276. Low-carb Diets for People with Diabetes: Latest Position Statement from Diabetes UK

A little progress
Diabetes UK has just released its latest statement on the use of Low-carb diets for those suffering from diabetes (1). Up to now this organisation, which is the leading charity on diabetes has set itself against recommending this approach so it is a step forward to accept that:
“Low-carbohydrate diets can be safe and effective in the short term in managing weight, and improving glycaemic control and cardiovascular risk in people with Type 2 diabetes.”
The importance of this is that it goes against the official advice in the Eatwell Guide which recommends that we should:
“Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates. Choose wholegrain where possible.”
And that:
“Starchy food should make up just over a third of the food we eat.” (2)
Of course this advice begs the question:
“What should replace the carbs?”
The statement makes no attempt to provide an answer. Since it cannot be protein, there has to be an increase in the fat content of diet. However the statement confirms the official position that saturated fats (SFAs) should be restricted with the emphasis on the unsaturates. Those familiar with my blogs will know that the case against the SFAs is flawed and there is actually conclusive evidence to show that these fats not dangerous but many of them are important nutrients in their own right. Furthermore there are serious doubts about the advice to increase polyunsaturates (high in omega-6s).
The statement is quite correct to advise that:
“People who chose to follow a low-carb diet should be supported to make changes to relevant diabetes medications and to monitor blood glucose to reduce the risk of hypoglycaemia.”
Unfortunately it may be difficult to get appropriate support from the healthcare professionals because many are very unsympathetic to the low-carb approach and may advise against it. If this is the case then there are plenty of sources on the internet and increasingly there are groups being established all over the UK. A good starting point would be the Public Health Collaboration website (3).
Still a long way to go
I am much less positive about the other aspects of the statement. With respect to Type 1 Diabetes (T1D) it concludes:
“There is absence of strong evidence to recommend low-carb diets to people with Type 1 diabetes.”
My response to this is to ask why there is mention of the outstanding work of Dr Richard Bernstein, which I described in a blog some time ago (4). The fact that he successfully coped with his own T1D and is still actively practising as a physician aged 83 years speaks for itself, not to mention the thousands of patients of both T1D and T2D he has helped to conquer their disease. This is a fact of life and simply cannot be denied, yet effectively that is what the statement does. It is disingenuous to claim there is no evidence because Randomised Controlled Trials (RCTs) have not been done. The results are there for anyone to see.
Fears for children
The next statement is:
“There is evidence that low-carb diets can affect growth in children and should not be recommended.”
Obviously there may be problems if the focus is on reducing the carbohydrates and not replacing them with anything so that the child does not get enough energy and is effectively starved. Provided there is adequate fat from sources such as meat, dairy and olive oil, there should be no problem. This is really just a scare story, which has been conjured out of thin air and is sheer supposition. Whoever drafted this seems to be unaware that semi-skimmed milk is not recommended for infants under the age of two years and should have whole milk to ensure that they have an adequate intake of energy (5). It is also pertinent to ask why there is absolutely no mention of the obvious dangers linked to a diet, which has a high content of carbohydrates.
Low-carb versus other strategies
One of the recommendations is that:
“A low-carbohydrate diet should not be regarded as a more superior or a better approach than other strategies as consistent evidence shows that total energy intake is the main predictor for weight loss.”
This really does give the game away. The underlying assumption is that there are other approaches which are equivalent to or perhaps even better than the low-carb one. I can quite categorically state that this rubbish. The conventional approach, which recommends that the fat intake should be reduced and that of complex carbohydrates increased. The NHS Choices website concludes that health will deteriorate with the following explanation:
“As type 2 diabetes usually gets worse, you may eventually need medication – usually tablets – to keep your blood glucose at normal levels.” (6).
Low-carb is superior
To imply that the conventional approach is anywhere near as effective as the low-carb one is simply ridiculous. Whatever basis is used for comparison it is as plain as a pikestaff that for thousands of individuals it certainly does work as demonstrated convincingly by improvements in health and well-being coupled with a reduction in drug usage with many able to stop using them completely. By contrast, the standard approach of reducing fat and increasing carbs does not work. I have yet to hear of a single individual for whom this has been successful. One only has to recognize that increasing carbs increases the demand for insulin, which makes things worse. It simply flies in the face of basic science to even contemplate that it would be successful. It is unbelievable that the work of Dr David Unwin has been ignored by those who prepared this statement (7). He offers his patients a choice between lifestyle, which is essentially Low-carb or drug treatment. Invariably they choose the lifestyle and are invariably successful. On top of this they lose body weight. This is rather ironic since those who choose calorie restriction (almost always low fat/high carb) to lose weight find it virtually impossible.
Diabetes UK is being forced to accept that Low-carb is actually an effective treatment for diabetes but is very reluctant to accept that this should always be the first option offered to patients. The elephant in the room is that if diabetes can be treated by altering the diet then the demand for insulin and other drugs will be slashed. Surely the Diabetes UK stance has nothing to do with those drug companies, which act as corporate sponsors for the organization? (8).

1. https://www.diabetes.org.uk/Professionals/Position-statements-reports/Food-nutrition-lifestyle/Low-carb-diets-for-people-with-diabetes/
2. http://www.nhs.uk/Livewell/Goodfood/Pages/the-eatwell-guide.aspx
3. https://phcuk.org/
4. https://vernerwheelock.com/219-the-life-and-work-of-dr-richard-bernstein/
5. http://www.nhs.uk/Livewell/Goodfood/Pages/milk-dairy-foods.aspx
6. http://www.nhs.uk/conditions/Diabetes-type2/Pages/Introduction.aspx
7. http://www.diabesityinpractice.co.uk/media/content/_master/4311/files/pdf/dip4-3-102-8.pdf
8. https://www.diabetes.org.uk/Get_involved/Corporate/Acknowledgements/

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