In part 1, I described how there is a real scope for reducing the expenditure on drugs and many medical procedures which make little contribution to improving health and very often do more harm than good. In this blog the emphasis will be to focus on the potential for curing and preventing diseases by making simple changes to the habitual diet.
This is best illustrated by considering diabetes. During 2013-2014 there were 45.1 million items prescribed for diabetes, with a net ingredient cost of £803.1million (1). This represents an increase of 66.5% in the number of items and 56.3% in the net ingredient cost since 2005-2006. In England it is estimated that 6% of the population has diabetes and the total cost is currently about £10billion, which is 10% of the NHS budget (2). It is expected that by 2025 there will be 5 million people with diabetes in England (3). Those with diabetes have a reduced life expectancy and an increased risk of retinopathy, stroke, kidney failure, heart disease and amputation of limbs.
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 (4).
Type 2 diabetes (T2D) is responsible for the increased incidence referred to above. There is ample evidence that it can be controlled, possibly even cured completely by making changes to the diet. The condition is directly due to the increased level of glucose in the blood. As a result the pancreas has to produce insulin to keep prevent excess glucose in the body. Excess insulin damages many of the organs, which can eventually lead to a range of diseases. If there is excessive glucose over a prolonged period the pancreas is unable to cope and the glucose becomes rampant, causing all sorts of damage. The solution is obvious. Reduce the amount of glucose which enters the body by altering the diet. Sugar is one of the main culprits, so it should be avoided like the plague. In addition starch is broken down to produce glucose. This means that foods such as refined flour, rice or pasta should be limited because the starch is released quickly giving rise to big increases in the blood glucose.
We now have convincing evidence that a diet which is LOW in CARBOHYDRATES and also HIGH in FAT can effectively cure T2D in many cases (5) and that it should always be used as the first approach to treatment. This has been confirmed by numerous individual case studies from individuals. Dr Jason Fung in Toronto has been treating patients successfully by advising them how to change their diet (6). Dr Sarah Hallberg is another physician who has achieved similar results (7).
Because those with T2D have an increased risk of many other diseases/conditions, a reduction in the incidence of T2D would result in a big improvement in the standard of public health. Furthermore there is now good evidence that a diet which is high in sugar/carbohydrates is a critical factor in the development of diseases which include cardiovascular disease, Alzheimer’s Disease and various cancers.
Sweden is probably the first country to make adjustments to the national diet in line these concepts. Butter consumption has increased to such an extent that shortages have been reported (8) and the incidence of obesity is starting to decline (9). There is also evidence that the incidence of T2D is falling and I hope to access the data in the near future.
The fundamental problem is that here in the UK and in most other countries the official dietary recommendations are almost entirely in direct conflict with the concepts outlined here.
According to the current official advice on Healthy Eating in the UK:
- ‘’We all need some fat in our diet, but eating too much makes us more likely to become overweight. What’s more too much of a particular kind of fat – saturated fat – can raise our cholesterol, which increases the risk of heart disease’’
- ‘’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’’
- ‘’Starchy foods such as potatoes, bread, cereals, rice, pasta should make up about one third of the food you eat’’.
As a consequence, the messages that you should reduce the consumption of fat, especially the saturated fat (SFA) and increase that of carbohydrates/starchy foods were heavily promoted. This was reinforced by the food industry which developed a range of products which could be marketed as “low fat”. All of this helped to alter the national diet so that the consumption of the carbohydrates increased at the expense of fat. Two of the main reasons were the low fat foods, in which the fat was frequently replaced by sugar and the explosive growth in the market for soft drinks, which can have a high content of sugar. These changes in consumption patterns have been accompanied by increases in the incidence of obesity, T2D, Alzheimer’s Disease and kidney disease. There are very sound scientific reasons for concluding that the dietary changes are largely responsible for this deterioration in public health standards.
It follows from this that there will have to be major changes in the official advice on Healthy Eating. This will not be easy because there are very powerful interests which will defend the existing established recommendations. The new ministerial team responsible for health must recognise that that that they should not rely entirely on the existing agencies such as NICE and the Scientific Advisory Committee on Nutrition (SACN). In recent years there have been a number of excellent evaluations of nutritional science that challenge the current conventional wisdom. These include “The Diet Delusion” by Gary Taubes (10) “The Big Fat Surprise” by Nina Teicholz (11) and “The Obesity Crisis” by Zoe Harcombe (12). In the past year “The Real Meal Revolution” by Professor Tim Noakes and colleagues in South Africa has had a massive impact and been on the best seller list for about 6 months (13). There is absolutely no questions that these publications are striking a chord with many individuals. Essentially they all agree that a healthy diet is low in sugar and starchy foods but also relatively high in the SFAs. There are literally thousands of individual case histories which demonstrate that changing to such diets are associated with improved health and weight loss. Even our Prime Minister has decided that he will be “cutting the carbs” (14).
We can be reasonably confident that the “establishment” does not take kindly to these concepts. In South Africa Tim Noakes has been subjected to rather hysterical criticism from those who still support the status quo. The reality is that this is not based on an objective view of the science. Many of the criticisms are absolutely extreme and cannot be supported by reliable scientific evidence. In truth, these critics are somewhat pathetic and lack the integrity to admit that in the past they got things badly wrong.
We really need ministers with the ability, confidence and determination to consider all the evidence objectively and decide the way forward. It is imperative to appreciate that existing policies are failing badly. We cannot continue indefinitely with the same strategy. Einstein’s definition of insanity was to continue doing the same thing and expecting a different result!
Do we have the politician with the necessary attributes to face up to these challenges? There really is the potential to start out on a path which will lead to significant improvements in health without the need for continuous growth in expenditure.
REFERENCES
- http://www.hscic.gov.uk/catalogue/PUB14681/pres-diab-eng-200506-201314-rep.pdf
- http://www.diabetes.org.uk/Documents/About%20Us/Statistics/Diabetes-key-stats-guidelines-April2014.pdf
- http://www.diabetes.org.uk/Documents/Reports/State-of-the-Nation-2012.pdf
- http://jama.jamanetwork.com/article.aspx?articleid=197439
- http://www.sciencedirect.com/science/article/pii/S0899900714003323
- https://www.youtube.com/watch?v=mAwgdX5VxGc
- https://www.youtube.com/watch?v=da1vvigy5tQ
- http://www.dietdoctor.com/butter-shortage-in-sweden
- http://www.dietdoctor.com/obesity-is-exploding-in-europe-except-in-this-country
- Gary Taubes (2007) “The Diet Delusion” Vermillion: London
- Nina Teicholz. (2014)“The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet” Simon & Shuster: New York
- Zoe Harcombe (2010) “The Obesity Epidemic” Columbus
- T Noakes, S-A Creed, J Proudfoot & D Grier (2014) “The Real Meal Revolution: Changing the World, One Meal at a Time” Quivertree Publications
- http://www.independent.co.uk/news/people/david-cameron-on-his-patriotic-struggle-to-quit-bread-9976617.html