In my last blog, I quoted a number of case studies from individuals who had successfully overcome diabetes by making changes to their diet. As a result the blood glucose had been reduced to “normal” levels and in most people, the need for drugs had been eliminated. It was therefore with some surprise that I noticed an article in The Guardian (1) which described how the former Chief Executive of the NHS, David Nicholson, had been diagnosed with diabetes and had managed to overcome it. At the end of 2012, Nicholson visited his GP who considered the symptoms and confirmed that he had Type 2 diabetes. It is highly significant that the GP told him the disease would be with him for life. In other words it could not be cured! The GP also explained that the main complications included heart failure, stroke, kidney failure, blindness and amputation of a lower limb.
The GP recommended that Nicholson should be prescribed a drug to lower his blood glucose. But what I find extremely interesting is that he rejected the advice. Instead he decided to take vigorous exercise for about half an hour every day and to change his diet, particularly by switching to carbohydrates with a low Glycaemic Index (GI). Examples include basmati rice and whole grain bread. He also practised portion control, limited eating between meals and drastically reduced his consumption of beer. These changes have made a “massive difference” to his blood glucose levels (the actual values are not given). He has also lost about 3 stones weight from the original 17.5.
Although Nicholson appears to have been reasonably successful, the impression I get from the article is that he was not fully aware of the evidence which demonstrates the effectiveness of reducing the total carbohydrate intake (irrespective of GI). In addition, he does not appear to realise that he can consume foods such as meat and dairy which are high in saturated fat (SFA)(2). These foods contain many individual fatty acids that are important nutrients and the presence of SFA in the diet can help to achieve satiety quite easily.
At this point it is worth emphasising that over 3 million people have been diagnosed with diabetes and that many more are undiagnosed. On top of that, there are millions who will undoubtedly develop diabetes if they maintain their existing life style. The disease costs the NHS £10 billion every year. In one Birmingham hospital 28% of patients are suffering from diabetes.
This whole issue epitomises the fundamental flaw in the current NHS strategy. Diabetes can be cured. Unfortunately there is a widespread view that it cannot be cured as illustrated by the David Nicholson’s GP. The result is that there is huge expenditure, most which would not be necessary if patients were made aware of the fact that the disease can be overcome and were given the correct advice on the lifestyle changes which should be made. Invariably the advice is given to reduce fat, because this is considered to be a risk factor for heart disease, which is more likely to occur in diabetics. To compensate for the fat, there has to be an increase in the consumption of carbohydrate foods, which inevitably increases blood glucose. The vilification of fat, especially the SFA is totally unjustified (3) and as illustrated here is probably a major factor contributing to the current incidence of diabetes.
It is a great pity that David Nicholson’s diabetes was not diagnosed much earlier in his career so that he might have instituted the extremely critical lessons he may have learned while he was still in a position to influence how the NHS operates. On the other hand it is not immediately obvious that he has appreciated the significance of his experience. So let me spell them out:
- Diabetes can be cured. However the earlier it is diagnosed the better, otherwise there is a danger of permanent damage, which cannot be cured
- The NHS professionals must be convinced that the disease is curable. It is unbelievable that Nicholson decided not accept the advice of his GP. Most people have great faith in their GP and many would completely accept the recommendations from their doctor. So the role of the GP is crucial and it is essential that they (and the dietitians!) are well informed.
- The diet must be changed so that the intake of sugar and refined carbohydrates is reduced substantially. There is no need to reduce the fat intake, especially the SFAs. If any fat is to be reduced it should be the polyunsaturated ones (4)
- It has been almost impossible to demonstrate that the use of drugs is effective when used to treat diabetes. A recent paper in the BMJ concluded that there were limited benefits of intensive glucose lowering treatment on all-cause mortality. In fact there is actually a possibility of a 19% increase in all-cause mortality and even a 43% increase in cardiovascular deaths (5)
- A national programme to monitor blood glucose would clearly identify those with diabetes as well as those at risk
- A strategy which is based on the concepts outlined here would have enormous benefits as it would result in very large numbers of people who currently suffer from diabetes avoiding it completely
- As the strategy depends primarily on lifestyle changes, the saving in costs of expenditure on drugs would be very substantial.
It really is a “no brainer” that we have the know-how to deal with diabetes. The current policy is a total failure and must be abandoned. It is impossible to over-estimate the contribution that diabetes makes to the poor standard of public health not only here in Great Britain but in most countries worldwide.
A man diagnosed with diabetes at age 40 will lose almost 12 years of life and 19 Quality Adjusted Life Years (QALYs) compared with a person without diabetes. A woman of the same age will lose about 14 years of life and 22 QALYs (6).
Those with diabetes are at least 3or 4 times more likely to develop Alzheimer’s Disease than those who do not have the disease (7).
The reality is that we can achieve enormous improvements in public health at a fraction of the current cost by adopting a policy based on our existing knowledge. Is there any chance that David Nicholson’s successor will see the light? I am not optimistic because the dominant approach is to treat the vast majority of diseases with drugs, which are usually much less effective than we are led to believe. Invariably it is symptoms or a surrogate which is being treated. However it is relatively rare for the fundamental cause to be identified and removed, which is the only logical approach to overcoming a disease and it is absolutely crucial if an effective programme of prevention is to be devised.
Although this blog has focused on diabetes, it is highly likely that a similar critique could be constructed for many of the other chronic diseases which are so common today.
- E W Gregg et al (2007) Annals of Internal Medicine 47 (3) pp149-155
- W L Xu (2009) Diabetologia 52 (6) pp 1031-1039