194. Review of Diabetes by House of Commons Public Accounts Committee

I have just discovered the House of Commons Public Accounts Committee(PAC) is undertaking a review of how the UK Department of Health/NHS is coping with diabetes. This is a follow-up to a previous review by the PAC which was not very complimentary about the quality of services at that time. Since then there has apparently been little progress as shown by a report from the National Audit Office entitled “The management of adult diabetes services in the NHS: progress review” (1). Unfortunately this illustrates the fundamental problem with the current official strategy because it starts off with the statement that:

Diabetes is a chronic condition where the body does not produce enough insulin to regulate blood glucose levels.”

While this is a reasonable 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. As this is the same definition which is used by NICE/NHS it is foundation of the existing policy. I find it unbelievable that this seems to be accepted without question. For those who are not familiar with current knowledge, I will explain. The underlying cause of T2D is excessive sugar (mainly glucose and fructose) in the blood. In order to control this, the pancreas has to produce extra insulin to keep the blood glucose under control and prevent it from building up in the body. One of the ways in which it does this is to direct the glucose to the liver where it is converted into fat, which is then stored resulting in weight gain and eventually obesity.

However the persistently high levels of insulin cause insulin resistance (IR) in many different organs in the body. This is somewhat similar to antibiotic resistance and so the main consequence is that even more insulin has to be produced in order to fulfil its role. It must be emphasised that IR per se represents a form of damage, which may ultimately result in serious chronic disease such as heart disease, cancer and impairment of the brain, which may progress to Alzheimer’s Disease. But there is even worse to come because eventually the pancreas simply cannot cope and at this point is unable to produce sufficient insulin to limit the blood glucose. The excess glucose then causes even further damage. For example, it sticks to proteins which it makes impossible for them to function properly. This is full-blown T2D. By this time the person is suffering a double whammy from both the IR and the hyperglycaemia (high blood sugar).

The current policies are doomed to failure because they are focussed on rather pathetic attempts to deal with the symptoms and have totally failed to identify the basic cause. In fact it is not rocket science. Sugar in the diet is broken down to glucose and fructose, while the starch which breaks down to glucose is present in foods such as bread, flour, rice and potatoes. There is absolutely no question that the only effective way to deal with T2D is to alter the diet by reducing the amount of sugar and other carbohydrate-containing foods. Sugar should be the primary target because as Professor Robert Lustig explains the 50:50 combination of glucose and fructose is particularly dangerous (2). There can be little doubt that the consumption of sugar-sweetened soft drinks coupled with the growth of “Healthy low fat“ foods are the major reasons why T2D has increased so much in recent years. Very often these low fat foods are formulated by removing the fat and replacing it with sugar.

On top of all this we have the NHS, as illustrated by its NHS Choices website (3), advocating a high intake of carbohydrate-containing foods as part of a healthy diet. This advice is also being recommended specifically for those with T2D by Diabetes UK (4). This is absolutely crazy because it is simply adding fuel to the fire and making the condition worse. Instead of stemming the flow of sugars into the body it is actually increasing them. There is a wealth of high quality research which demonstrated that diets which are low in carbohydrates and high in fat can be used for the successful treatment and control of T2D.

Here is one very comprehensive review which was published recently (5). In addition there are literally hundreds of individuals who have successfully coped with the disease using this approach and many of them have been able to stop all treatment with drugs (6). Incidentally, this strategy is also very effective with T1D because when the carbohydrates are restricted, less insulin is needed and the frequency of “hypos” is reduced significantly.

There is not the slightest doubt that the current policy is a complete and utter disaster which is not only failing to address the fundamental issue but is actually contributing to the problem. It is not in the least surprising that more and more people are finding this out for themselves. As a consequence, there is widespread pressure building up from the grassroots as shown by these responses (7, 8, 9).

If the PAC is to do its job properly then it must address the issues which I have highlighted here. Unfortunately so far it appears to have accepted the basic premise of the current official policy without question. There are many examples where the approach advocated here is being put into practice. In Sweden, the importance of increasing the fat in the diet has been accepted as part of official policy, this is one of the few countries where the increase in obesity has been halted and I understand that there are also indications the T2D is being brought under control (10). In South Africa, there is rapidly growing interest as shown by the large number of restaurants which specialise in providing meals which are low in carbohydrates and high in fat. Further details are given in this reference (11).

Here in the UK, Dr David Unwin, a GP in Southport has had great success (12). Perhaps the PAC would be especially interested in the fact that he has been able to save about £27,000 per annum on the costs of drugs in his practice. Patients with T2D or who wish to lose weight are encouraged to switch to a diet along the lines suggested here. Ultimately there will have to be an admission that the current policy has failed completely. To continue along the present lines will eventually bankrupt the NHS not to mention the fact that millions will continue to suffer and die prematurely.



  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.youtube.com/watch?v=dBnniua6-oM
  3. http://www.nhs.uk/livewell/loseweight/pages/the-truth-about-carbs.aspx
  4. https://www.diabetes.org.uk/About_us/What-we-say/Food-nutrition-lifestyle/Consumption-of-carbohydrate-in-people-with-diabetes/
  5. http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/pdf
  6. https://vernerwheelock.com/?p=229
  7. http://healthinsightuk.org/2015/09/29/time-for-diabetes-uk-to-unplug-ears-and-respond-to-chorus-of-disapproval-demanding-u-turn/ …
  8. https://www.facebook.com/AmericanDiabetesAssociation/posts/10153140618374033 … …
  9. http://www.bmj.com/content/351/bmj.h4023/rapid-responses …     
  10. http://www.dietdoctor.com/obesity-is-exploding-in-europe-except-in-this-country
  11. http://www.thenoakesfoundation.org/news/blog/profs-words-the-real-food-revolution-gains-momentum
  12. http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf


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