For some time, I have been urging Diabetes UK to take account of the work of Dr David Unwin, the Southport GP, who has been extremely successful in treating those with T2D. As a result, he has achieved national and international recognition. In 2016, Dr Unwin was selected as NHS Innovator of the Year. Within the last few days, I have been informed that a poster he presented at a Diabetes UK conference by Dr Unwin has been awarded a prize.
So perhaps this would be a good time to compare the approach adopted by Dr Unwin with that of Diabetes UK.
The most significant fact to emerge is that those who follow the advice of Dr Unwin are so often successful.
In a paper published in 2016, Dr Unwin presents the results for 68 out of 69 patients who had completed an average of 13 months, in which they had complied with the lifestyle advice (1).
- Patient satisfaction was high from reports of feeling better and having more energy. Mean body weight fell by 9.0 kg, waist circumference fell by 15 cm, blood glucose (BG) control measured as HbA1c, fell by 10 mmol/mol or 19%, liver function measured as serum glutamyl transferase (GGT) improved by 39% and total cholesterol (TC) fell by 5%. Systolic and diastolic BPs dropped significantly too. Plasma triglycerides were not measured, but in common with prior observations for low-carbohydrate diets a significant improvement would have been anticipated.
- From the perspective of the practice, there has been a huge saving in the expenditure on drugs used for the treatment of diabetes. The actual figure is about £38,000 per year against the regional average, which represents the lowest spend per 1000 patients in any of the 19 surgeries in the surrounding Southport (UK) and Formby area for which information was available. This saving should be seen against the extra costs of the Norwood Surgery diabetes intervention at just under £9,000 per year.
- There has also been an improvement in the obesity prevalence as determined by BMI. This has dropped from 9.4% before the initiative commenced to 8.4%. The National Health Survey for England shows that for adults there has been a steady increase in the prevalence of obesity in England between 2010 and 2015 (Table 1).
Table 1. Prevalence of obesity in England, %
I have not been able to find values that are directly comparable but these results clearly show that in Dr Unwin’s practice, substantial progress is being made in reducing the prevalence of obesity. By contrast, there is absolutely no indication that this is happening countrywide. In fact, it is evident that obesity is increasing.
No doubt about the success of Dr Unwin but the national picture continues to deteriorate
It will be obvious from this information that Dr Unwin is achieving very valuable progress in his practice. On the other hand, it is also clear that from the national perspective (England), which we can assume would be a fair reflection of the progress (or lack of it), that may be attributed to the efforts of Diabetes UK.
The one conclusion that can be reached is that the approach adopted by Dr Unwin is working. Patients are definitely showing improvements in their health, and the use of drugs is being reduced. However, as the national picture is deteriorating it follows that the Diabetes UK strategy is not working. Hence, we have to consider the difference between the two approaches.
The dietary advice
Dr Unwin emphasizes that it is important to reduce the amounts of not only sugar but also foods that contain starch, which breaks down to produce glucose. Here is an example of the advice issued by the practice:
“Reduce starchy carbs a lot (remember they are just concentrated sugar). If possible cut out the ‘White Stuff’ like bread, pasta, rice – though porridge, new potatoes and oat cakes in moderation may be fine.
Sugar – cut it out altogether, although it will be in the blueberries, strawberries and raspberries you are allowed to eat freely.
Cakes and biscuits are a mixture of sugar and starch that make it almost impossible to avoid food cravings; they just make you hungrier!!” (3).
The advice on fruit and fat is especially interesting:
“Fruit is trickier; some have too much sugar in and can set those carb cravings off. All berries are great and can be eaten freely; blueberries, raspberries, strawberries, apples and pears too, but not tropical fruits like bananas, oranges, grapes, mangoes or pineapples.”
“Fats (yes, fats can be fine in moderation): olive oil is very useful, butter may be tastier than margarine and could be better for you! Coconut oil is great for stir fries. Four essential vitamins A, D, E and K are only found in some fats or oils. Please avoid margarine, corn oil and vegetable oil….
Beware ‘low fat’ foods. They often have sugar or sweeteners added to make them palatable. Full fat mayonnaise and pesto are definitely on!!”
Now consider the dietary advice on the Diabetes UK website:
“Potatoes, rice, pasta, bread, chapattis, naan and plantain all contain carbohydrate, which is broken down into glucose and used by your cells as fuel. Better options of starchy foods – such as wholegrain bread, wholewheat pasta and basmati, brown or wild rice – contain more fibre, which helps to keep your digestive system working well. They are generally more slowly absorbed (that is, they have a lower glycaemic index, or GI), keeping you feeling fuller for longer.
Try to include some starchy foods every day.
- two slices of multigrain toast with a scraping of spread and Marmite or peanut butter
- rice, pasta or noodles in risottos, salads or stir-fries
- potatoes any way you like – but don’t fry them – with the skin left on for valuable fibre. Choose low-fat toppings, such as cottage cheese or beans
- baked sweet potato, with the skin left on for added fibre
- boiled cassava, flavoured with chilli and lemon
- chapatti made with brown or wholemeal atta” (4).
The crucial difference between the two sources of advice is that Dr Unwin advocates strict control on the consumption of all foods that contain starch. In direct conflict with this, Diabetes UK recommends “some starchy foods” every day and presumably would not disagree with the official Eatwell Guide that meals should be based:
“on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally wholegrain” (5).
The results explained
T2D is essentially caused by exhausting the pancreas so that it is unable to produce enough insulin to control the BG. As a consequence, the BG level increases and it is only at this point that T2D will probably be diagnosed, although it is has to be recognized that many remain undiagnosed for years. The primary cause is excessive consumption of sugar and carbohydrates over a long period. One of the critical features is that when high concentrations of insulin are present in the blood, the body organs develop a condition known as “Insulin Resistance” (IR). It is rather ironic that the IR means that even more insulin is needed to control the BG. Ultimately the demands on the pancreas to produce insulin cause the system to break down (ie the pancreas is damaged and cannot function effectively). Hence it follows logically that reducing the intake of sugar and carbohydrates will relieve some of the pressure. There is debate about the potential for the pancreas to recover the ability to produce insulin. Nevertheless, the fact remains that even if this does not occur, when the sugar/carbohydrates in the diet are reduced substantially, there will be a corresponding reduction in the amount of glucose entering the blood. So, it is not in the least surprising that Dr Unwin’s approach is proving to be successful. Similarly, the emphasis by Diabetes UK and the Public Health England to advocate lots of carbohydrates as a key element of a Healthy Diet just does not make sense because it must inevitably increase the glucose entering the blood. One comment by Dr Unwin is particularly apposite and gives the game away:
“For many years I followed the advice given by PHE (Public Health England) and Diabetes UK.
It didn’t go well.
They (the patients) really struggled to lose weight and their blood glucose remained high and many relied on medication” (6).
It really is time that Diabetes UK (and the NHS) faced up to the fact that their approach to the T2D is a complete and utter failure. They have been brutally exposed by the excellent results obtained by Dr Unwin and his team in Southport. Not only are the results outstanding but the logic, which underpins that success is undeniable. At the same time, it is obvious that the promotion of diets based on carbohydrates for people with T2D is totally without foundation. In fact, it would be expected to make the condition worse and that is exactly what happens. How much longer do we have to put up with so much nonsense that is responsible for needless suffering, not to mention the enormous waste of money on drugs and other treatments that are ineffective?