I have just noticed a paper, which was designed to compare an intensive lifestyle intervention with standard care for the treatment of T2D. A secondary objective was to study the impact on the amount of medication used for, glucose-lowering. Unfortunately the paper are behind a paywall so I have not been able to access the finer details but the protocols are available in a previous paper (2) and the key results in the abstract are sufficient for me to draw conclusions.

The procedures

The trial was conducted in Copenhagen with 2 groups of patients that have been diagnosed with T2D.  It lasted for 12 months. One is simply given the standard treatment for diabetics in Denmark. But the other was encouraged to adopt an intensive lifestyle based on the following components:

  1. Increased levels of structured and supervised training
  2. Antidiabetic diet
  3. Increased levels of basal physical activity
  4. Increased sleep duration
  5. Self-monitoring of behaviours related to components 1–4 as well as perceived stress level, mood and motivation
  6. Diabetes management education and networking.

Physical activity

The physical activity expected is unbelievable. This consisted of four aerobic training sessions per week of 45–60?minute duration. On top of this there were two more sessions made up of aerobics for 30-35 minutes plus another 30 minutes of resistance training. The training was structured with supervision throughout the period. The participants worked in groups of 4-8 and each group had at least two certified coaches assigned to it.

Diet

The diet is based the recommendations of the American Diabetes Association (ADA) and the Canadian Diabetes Association. Specifically this translates into a diet consisting of 45–60E% carbohydrate, 15–20E% protein and 20–35E% fat (<7E% saturated fat). Here is the justification:

“As T2D is associated with comorbidities like cardiovascular disease and saturated fat intake is related to cardiovascular disease risk, the U-TURN intervention aims at reducing saturated fat intake to <7E% as proposed by ADA. As successful management of T2D is highly related to diets rich in whole grains, fruits, vegetables and nuts and legumes and low on refined grains, red or processed meat and sugar sweetened beverages, focus on these items will be central part of the meal plans.”

Results

The glycated haemoglobin (HbA1c) was recorded. In the lifestyle group the mean HbA1c changed from 6.65% to 6.34% and in the standard care group from 6.74% to 6.66%. In addition, there was a reduction in glucose-lowering medication in 47 participants (73.5%) in the lifestyle group and 9 participants (26.4%) in the standard care group. There were 32 adverse events (most commonly musculoskeletal pain or discomfort and mild hypoglycaemia) in the lifestyle group and 5 in the standard care group.

A futile study

My initial reaction is this trial illustrates all that is wrong with the current official approach to the treatment of T2D in many countries throughout the world. Despite the huge effort expected in the lifestyle group the improvement in HbA1c was marginal. The fundamental problem is the diet because the amount of carbohydrates being advocated meant that it was extremely difficult to achieve any kind of success.

The primary cause of T2D is the relatively high content of carbohydrates in the diet. Unless this addressed then there is no realistic possibility that the disease can be controlled. In fact this investigation simply confirms that the conventional approach does not work. This is another example of the enormous resources, which purport to provide a solution to T2D but in reality are a waste of money and effort.

The ADA guidelines

It really beggars belief that the guidelines adopted by the ADA are being used to underpin this investigation. There is not a shred of evidence to demonstrate that they are effective. Three years ago the ADA posted this question on Facebook:

“What was your most recent blood glucose reading?”(3).

Here is a selection from the responses:

  • I started a low carb high fat way of eating on March 31, 2015. Diabetic for 11 years, adding more and more drugs and watching my a1c climb until it reached 11.2. At that point I started to take the insulin 4 times a day and it cost over $900.00 per month. For one month I strictly followed ADA recommendations. My dosage was raised twice in that month. When I started low carb high fat one month later, my insulin was reduced a lot 3 times in 3 weeks actually, by August 3, 2015 my a1c has dropped to 6.6 in 5 months and my average daily bs now is within healthy range. This way of eating is a revelation and a revolution. We will flip the pyramid and we will win and be healthier and live longer.
  • I was termed a Brittle Diabetic following ADA diet. Went on LCHF, and never see lows or at the highest maybe 150 sometimes. It gave me my life back. Thank you Dr. Bernstein!
  • 80 – and no thanks to the ADA! If I followed the guidelines of the ADA I would still be obese with T2 symptoms! T2 folks have no business eating grains or any carbs/sugar that don’t come from veggies. Shame on the ADA. Eat a low carb high fat diet to control your T2 disease!! My fbs is typically 70-90 and my last A1C was 4.5. Food is the answer not meds!
  • I went from “Prediabetic” to Type 2 thanks to following ADA diet recommendations. I gained more weight on your diet than at any other time in my life. And I felt worse than ever. If I hadn’t decided to be “noncompliant” and reduce my carb load to 60gm/day I know I’d be even worse off. I now eat LCHF and my sugars run between 70-90s and no huge spikes anymore since I know WHAT to eat. I test 8-12 times a day in order to “keep an eye” on my sugars. And because of LCHF I’ve lost 26 lbs of the weight your stupid plan added! Why on earth would you tell DIABETICS to eat CARBS especially in the asinine levels you recommend? The ADA should be ashamed and either revamp or go away. I’m all for a class action suit. My fbs this morning? A healthy 74!

Conclusion

It is absolutely clear that the ADA guidelines are a disaster but, of course, the organisation carries on regardless. It does not take a genius to work out how T2D can be tackled and there are thousands who have successfully switched to an LCHF diet and effectively controlled their T2D. Why does mainstream medicine continue to ignore those practitioners like Dr David Unwin (4) and Dr Richard Bernstein (5) (mentioned above), who have been highly successful in treating patients with T2D and Type I Diabetes (T1D) by advising them to reduce their intake of carbohydrates?

And finally, we hear so much about the growing costs of healthcare yet politicians fail to understand that if present trends continue, nations will become bankrupt. There has be a complete re-think and a new approach to diabetes as outlined here would not only save huge amounts of money but also achieve major improvements in public health. But this only the tip of the iceberg. I am confident that similar strategies would also work for other common chronic diseases such as heart disease, cancer and Alzheimer’s Disease. That really would be significant breakthrough.

 

References

  1. https://www.ncbi.nlm.nih.gov/pubmed/28810024?dopt=Abstract
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679918/
  3. https://www.facebook.com/AmericanDiabetesAssociation/posts/10153140618374033
  4. http://vernerwheelock.com/198-more-good-work-from-dr-david-unwin/
  5. http://vernerwheelock.com/219-the-life-and-work-of-dr-richard-bernstein/