme to provide lifestyle programmes to pre-diabetic patients in order to reduce the risk of their developing diabetes. The Department is also building on the Diabetes Prevention Programme to improve the outcomes of people with and at risk of diabetes and will put forward our plans in due course.”

In other words she is telling me to “get lost” and there was not the slightest attempt to deal with the points which I made. Had she been doing her job properly (and an effective politician) she would instructed her civil servants to explain why my proposals were faulty. In effect she just ignored my arguments.

Unfortunately this Prevention Programme is based on the same old discredited approach which has failed so miserably in the past. So the reality is that as long as this remains the cornerstone of the strategy there will be no progress and things will continue to get worse.

It is vital to appreciate that for every individual who manages to cope successfully like Ian Day there will be many more who faithfully comply with the official advice only to experience a deterioration in their health and quality of life. The size of this problem is enormous because it means that millions of people are suffering and dying prematurely.

The fundamental issue is that the performance of Ministers is abysmal. They are relying on “experts” whose advice has proved to be spectacularly wrong and are unable to face up to the fact that they have been at fault.

The one encouraging sign is that there are some professionals who have recognised that the approach advocated here is valid and have applied it with great results.

Dr David Unwin and colleagues have successfully treated diabetics with a diet which is low in carbohydrates in their General Practice based in Southport (5). In a study with over 60 people the average weight loss was 9kg, the blood sugars were normalised and the fat in the liver was reduced substantially.

The case history of one patient is particularly impressive.

This was a 55-year old woman who started out with an HbA1c of 84 mmol/mol (9.8%) which is effectively out of control and a GGT of 103 iu/L which showed that the liver function was deranged. Essentially this is a bad case of T2D. She had been prescribed metformin. After 3 months on the low carb diet the GGT was down to 12 iu/L (a reduction of almost 90 %!!) and an ultrasound scan confirmed the liver was functioning normally. She also lost 7.9 kg. In the longer term she has lost a bit more weight, the liver function is fine, her HbA1c is just about OK but she has come off the metformin. She has lost 17 cm from her waist and says she feels “10 years younger”.

(Note HbA1c is a measure of blood sugar and GGT is a marker for Non Alcoholic Fatty Liver Disease).

To cap it all, this practice has reduced its expenditure on drugs by almost £30,000 per annum

The other example is Dr Rangan Chatterjee who made 3 programmes which were shown recently on BBC TV (6). He has successfully helped several families to achieve huge improvements in personal health by making relatively simple changes to their lifestyle with respect to diet and exercise. In particular one lady effectively overcame her T2D by a programme which included a diet low in carbohydrates.

The present position is a disaster which is ought to be unacceptable in this day and age. It is totally outrageous that the Government policy has not only failed but is a critical part of the problem. The performance of Ministers is pathetic. The fact that the Southport study made such a substantial saving in the costs of drugs gives the game away. The driving force behind current policy is the pressure to use drugs. It is quite clear that most of those prescribed for the treatment of diabetics are not effective. By contrast, altering diet by reducing the consumption of carbohydrates does work and eliminates the need for many of the drugs.

It is essential that Ministers take control and demand a complete re-think. They must realise that it is no longer acceptable to hide behind the so-called “experts”. It is not rocket science. We know that diabetes is caused by excess sugar in the body. It does not take a genius to work out that to tackle the cause you must limit the supply which means less sugar and other sources such as potatoes, bread, rice and pasta in the food.

If Ministers fail to respond then Julian it is up to you and your colleagues to ensure that pressure is exerted to bring about the necessary changes in policy. The time for hand-wringing is past. You have a responsibility to your constituents to act.

REFERENCES

  1. http://www.lowcarbdiabetic.co.uk/My%20Friends%20Stories.htm
  2. http://healthinsightuk.org/2015/09/29/time-for-diabetes-uk-to-unplug-ears-and-respond-to-chorus-of-disapproval-demanding-u-turn/ …
  3. https://www.facebook.com/AmericanDiabetesAssociation/posts/10153140618374033 … …
  4. http://www.bmj.com/content/351/bmj.h4023/rapid-responses
  5. http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf
  6. http://vernerwheelock.com/?p=912

 

 

198. More Good Work from Dr David Unwin

Background

The benefits of a diet which restricts the amount of carbohydrates consumed have had further confirmation in a recent paper by Dr David Unwin and colleagues (1). This is a continuation of the work reported in an earlier blog (2). The primary objective is to treat and control Type 2 Diabetes (T2D) while keeping the use of drugs to a minimum. It is accepted that non-alcoholic fatty lever disease (NAFLD) plays an important role in the development of T2D and of obesity. NAFLD is now found in 20% of the population of the developed world, so it was decided to monitor the activity of the enzyme gamma-glutamyl transferase (GGT) which is a reliable marker for NAFLD.

The study

A total of 36 women and 33 men (average age 58 years) agreed to participate. In order to adjust to a low carbohydrate (LC) diet they were advised to reduce sugar and foods with a high starch content such as bread, pasta and rice. This could be replaced by increasing consumption of green vegetables, whole-fruits, such as blueberries, strawberries, raspberries and the “healthy fats” found in olive oil, butter, eggs, nuts and full-fat plain yoghurt were advocated. There was no need to do any calorie counting. Progress was reviewed every month with a GP or practice nurse. All but 2 of the participants completed at least 3 months. The average follow-up period was 13 months so compliance was excellent.

The participants reported that they felt healthier and more energetic on the LC diet. They also appreciated that the diet did not involve any weighing of food or calorie counting.

The results were all very positive. There was an average reduction in the HbA1c from 52.4, to 42.4 mmol/mol which is regarded as “normal”. These results were only for the 27 people who had raised levels at the start of the investigation The GGT activity also showed a marked and significant reduction and, on average, the weight loss was almost 9kg.

Case history

The case history of one patient is particularly impressive.

This was a 55-year old woman who started out with an HbA1c of 84 mmol/mol (9.8%) which is effectively out of control and a GGT of 103 iu/L which showed that the liver function was deranged. Essentially this is a bad case of T2D. She had been prescribed metformin. After 3 months on the LC diet the GGT was down to 12 iu/L (a reduction of almost 90%!!) and an ultrasound scan confirmed the liver was functioning normally. She also lost 7.9 kg. In the longer term she has lost a bit more weight, the liver function is fine, her HbA1c is just about OK but she has come off the metformin. She has lost 17 cm from her waist and says she feels “10 years younger”.

Implications

This is all great news. This study shows that with the right kind of support and advice very high compliance can be achieved. This is absolutely crucial and contrasts with the conventional calorie reduction strategy which invariably has very high drop-out rates. Even more important is that the results for the important biomarkers like HbA1c are in the right direction. In addition this work also has the information on NAFLD which is extremely valuable.

It was highly significant that there was no clear relationship between weight loss and the reduction in GGT. In fact in most cases, it was found that most of the improvements in GGT were observed in the first month which was well before the majority of weight loss was achieved. If this is confirmed in subsequent investigations then it has enormous implications for the treatment of T2D. This is because it means that the reduction in the NAFLD which is a key element of T2D is independent of weight loss per se.

This result complements the work of Gannon & Nuttall who found that by reducing the carbohydrate content of the diet in T2D patients they could achieve a substantial reduction in the HbA1C within 5 weeks without any concomitant weigh loss (3). However there is extensive evidence that LC diets which also have a high fat content can achieve weight loss in the long term (4).

In the conventional approach to T2D there is much emphasis on weight loss and the usual advice by the NHS is to reduce calories, in which the emphasis is on reducing fat because it is a concentrated form of calories(5). Furthermore in a healthy diet carbohydrates should be the body’s main source of energy (6).

It is not in the least surprising that those who follow this advice rarely succeed.

The implications are really quite profound. T2D is caused by excessive glucose in the body. The logical and obvious way to overcome this is to reduce the supply which means reducing the amount of sugar and other carbohydrates in the diet. When this is done as demonstrated here and in many other investigations the pressure is off and the body can start to recover. One aspect of the recovery is that the fat which has accumulated in the liver starts to be dispersed quite quickly.

Dr Unwin and colleagues are to be congratulated on the work they are doing. His patients are receiving sound advice which is enabling them to improve their health. The use of drugs has been reduced which means less risks of exposure to undesirable side effects not to mention the cost savings to the NHS.

All of this pales into insignificance when compared with the value of the insight and knowledge gained which has the potential to transform the national and international strategies for the treatment of T2D and related conditions. The tragedy is that this is not happening. There is absolutely no recognition of the contribution this kind of information can make in the development of the Diabetes Prevention Programme (7).

It is staggering what has been achieved by this team since it was effectively working with a shoestring budget. Bear in mind too that as well as directing this project, Dr Unwin had to carry on his duties as a GP.

Would it not make much better sense to encourage more projects like this rather than continuing to spend zillions of $/£/€ on so-called high powered research which is making little contribution to overcoming the common contemporary forms of ill-health??

REFERENCES

  1. D Unwin et al (2015)http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf
  2. http://vernerwheelock.com/?p=842
  3. M C Gannon & F Q Nuttall (2006) Nutrition and Metabolism (London) 3 pp16-24
  4. R D Feinman et al (2015) Nutrition 31 (1) pp 1-13
  5. http://www.nhs.uk/Livewell/loseweight/Pages/how-to-diet.aspx
  6. http://www.nhs.uk/livewell/loseweight/pages/the-truth-about-carbs.aspx
  7. http://vernerwheelock.com/?p=863

197. The Exploits of Dr Rangan Chatterjee

Rangan Chatterjee is a GP who works in the Oldham area of Greater Manchester. He is featured in a rather unique series of TV programmes on the BBC entitled “Doctor in the House”. Dr Chatterjee lives with a family for a period so that he can get to know and understand individual members in order to gain insight the root causes of any illnesses they have. His approach has stemmed from the fact that in his early days as a GP he soon realised that he was only helping about 20% of his patients. The problem was that his training had not prepared him for the majority of issues raised by his patients which include headaches, joint pain, gut problems, indigestion, weight gain, stress, diabetes and skin complaints. As a consequence, he undertook an extensive programme of additional training to obtain the expertise needed to deal with the wide range of conditions he encountered.

In the first TV programme one of the people Dr Chatterjee met was Sandip, the step-dad who was aged 49 years and had been suffering from T2D for about 10 years (1). It was evident that the condition was potentially very serious because the HbA1c was about 9, there was nerve damage in his fingers which could result in amputation and he was on 3 different drugs. He and the rest of the family were persuaded to make drastic changes to their diet. All the foods and drinks that contained sugar and carbohydrates were dumped. The focus was on plenty of fresh foods, especially vegetables. Despite a certain amount of difficulty the family eventually managed to adjust to the challenge. Because of his T2D, Sandip agreed to starve completely for one day a week on a regular basis as it has been established that this can help to overcome the T2D.

Sandeep was encouraged to take up exercise and was shown how he could apply High Interval Intensity Training (HIIT) techniques to his walks. This involves setting targets which enable him to achieve continuous improvement in his fitness.

The impact of all the measures was extremely successful. The HbA1c came down to about 7 and he was able to stop taking 2 of the 3 drugs he had been prescribed. Although not ideal, it was clear that he had made incredible progress and that further improvement would be expected.

In the second programme Dr Chatterjee met Ray, who worked in the NHS as an IT manager and also owned his a fitness centre so he led a busy stressful life (2). He had been suffering from severe back pain for many years and was taking incredible amounts of painkillers and other drugs to deal with his condition. To cut a long story short, Dr Chatterjee was able to find the right kind of support. He was shown exercises that were beneficial and as a consequence he achieved a complete recovery. Drugs were no longer required and Ray reckoned that he was a “new” man.

These results are extremely encouraging and demonstrate the huge potential for dealing with the many forms of ill-health that are so common today.

On the other hand, they also highlight the serious inadequacies of the modern health care system. Those who featured in the programmes are the lucky ones. Without the help and support from Dr Chatterjee they would still be struggling to cope with their poor health which in all probability would continue to deteriorate. The reality is that there are millions of people who will not benefit in the same way because the treatments provided are not working.

There are a number of reasons to explain why this is happening.

  • It is evident from the experience of Dr Chatterjee that the training of doctors is far too limited. Hence they simply do not have the expertise or the awareness of most of the conditions they encounter.
  • The usual time allowed for a consultation with a GP is about 10 minutes, which is simply not long enough to get to know enough about the patient and their lifestyle to understand the fundamental causes of their ill-health.
  • The almost universal mantra on the part of patients and medical professionals that the answer is some form of medication. It is notable that in both the cases mentioned above once the root cause had been identified and addressed that the need for medication was drastically reduced or eliminated completely.

The insight gained from these programmes only serves to reinforce the conclusion that our healthcare services are not fit for purpose. Despite the continued increase in expenditure all the indications are that public health standards are getting worse. The incidence of diabetes has doubled in the past 15 years and all the prognostications are it will continue to increase. Obesity, kidney disease and Alzheimer’s Disease (AD) also have similar trends. The same pattern is evident in most other countries.

If things continue along the same lines it is predicted that the NHS faces a funding shortfall of £30 billion by 2020/21.

There is only one possible conclusion: the strategy is fundamentally flawed. It is absolute madness to carry on in the same old way, throwing money into the system and expecting a different result. The brutal truth is that the existing approach is not sustainable in the long run because there is a limit on how much can be spent. Eventually events will dictate that there has to be a complete overhaul.

The lesson from “Doctor in the House” is that there are ways and means of successfully overcoming many common chronic conditions. Clearly it is not feasible to provide the resources deployed in making these TV programmes to everyone with similar health problems. However the knowledge and insight gained from this type of exercise is extremely valuable. This must be used to develop completely new strategies for the mainstream health professionals.

I have no illusions about the major difficulties which will be encountered in any attempt to make radical changes. It would be a terrific start if only there was a more widespread recognition that maintaining the status quo cannot be the right option. There is huge potential for a totally new approach which provides individuals with appropriate accurate information and enables them to take on a much greater degree of personal responsibility. Self-empowerment will go a long towards increased efficiency in the utilization of resources.

Above all, Dr Chatterjee deserves to be congratulated for his own personal initiatives to extend his expertise and the amazing success he has achieved.

REFERENCES

  1. http://www.bbc.co.uk/iplayer/episode/b06q6y95/doctor-in-the-house-episode-1
  2. http://www.bbc.co.uk/iplayer/episode/b06qqwlx/doctor-in-the-house-episode-2

 

 

 

 

196. Letter from George Osborne to Jeremy Hunt

My dear Jeremy,

As you know it is imperative that we eliminate the financial deficit and that one key element of our strategy it to ensure that that we use public money as efficiently as possible. Since the election the Treasury has been conducting evaluations of the various government departments and agencies to determine how effectively they fulfil their role. As part of that we have been considering if they offer value for money.

I am sorry to have to tell you that the Department of Health (DoH)/NHS has come out of this extremely badly. In fact it was bottom of this particular league table by a big margin. Despite the enormous expenditure which never seems to be enough it is evident that the standard of public health is lower than it has been for years and continues to deteriorate. If things continue along the same lines it is predicted that the NHS faces a funding shortfall of £30 billion by 2020/21.

We have also discovered that many of the treatments and procedures are ineffective and inappropriate. In fact some of them do more harm than good. Diabetes was one area we examined in depth and, quite frankly, the results were absolutely appalling. I am sure you are aware that the costs of treatment are about £10Bn per annum of which about £1Bn is for drugs. On top of this we have the costs to the national economy because workers have to take time off because of illness. Despite this, all the prognostications from your people are that the number affected will continue to increase. Surely it must be obvious to you that your existing policies are not working and that it is imperative that a totally different strategy is needed? It has emerged that the definition of diabetes which underpins your Diabetes Prevention Programme is:

“a chronic condition where the body does not produce enough insulin to regulate blood glucose levels” (1).

While this is a reasonably accurate definition of Type 1 Diabetes (T1D) it is certainly totally inaccurate and misleading as far as Type 2 Diabetes (T2D) is concerned. Since T2D accounts for about 90% of all cases of diabetes the definition/cause is absolutely crucial. The fundamental cause of T2D is excessive sugars in the blood. Therefore the pancreas has to produce extra insulin to ensure that the blood sugars are kept under control. However this then causes insulin resistance (IR) which is responsible for widespread damage inside the body. One effect of the IR is to increase the requirement for insulin which places even more strain on the pancreas. Eventually the pancreas is unable to cope and it cannot produce enough insulin. Consequently the blood sugar can no longer be kept under control. This is full-blown T2D. The excess sugar causes even further damage which may result in blindness and amputation of limbs.

Is there no-one in the DoH who understands that the fundamental problem is too much insulin?

There is only one way to cope with T2D and that it is to stop the build-up of sugars in the body. So the habitual diet must be altered. This means that the intake of sugar and those foods which contain starch (which breaks down to glucose) must be restricted. We know from the studies of Professor Robert Lustig that sugar is especially dangerous. It is present in many soft drinks and in lots of “healthy” low fat foods. It seems to us that sugar consumption must be reduced. Ideally it should eliminated from diet, especially for those who cannot tolerate it. But that is not sufficient and many people will also have to reduce their consumption of the carbohydrate-containing foods such as bread, flour, rice and pasta. Therefore I find it unbelievable that NHS choice website has the following advice for those with T2D:

“The important thing in managing diabetes through your diet is to eat regularly and include starchy carbohydrates, such as pasta” (2). This is linked another section which has the following advice:

Starchy foods are our main source of carbohydrate, and play an important role in a healthy diet.

Starchy foods such as potatoes, bread, cereals, rice and pasta should make up about a third of the food you eat, as shown by the eatwell plate” (3).

Surely you appreciate that this is only making things a lot worse? There is a sound body of research which demonstrates conclusively that people with T2D can cope with the disease and improve their health significantly by consuming a diet which is low in carbohydrates and high in healthy fats (LCHF) (4). Furthermore there are numerous case studies from individuals who have been extremely successful in overcoming T2D using this approach. Here are some examples (5, 6, 7). The last reference is to the outstanding work of Dr David Unwin, a GP in Southport who has had wonderful results. I am especially impressed by the fact that he has been able to save over £20,000 per years by prescribing less drugs. I do hope you watched the excellent TV programme “Doctor in the House” in which Dr Rangan Chatterjee spent some time with a family advising the members how they can improve their health (8). This showed precisely how the NHS is failing but also provides valuable insight which I am sure you will find helpful in devising completely new strategies.

In the light of what we have learned I have decided that sugar has to be controlled in the same way as alcohol and tobacco. It may take a little time to set up the necessary arrangements to do so. Ideally there should be total ban but I am realistic enough to understand that this would drive the trade underground. However I am convinced that a system of licensing is feasible. In the meantime I propose to introduce legislation which will prohibit the use of added sugar in all foods which are marketed to children. The implementation will be phased in over the next two years. In the meantime I expect you to cease the existing policies forthwith and develop new ones based on research and practice which are demonstrably successful.

Moving on to other areas we examined. It is obvious that the use of drugs is far too excessive and costly. I strongly suspect that Dr Unwin’s experience is just the tip of the iceberg and that many of the drugs currently in use have minimal benefit and once the adverse side-effects are factored in probably do more harm than good. In addition to savings in the treatment of diabetes, I find the case for statins lacks conviction. You probably saw the recent paper in BMJ Open which showed that the benefits of statins are just a few extra days of life (9). In view of the nasty side effects, I doubt if anyone would wish to be treated with them. Personally I know several members of my own family who have suffered from severe aches and pains before decided to stop the treatment. Consequently I have decided that we can no longer justify this expenditure.

This takes me to NICE, which relies heavily on people who are closely involved with the pharmaceutical industry. I am also aware of the many recent studies which have shown conclusively that we cannot rely on the drug companies to be responsible for the testing of their own products (10). Furthermore the vast majority of new drugs are not an improvement on those already available (11). We must cut down drastically on the use of drugs and where possible use those which are tried and tested rather than new ones which are usually horrendously over-priced. Accordingly I have decide to abolish NICE at the earliest opportunity. In its place I will establish a new organisation which will be totally independent. This body will be responsible for all testing and will be funded by a levy on the sales of drugs. It is my intention to re-invent our health services so that there is considerably less emphasis on the use of drugs and much more on identifying the fundamental causes. Essentially this will mean that the focus will have to be on lifestyle.

Which brings me to my final issue because nutrition will be fundamental to this new strategy. I have to tell you that I am appalled at the recommendations on Healthy Eating which the DoH has been promulgating. I realise that this is based on the advice of the Scientific Advisory Committee on Nutrition (SACN). I find that its performance has been abysmal. It took seven years to complete its report on carbohydrates yet the recommendations were fatally flawed as Zoe Harcombe has so effectively exposed (12). It is all far too complacent and cozy. In fact I am now convinced that this committee system is fundamentally flawed. It is much too easy for one forceful individual to get his/her ideas accepted and then the final report is regarded as gospel. In any case I find that these committees tend to be dominated by specialist scientists who lack the expertise in policy aspects. I have therefore decided that SACN and all other similar advisory committees will be disbanded immediately. In future we will scour the world for individuals with a proven track record who are genuinely independent of commercial interests. We will ask them to provide a report which will then be open to scrutiny and if necessary challenged. I believe this will provide us with the high quality advice which is essential if we are to get policies which are robust and effective.

I appreciate that my decisions will upset some of our “friends” in the food and pharmaceutical industries. As far as food is concerned, people will always have to eat so there will still be plenty of business. It is up to the food companies to make the necessary adaptations. This is nothing new because the food industry is in a constant state of flux. However I do envisage that the market for drugs will definitely be a fraction of what it is at the moment. But to be perfectly honest it is a pretty awful business as Peter Gøtzsche has explained in his excellent book (13).

Peter Rost is a whistle blower who used to be in a senior position with Pfizer and has described the industry as follows:

“It is scary how many similarities there are between this industry and the mob. The mob makes obscene amounts of money, as does this industry. The side effects of organized crime are killings and deaths, and the side effects are the same in this industry. The mob bribes politicians and others, and so does the drug industry …” (14)

I am resigned to the fact that we will just have to take a hit. On the other hand I have not the slightest doubt that this will be more than compensated by the fact that we will have a highly productive workforce and that we will be spending much less on the costs of health care. In addition the new policies which I am introducing will create a whole plethora of opportunities for new businesses, which will facilitate the improvement of personal health. The fundamental weakness with the existing set up is that the profitability of too many businesses is dependent on people remaining ill.

But there is a lot more to it than that. By making these innovative changes in policy we will be stimulating the development of new skills and starting new companies which have the potential for business in many other countries as they come to understand that our current health policies are no longer sustainable. I have total confidence that is the way we must go and I trust that I will have your enthusiastic support.

In the long run, I am convinced that it is essential to take initiatives like this in order to demonstrate that the Conservative Party is actively promoting the interest of the man in the street and even more important is seen to do so. As a consequence we will be able to gain positive support from millions of people who will not only vote for us but would be prepared to make small donations. This would mean that we would no longer have to rely on large contributions from a small number of individuals, which realistically cannot continue. It is becoming increasingly difficult to justify. In any case I am simply fed up to the back teeth with the necessity of having to lunch with those awful types who are stupid enough to spend up to £50,000 every year for the privilege (15).

 

With best wishes

George

REFERENCES

  1. https://www.nao.org.uk/wp-content/uploads/2015/10/The-management-of-adult-diabetes-services-in-the-NHS-progress-review.pdf
  2. http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Living-with.aspx
  3. http://www.nhs.uk/Livewell/Goodfood/Pages/starchy-foods.aspx
  4. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/pdf
  5. http://www.drbriffa.com/2012/10/02/diabetic-transforms-his-health-with-a-low-carb-diet-and-his-doctor-urges-him-to-eat-more-carbs/
  6. http://vernerwheelock.com/?p=422
  7. http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf
  8. http://www.bbc.co.uk/iplayer/episode/b06q6y95/doctor-in-the-house-episode-1
  9. http://bmjopen.bmj.com/content/5/9/e007118.full
  10. http://healthland.time.com/2012/09/24/a-doctors-dilemma-when-crucial-new-drug-data-is-hidden/
  11. D W Light, J Lexchin & J J Darrow (2013) Journal of Law, Medicine and Ethics 14 (3) pp 590-610
  12. http://www.zoeharcombe.com/2015/07/sacn-report-carbohydrates-health/
  13. Peter Gøtzsche (2013). “Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare” Radcliffe Publishing London
  14. https://www.guernicamag.com/interviews/healthscare/
  15. https://www.conservatives.com/donate/Donor_Clubs

195. Diabetes Review by Public Accounts Committee. Call for Action

The UK House of Commons Public Accounts Committee (PAC) is currently reviewing the effectiveness of the treatment of diabetes by the Department of Health (DoH) and the NHS. My previous blog has explained the background (1). I have now had a chance to look at the transcript of the session when officials from the DoH/NHS presented evidence to the Committee. It is very obvious that there is general acceptance of the current strategy. It is clearly recognised that the number of people affected is increasing but the emphasis of the proceedings was on how to improve the effectiveness of the existing programmes. This is probably because as shown below the PAC’s remit is to consider how public money is spent, while government policy would be examined by the Health Committee.

Nevertheless there are several members who clearly wish to know why things are getting worse and why there is so little progress. However it was also evident that they were completely unaware of why the current strategy is going nowhere and is really part of the problem not part of the solution. They seemed to have no idea that there are numerous initiatives all over the world which demonstrate conclusively that Type 2 Diabetes (T2D) can be overcome by a diet which is low in carbohydrates and high in fat (LCHF).

Furthermore it could well be argued that this approach is not inconsistent with current policy as there are some individuals who are using the LCHF strategy within the NHS. One of the most notable is Dr David Unwin in Southport (2).

The purpose of this blog is to encourage anyone who wishes to see genuine progress with T2D and other diseases by  adopting an LCHF diet to make contact with the committee secretariat, chair and individuals. I believe it is important they are properly informed of the enormous benefits of an LCHF diet and of the growing pressure for a fundamental change in mainstream attitudes towards the dietary guidelines (which would require a change in policy) and in the treatment of T2D.

My previous blog summarises the main points but as far as the PAC is concerned it should be worth highlighting the financial aspects. Interestingly there are some relevant points made in the submission from Novo Nordisk (3). These include:

  • Since the previous PAC report on the management of diabetes in 2012 an additional 900,000 people in England have been diagnosed with diabetes which makes a total of 3.2 million people with diabetes in England. It is estimated that an additional 9.6 million people in England are at high risk of getting T2D.
  • The NHS faces a predicted funding shortfall of £30 billion by 2020/21. Presently diabetes costs the NHS nearly £10 billion a year in direct costs. Which is about 10% of the NHS budget. In addition, the annual social care costs associated with supporting people with diabetes are estimated to be a further £1.4 billion. This figure is expected to rise to £2.5 billion by 2030..
  • The costs to the economy, due to people with diabetes not working because of poor health, having a lower level of productivity or as a result of death, are estimated at nearly £9 billion per annum. It follows that these costs will continue to increase in line with the number diagnosed which is estimated at 5% every year.
  • The National Diabetes Inpatient Audit states that about 1 in 6 hospital beds in England are occupied by a person with diabetes. The estimated cost of avoidable admissions in diabetes is £686 million per year.
  • Patients admitted to hospital with diabetes also stay on average 1.1 days longer than a person admitted for a similar compliant without the condition, leading to bed blocking and capacity issues for the NHS.

These are all points well worth re-iterating.

Finally, the PAC should consider inviting Dr David Unwin to present a paper which describes his success in treating T2D with the LCHF. Many of his patients have improved their health very significantly as a result. Because this has enabled them to reduce their dependency on drugs, the practice has saved at least 20,000 for each of the past 3 years. Presumably he is operating within the framework of current policy especially as Dr David Haslam, Chair of NICE has said that NICE guidance is not meant to be prescriptive and should not replace a doctor’s clinical judgment (5).

Call for action

If you wish to see progress, please feel free to use any of the information here or in any other blogs, especially the previous one (1). No doubt many of you have lots of your own ideas and stories that will be appropriate.

All the relevant contacts are shown below. Click on the names to obtain emails and other details. Although I do not know of any plans by the Health Committee to tackle T2D, I suggest a direct approach to PAC members but copy to Health Committee members.

Public Accounts Committee

The PAC is appointed by the House of Commons to examine:

“the accounts showing the appropriation of the sums granted to Parliament to meet the public expenditure, and of such other accounts laid before Parliament as the Committee may think fit”

The Committee looks at how rather than why public money has been spent and does not examine the merits of Government policy. That role is performed by the relevant Departmental Select Committee.

Member Party
Meg Hillier (Chair) Labour (Co-op)
Mr Richard Bacon Conservative
Harriett Baldwin Conservative
Deidre Brock Scottish National Party
Chris Evans Labour (Co-op)
Caroline Flint Labour
Kevin Foster Conservative
Mr Stewart Jackson Conservative
Nigel Mills Conservative
David Mowat Conservative
Stephen Phillips Conservative
Bridget Phillipson Labour
John Pugh Liberal Democrat
Karin Smyth Labour
Mrs Anne-Marie Trevelyan Conservative

Committee contact details:

Committee of Public Accounts House of Commons London SW1P 3JA

Telephone: 020 7219 4099 Fax: 020 7219 2782

Email: pubaccom@parliament.uk

Health Committee

The Health Committee is appointed by the House of Commons to examine the policy, administration and expenditure of the Department of Health and its associated bodies

Member Party
Dr Sarah Wollaston (Chair) Conservative
Mr Ben Bradshaw Labour
Julie Cooper Labour
Dr James Davies Conservative
Andrea Jenkyns Conservative
Andrew Percy Conservative
Emma Reynolds Labour
Paula Sherriff Labour
Maggie Throup Conservative
Helen Whately Conservative
Dr Philippa Whitford Scottish National Party

Committee contact details:

Health Committee House of Commons London SW1A 0AA

Telephone: 020 7219 6182

Email:healthcom@parliament.uk

 

REFERENCES

  1. http://vernerwheelock.com/?p=897
  2. http://vernerwheelock.com/?p=842
  3. http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/public-accounts-committee/diabetes-followup/written/24521.html
  4. http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf
  5. http://www.gponline.com/gps-patients-choose-when-ignore-nice-advice-says-haslam/article/1368070