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Self management of Type 2 diabetes
My first year to April 2015
(This is a slightly adapted conversion from a presentation sent to my local health practice).
Summary
Highlights
Introduction and diagnosis
I had blood tests in March 2014 following reported listlessness and exhaustion. There were none of the ‘classic’ T2 symptoms of excessive thirst, need to urinate, blurred vision etc.
Diagnosis was confirmed on 24 March with an HbA1c of 65 mmol/mol (8.1%). (It later transpired that in 2008 a blood test showed I had an HbA1c of 44 (6.2%), i.e. prediabetic. Apparently the trigger criterion was different then. Nothing was mentioned anyway, pity.)
No guidance was given, I was just told this was life-changing, to lose weight (I was 90 kg, BMI of 31.5), exercise more and make an appointment to see the diabetes nurse. The earliest appointment available was for 16 April, over three weeks away. Because of elevated blood pressure (spot reading of 160/90 when blood samples taken) I was told to take two weeks of readings to take to this appointment (how? where? – at a chemist or buy yourself a meter, great, thanks).
Because of total cholesterol of 6.9 I was prescribed Simvastatin without any explanatory discussion and without my prior agreement. More on this later (I never took them).
Something about me
I’ve never been one for taking medication if I can help it. The human body is often underestimated as a self-healing mechanism. A few paracetamol a year is normally more than enough for me.
I’m a scientist by training so when faced with something like this my first reaction is to find out about it and not take anything at face value without assessing it myself.
On the other hand the T2 diagnosis was a wakeup call and the kick I needed to sort my weight and well being out. Immediately I started walking for about 30 minutes every day (average).
I got on the internet and found the diabetes.co.uk website and forum; learned about carbohydrates and the impact on blood sugars; could understand the logic of low-carb high-fat (LCHF) diets; and just went for it at 50 g carbs per day – no bread, no potatoes, no rice, no pasta. Fortunately I didn’t suffer the withdrawal symptoms sometimes experienced by changing so abruptly. I bought a blood glucose monitor and started testing myself. I started losing weight straight away as I got into ketosis and my body started to preferentially burn stored fat for energy.
I also read about cholesterol and statins and determined that I wasn’t going to touch them with a barge pole.
First DN appointment
Three weeks in and I was already making progress on diet and exercise alone.
Fasting BGs were down from over 10 mmol/l to around 6.5; pre-dinner BGs in the high 5s; and BGs two hours after eating in the high 6s and mid 7s, so I was learning what I could and couldn’t eat in terms of blood sugar control.
My weight was down from 90 kg to 84.5 kg, and blood pressure was down to around 140/80.
It was agreed for me to carry on with diet and exercise alone, no medication, with a review in three months time.
Interim progress
In July 2014 my HbA1c was 45 (6.3%, down from 65), so I was now in the prediabetic range.
Total cholesterol was down to 6.0, but more importantly triglycerides were down from 5.66 to 1.97 mmol/l, and HDL-C was up from 1.22 to 1.62, with total/HDL and triglycerides/HDL ratios both dropping into normal range.
ALT liver function was down from 51 to 17 iu/l, indicating a reversal of fatty liver condition.
My weight was now 76 kg (BMI 26.6), a percentage loss of over 15%, and BP stable around 125/70.
I had also invested in a rowing machine to supplement the walking.
By October 2014 my HbA1c was 42 (6.0%), weight was 72 kg (BMI 25.2) and BP around 120/65.
One year on, March 2015
A picture speaks a thousand words, so rather than more dull text some more graphs follow covering the period from March 2014 to March 2015.
My HbA1c is now 38 mmol/mol (5.6%) which is within the non-diabetic range. I am still diabetic of course but I am protecting the remaining beta cell function in my pancreas as best I can, and avoiding exacerbating my insulin resistance. This is all due to carbohydrate restriction, which has also reduced triglycerides significantly, and the fat component of the LCHF diet has helped raise my HDL-C to 1.95. In this context my total cholesterol of 6.1 is of no concern to me.
The slight rises and falls in fasting blood sugar (the points are two-week averages) reflect life conditions such as work stress – but at least through testing I know what is going on.
My weight is now stable at 70 +/- 1 kg (BMI 24.5), which represents a 22% loss in 12 months; and BP around 115/65. My waist is now 37 in (94 cm) having been 45.5 in (116 cm) a year ago.
What do I eat?
I’ve done all this without any medication, and just with diet and exercise. So what actually do I eat with LCHF? This is a typical day’s meals:
Selected reading
Trudi Deakin (X-Pert Health) - Eat Fat, Step-by-Step Guide to Low Carb Living http://www.xperthealth.org.uk/shop/details/p/handbook-lowcarb-highfat-lifestyle
Trudi Deakin - High fat, low carb diets and the evidence, Diabetes UK Conference March 2015
[url=http://www.xperthealth.org.uk/Portals/0/Downloads/High fat, low carb diets and the evidence_Diabetes UK 2015_reduced memory.pdf]http://www.xperthealth.org.uk/Portals/0/Downloads/High%20fat,%20low%20carb%20diets%20and%20the%20evidence_[/url][url=http://www.xperthealth.org.uk/Portals/0/Downloads/High fat, low carb diets and the evidence_Diabetes UK 2015_reduced memory.pdf]Diabetes%20UK%202015_reduced%20memory.pdf[/url]
Dyson PA, et al. - A low-carbohydrate diet is more effective in reducing body-weight than healthy eating in both diabetic and non diabetic subjects, Diabetic Medicine, 2007
Andreas Eenfeldt - Low Carb, High Fat Food Revolution and the website www.dietdoctor.com/lchf
Feinman RD et al. - Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base, Nutrition 31,1 Jan 2015, http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext#bib94
Zoe Harcombe (diet and nutrition blogger) - http://www.zoeharcombe.com/
Malcolm Kendrick - book The Great Cholesterol Con and blog at www.drmalcolmkendrick.org
Jenny Ruhl - books Blood Sugar 101: What They Don’t Tell You About Diabetes, and Diet 101: The Truth About Low-Carb Diets; and the website www.phlaunt.com/diabetes
Scientific American (after meta-analysis by Krauss RM et al in American Journal of Clinical Nutrition, March 2010) - Carbs against Cardio: More Evidence that Refined Carbohydrates, not Fats, Threaten the Heart http://www.scientificamerican.com/article/carbs-against-cardio/
Shai I, et al. - Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet, New England Journal of Medicine, 2008.
David Unwin - Diabesity: Perhaps we can make a difference after all? Diabesity in Practice 3, 4, 2014
http://www.diabesityinpractice.co.uk/media/content/_master/3963/files/pdf/dip3-4-131-4.pdf
Westman EC, et al - The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus, Nutrition & Metabolism (London), 2008.
Commentaries
The content to this point has comprised factual descriptions of what I have done and achieved.
The following content represents my own commentaries on various diabetes-related issues. You may not agree with all of them but they underpin my decision making and management of my condition.
I’m not medically trained but I am a scientist and well used to research, analysis and empirical procedures.
I know that what I have done works, and that I have the willpower to carry on with it indefinitely and thereby defeat the commonly-held perception that T2 diabetes is inevitably a declining condition with increasing medication and often unpleasant complications.
The good thing about T2 diabetes is that you can manage it perfectly well yourself if you have the incentive (health and active life) and the tools (knowledge and a test meter). It’s depressing to me that so many diabetics are failed by the current system and doomed to more medication and declining health when in principle all T2s could do the same. As it is, the people who benefit the most are the drugs companies.
What causes Type 2 diabetes?
Despite popular perception (even held by some medical professionals) Type 2 diabetes is not caused by obesity - there are many thin T2s and many obese people who will never develop diabetes.
Some people are just genetically predisposed to developing the condition due to impaired insulin sensitivity, which is then exacerbated by the wild fluctuations in blood sugars resulting from sugar and carbohydrate consumption. In fact obesity in diabetics is more likely to be caused by the diabetes - due to the insulin resistance resulting in excess insulin in the system - not the other way round.
Type 2 diabetes is not a disease as such, just a condition with elevated blood sugars as a common denominator. It can be caused by pancreatic beta cell impairment, enhanced insulin resistance, problems in communication between the stomach, brain and pancreas concerning insulin release and so on.
It is a pity that the medical profession cannot get this message across to the media more effectively.
NICE and the Eatwell Plate
Medical professionals are legally obliged to advise on the basis of NICE guidelines. This includes recommendations to eat carbohydrates with every meal in accordance with the Eatwell Plate.
Even a cursory study of how the body deals with food will show that eating carbohydrates is a disaster for diabetics unless they are so determined to eat them that they are happy to take as much gliclazide, insulin etc to allow it.
Carbohydrates metabolise quickly to glucose in the bloodstream, some quicker than others, but the idea that there are ‘good’ carbohydrates is generally incorrect. ‘Wholemeal’ products will still spike you, especially wheat-based ones.
Would you give a Snickers bar to someone with a nut allergy? Would you suggest an alcoholic has a can of lager with every meal? Of course not – so why recommend carbohydrates to diabetics?
There is nothing new in managing T2 diabetes with low-carb diets. The Edwardians knew this – see
http://archive.org/stream/diabeticcookeryr00oppeiala#page/12/mode/2up
Ancel Keys and the low-fat dogma
The American Ancel Keys in the 1950s hypothesised that high cholesterol was a significant cause of CVD. He carried out a survey of total cholesterol vs rate of CVD in many countries. Basically there is no systematic relationship overall.
But Ancel Keys decided to cherry pick seven countries that backed up his hypothesis. This is about the worst piece of supposed science I have ever encountered, especially given the consequences of this study. You could pick a different set of populations that show exactly the opposite (Switzerland, Australian aborigines for example). Unfortunately Keys’ work provided the basis of the dogma that went on to underpin health guidelines in most countries – cholesterol causes heart disease > cholesterol increases when you eat fat > therefore fat is bad for you and you must reduce cholesterol.
So without fat where do you get energy from? Protein? (but watch out for your kidneys (also a fallacy in most cases)). That just leaves carbohydrates – the sugar and processed food industries must have been laughing themselves all the way to the bank.
Consequences of low-fat
Recommendations to eat a low-fat diet were supposed to reduce incidence of CVD and tackle obesity. But in the years that low-fat has been religiously promoted, obesity has exploded.
Fat is natural. Breast milk is full of it. It’s an efficient source of energy, and is well capable (with protein) of being processed by the body to provide the brain with the glucose it needs. You don’t need carbohydrates for this (if you did how did the human species ever survive?).
Eating fat does not make you fat. Sugars and carbohydrates make you fat. But when the food companies remove the fat they find that the texture and flavour are affected, so what do they do? Add sugar! Check out the sugar content of so-called healthy low-fat products and compare with the full-fat versions. Check out the sugar content of cereals like Special K.
Industrial trans-fats found in margarine etc. are undoubtedly harmful due to the Omega 6 content amongst others, but are still promoted as healthy alternatives to natural saturated fats like butter.
What's natural for humans?
Early man as hunter-gatherer would have lived on fatty meat, fish, eggs and occasional seasonal vegetables and fruits. Bread on a subsistence basis developed with agriculture, but it is very recently in evolutionary terms that sugar and refined carbohydrates became such a major part of our diets. The human body is simply not geared to process such a diet, and can’t evolve to do so in just a few hundred years.
Nevertheless, sugar producers and food processing companies are pushing more and more sugar and refined carbohydrate products at us. It’s cheap and very profitable, but the consequences in overall population health are clear to see. The NHS is in financial meltdown yet so much could be saved if people ate real food and not sugary carb-heavy junk.
Cholesterol
About 80% of cholesterol is produced by the liver, and only a small proportion comes from diet. If we get more from food, the liver cuts back to compensate. Cholesterol is everywhere in the body and particularly the brain. As with fat, if it is so essential why would we want to reduce it?
Yes, cholesterol is present in plaques at the sites of constricted arteries, but that’s not to say that cholesterol is the cause of CVD. Cholesterol is there because the body is trying to alleviate the symptoms of chronic inflammation caused by other factors. There is in fact no systematic evidence that high cholesterol actually causes heart attacks – CVD fatalities are just as likely to be associated with normal cholesterol as elevated cholesterol.
Total cholesterol is fairly meaningless as a marker. It’s the components (the lipid profile) that are important. HDL-C ‘hoovers’ the bloodstream and should be maintained, and triglycerides (associated with carbohydrate consumption) should be reduced. LDL-C is also of limited value since it contains both small dense particles (bad) and large ‘fluffy’ particles (good).
If you eat low-carb high-fat then HDL-C is boosted, triglycerides are reduced and LDL-C is likely to be dominated by the larger particles.
Statins
As soon as Ancel Keys’ ‘Seven Countries’ report was published, the drugs companies wanted to develop something that would reduce cholesterol. They found it in statins.
Statins undoubtedly lower cholesterol, but why would we want to do that? Cholesterol is natural and essential to the functions of the body, we just need to make sure we have the right lipid profile.
Statins are a blunt instrument. In lowering cholesterol they take out essential co-enzyme Q10 and dolichols as collateral damage. The drugs companies know this full well but don’t want to upset the cash cow.
Despite being of very limited value as a diagnostic marker, and despite there being no proof of a causative link between cholesterol and CVD, statins are being pushed at more and more people with less and less medical justification.
Statins are far from being free of side effects, ranging from muscular pain to memory loss and impaired cognitive function. They are a ticking time bomb that will one day explode in the faces of the drugs industry. And yet there have been proposals to administer them to all healthy adults! That is just insane.
Back to Type 2 diabetes
According to the National Diabetes Audit 2010-2011 only 27.5% of T2s achieve non-diabetic or prediabetic HbA1c numbers. It doesn’t say how many of the 27.5% are dependent on medication to do that.
39.9% have HbA1c between 48 and 58 mmol/mol; 25.8% between 59 and 86; and 6.8% 87 and above.
These figures could be drastically improved if the crazy recommendations to eat carbohydrates with every meal were dropped. No wonder the condition is so often perceived as an inevitable decline. Collectively NICE should be ashamed of themselves and could be regarded as culpable in promoting unnecessary suffering and early death in thousands of people.
There is a diabetes epidemic and the NHS is in crisis. How much does all the medication cost? How much does treating complications cost? Does anyone care?
I pay for my own test kit and I don’t intend to burden the NHS coffers with any diabetes-related treatment. If I can do it why not more?
What I would like to see done
Some questions for health professionals
If you were diagnosed with Type 2 diabetes, would you follow the Eatwell Plate recommendations?
Would you take statins for the rest of your life? Would you prescribe them to your families?
Do you follow the Hippocratic Oath? Especially the bit about ‘causing no harm’?
What is the main objective of the pharmaceutical industry (hint: it’s not to make us healthy)?
How many members of NICE are independent of all connections to the pharmaceutical industry?
Conclusions
Being diagnosed with Type 2 diabetes has certainly been a life changer for me. Not because of any NHS advice but because it kicked me into researching it and working it out for myself. Just as well, because otherwise I would now be in decline and probably on an increasing cocktail of medication.
Within a year I have got my HbA1c down from 65 mmol/mol to 38, i.e. in the non-diabetic range. I am still diabetic of course but I am minimising the risk of any complications later. I did this with LCHF diet and exercise alone, no medication. As a consequence my weight, blood pressure and liver function are now also in normal ranges. The medical profession might consider my cholesterol to be high, but I know my lipid profile is good so I am not worried by my total cholesterol and LDL-C numbers.
As a body, the medical profession and government health bodies need to confront the pharmaceutical and food industries head on. They are making vast profits at our expense and slowly but surely damaging our health in the process. Medical professionals should promote truly independent research and not just accept what glossy brochures produced by the drugs industry say.
Thank you
If you have got this far, thank you for your attention, even if you are thinking ‘who the hell does this guy think he is?’.
This just started as the story of my first year as a Type 2 diabetic, but inevitably along the way I have developed a number of views on diabetes management and the guidance currently available. You may or may not agree with it but you cannot deny that my approach has worked. And if it works for me it can work for virtually everyone.
UK health professionals are obliged to follow NICE guidance, but if this encourages them to think a bit more about what this is doing for diabetics and how pernicious the influence of the drugs companies is, then that will have made my effort worthwhile.
Meanwhile I’ll continue to pass on my experience to others and hopefully help to improve the quality of some lives under this condition.
My first year to April 2015
(This is a slightly adapted conversion from a presentation sent to my local health practice).
Summary
- Diagnosed Type 2, March 2014 (HbA1c 65 mmol/mol, 8.1%)
- No medication
- Self-testing
- Low-carb diet
- Now in non-diabetic range (HbA1c 38 mmol/mol, 5.6%)
- 20 kg weight loss
- Improved lipid profile
Highlights
March 2014 | March 2015 | |
HbA1c | 65 mmol/mol (8.1%) | 38 mmol/mol (5.6%) |
Weight (BMI) | 90 kg (31.5) | 70 kg (24.5) |
Waist | 116 cm | 94 cm |
Liver Function ALT | 51 iu/l | 14 iu/l |
Blood Pressure | 160/90 | 115 |
Introduction and diagnosis
I had blood tests in March 2014 following reported listlessness and exhaustion. There were none of the ‘classic’ T2 symptoms of excessive thirst, need to urinate, blurred vision etc.
Diagnosis was confirmed on 24 March with an HbA1c of 65 mmol/mol (8.1%). (It later transpired that in 2008 a blood test showed I had an HbA1c of 44 (6.2%), i.e. prediabetic. Apparently the trigger criterion was different then. Nothing was mentioned anyway, pity.)
No guidance was given, I was just told this was life-changing, to lose weight (I was 90 kg, BMI of 31.5), exercise more and make an appointment to see the diabetes nurse. The earliest appointment available was for 16 April, over three weeks away. Because of elevated blood pressure (spot reading of 160/90 when blood samples taken) I was told to take two weeks of readings to take to this appointment (how? where? – at a chemist or buy yourself a meter, great, thanks).
Because of total cholesterol of 6.9 I was prescribed Simvastatin without any explanatory discussion and without my prior agreement. More on this later (I never took them).
Something about me
I’ve never been one for taking medication if I can help it. The human body is often underestimated as a self-healing mechanism. A few paracetamol a year is normally more than enough for me.
I’m a scientist by training so when faced with something like this my first reaction is to find out about it and not take anything at face value without assessing it myself.
On the other hand the T2 diagnosis was a wakeup call and the kick I needed to sort my weight and well being out. Immediately I started walking for about 30 minutes every day (average).
I got on the internet and found the diabetes.co.uk website and forum; learned about carbohydrates and the impact on blood sugars; could understand the logic of low-carb high-fat (LCHF) diets; and just went for it at 50 g carbs per day – no bread, no potatoes, no rice, no pasta. Fortunately I didn’t suffer the withdrawal symptoms sometimes experienced by changing so abruptly. I bought a blood glucose monitor and started testing myself. I started losing weight straight away as I got into ketosis and my body started to preferentially burn stored fat for energy.
I also read about cholesterol and statins and determined that I wasn’t going to touch them with a barge pole.
First DN appointment
Three weeks in and I was already making progress on diet and exercise alone.
Fasting BGs were down from over 10 mmol/l to around 6.5; pre-dinner BGs in the high 5s; and BGs two hours after eating in the high 6s and mid 7s, so I was learning what I could and couldn’t eat in terms of blood sugar control.
My weight was down from 90 kg to 84.5 kg, and blood pressure was down to around 140/80.
It was agreed for me to carry on with diet and exercise alone, no medication, with a review in three months time.
Interim progress
In July 2014 my HbA1c was 45 (6.3%, down from 65), so I was now in the prediabetic range.
Total cholesterol was down to 6.0, but more importantly triglycerides were down from 5.66 to 1.97 mmol/l, and HDL-C was up from 1.22 to 1.62, with total/HDL and triglycerides/HDL ratios both dropping into normal range.
ALT liver function was down from 51 to 17 iu/l, indicating a reversal of fatty liver condition.
My weight was now 76 kg (BMI 26.6), a percentage loss of over 15%, and BP stable around 125/70.
I had also invested in a rowing machine to supplement the walking.
By October 2014 my HbA1c was 42 (6.0%), weight was 72 kg (BMI 25.2) and BP around 120/65.
One year on, March 2015
A picture speaks a thousand words, so rather than more dull text some more graphs follow covering the period from March 2014 to March 2015.
My HbA1c is now 38 mmol/mol (5.6%) which is within the non-diabetic range. I am still diabetic of course but I am protecting the remaining beta cell function in my pancreas as best I can, and avoiding exacerbating my insulin resistance. This is all due to carbohydrate restriction, which has also reduced triglycerides significantly, and the fat component of the LCHF diet has helped raise my HDL-C to 1.95. In this context my total cholesterol of 6.1 is of no concern to me.
The slight rises and falls in fasting blood sugar (the points are two-week averages) reflect life conditions such as work stress – but at least through testing I know what is going on.
My weight is now stable at 70 +/- 1 kg (BMI 24.5), which represents a 22% loss in 12 months; and BP around 115/65. My waist is now 37 in (94 cm) having been 45.5 in (116 cm) a year ago.
What do I eat?
I’ve done all this without any medication, and just with diet and exercise. So what actually do I eat with LCHF? This is a typical day’s meals:
- Breakfast – cooked breakfast of bacon, eggs, mushrooms and tomato; occasionally full fat Greek yoghurt with a few berries. Tea and/or coffee with double cream.
- Lunch – ‘tapas’ style platter, choose from salami, olives, a little hummus, guacamole, cheese, mackerel pate, tomato, salad leaves.
- Dinner – avocado vinaigrette, meat or fish with above-ground vegetables or salad, berries and double cream, glass of red wine.
- Snacks if necessary – cheese or brazil nuts.
- Plenty of water. Decaffeinated tea or coffee after midday.
Selected reading
Trudi Deakin (X-Pert Health) - Eat Fat, Step-by-Step Guide to Low Carb Living http://www.xperthealth.org.uk/shop/details/p/handbook-lowcarb-highfat-lifestyle
Trudi Deakin - High fat, low carb diets and the evidence, Diabetes UK Conference March 2015
[url=http://www.xperthealth.org.uk/Portals/0/Downloads/High fat, low carb diets and the evidence_Diabetes UK 2015_reduced memory.pdf]http://www.xperthealth.org.uk/Portals/0/Downloads/High%20fat,%20low%20carb%20diets%20and%20the%20evidence_[/url][url=http://www.xperthealth.org.uk/Portals/0/Downloads/High fat, low carb diets and the evidence_Diabetes UK 2015_reduced memory.pdf]Diabetes%20UK%202015_reduced%20memory.pdf[/url]
Dyson PA, et al. - A low-carbohydrate diet is more effective in reducing body-weight than healthy eating in both diabetic and non diabetic subjects, Diabetic Medicine, 2007
Andreas Eenfeldt - Low Carb, High Fat Food Revolution and the website www.dietdoctor.com/lchf
Feinman RD et al. - Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base, Nutrition 31,1 Jan 2015, http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext#bib94
Zoe Harcombe (diet and nutrition blogger) - http://www.zoeharcombe.com/
Malcolm Kendrick - book The Great Cholesterol Con and blog at www.drmalcolmkendrick.org
Jenny Ruhl - books Blood Sugar 101: What They Don’t Tell You About Diabetes, and Diet 101: The Truth About Low-Carb Diets; and the website www.phlaunt.com/diabetes
Scientific American (after meta-analysis by Krauss RM et al in American Journal of Clinical Nutrition, March 2010) - Carbs against Cardio: More Evidence that Refined Carbohydrates, not Fats, Threaten the Heart http://www.scientificamerican.com/article/carbs-against-cardio/
Shai I, et al. - Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet, New England Journal of Medicine, 2008.
David Unwin - Diabesity: Perhaps we can make a difference after all? Diabesity in Practice 3, 4, 2014
http://www.diabesityinpractice.co.uk/media/content/_master/3963/files/pdf/dip3-4-131-4.pdf
Westman EC, et al - The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus, Nutrition & Metabolism (London), 2008.
Commentaries
The content to this point has comprised factual descriptions of what I have done and achieved.
The following content represents my own commentaries on various diabetes-related issues. You may not agree with all of them but they underpin my decision making and management of my condition.
I’m not medically trained but I am a scientist and well used to research, analysis and empirical procedures.
I know that what I have done works, and that I have the willpower to carry on with it indefinitely and thereby defeat the commonly-held perception that T2 diabetes is inevitably a declining condition with increasing medication and often unpleasant complications.
The good thing about T2 diabetes is that you can manage it perfectly well yourself if you have the incentive (health and active life) and the tools (knowledge and a test meter). It’s depressing to me that so many diabetics are failed by the current system and doomed to more medication and declining health when in principle all T2s could do the same. As it is, the people who benefit the most are the drugs companies.
What causes Type 2 diabetes?
Despite popular perception (even held by some medical professionals) Type 2 diabetes is not caused by obesity - there are many thin T2s and many obese people who will never develop diabetes.
Some people are just genetically predisposed to developing the condition due to impaired insulin sensitivity, which is then exacerbated by the wild fluctuations in blood sugars resulting from sugar and carbohydrate consumption. In fact obesity in diabetics is more likely to be caused by the diabetes - due to the insulin resistance resulting in excess insulin in the system - not the other way round.
Type 2 diabetes is not a disease as such, just a condition with elevated blood sugars as a common denominator. It can be caused by pancreatic beta cell impairment, enhanced insulin resistance, problems in communication between the stomach, brain and pancreas concerning insulin release and so on.
It is a pity that the medical profession cannot get this message across to the media more effectively.
NICE and the Eatwell Plate
Medical professionals are legally obliged to advise on the basis of NICE guidelines. This includes recommendations to eat carbohydrates with every meal in accordance with the Eatwell Plate.
Even a cursory study of how the body deals with food will show that eating carbohydrates is a disaster for diabetics unless they are so determined to eat them that they are happy to take as much gliclazide, insulin etc to allow it.
Carbohydrates metabolise quickly to glucose in the bloodstream, some quicker than others, but the idea that there are ‘good’ carbohydrates is generally incorrect. ‘Wholemeal’ products will still spike you, especially wheat-based ones.
Would you give a Snickers bar to someone with a nut allergy? Would you suggest an alcoholic has a can of lager with every meal? Of course not – so why recommend carbohydrates to diabetics?
There is nothing new in managing T2 diabetes with low-carb diets. The Edwardians knew this – see
http://archive.org/stream/diabeticcookeryr00oppeiala#page/12/mode/2up
Ancel Keys and the low-fat dogma
The American Ancel Keys in the 1950s hypothesised that high cholesterol was a significant cause of CVD. He carried out a survey of total cholesterol vs rate of CVD in many countries. Basically there is no systematic relationship overall.
But Ancel Keys decided to cherry pick seven countries that backed up his hypothesis. This is about the worst piece of supposed science I have ever encountered, especially given the consequences of this study. You could pick a different set of populations that show exactly the opposite (Switzerland, Australian aborigines for example). Unfortunately Keys’ work provided the basis of the dogma that went on to underpin health guidelines in most countries – cholesterol causes heart disease > cholesterol increases when you eat fat > therefore fat is bad for you and you must reduce cholesterol.
So without fat where do you get energy from? Protein? (but watch out for your kidneys (also a fallacy in most cases)). That just leaves carbohydrates – the sugar and processed food industries must have been laughing themselves all the way to the bank.
Consequences of low-fat
Recommendations to eat a low-fat diet were supposed to reduce incidence of CVD and tackle obesity. But in the years that low-fat has been religiously promoted, obesity has exploded.
Fat is natural. Breast milk is full of it. It’s an efficient source of energy, and is well capable (with protein) of being processed by the body to provide the brain with the glucose it needs. You don’t need carbohydrates for this (if you did how did the human species ever survive?).
Eating fat does not make you fat. Sugars and carbohydrates make you fat. But when the food companies remove the fat they find that the texture and flavour are affected, so what do they do? Add sugar! Check out the sugar content of so-called healthy low-fat products and compare with the full-fat versions. Check out the sugar content of cereals like Special K.
Industrial trans-fats found in margarine etc. are undoubtedly harmful due to the Omega 6 content amongst others, but are still promoted as healthy alternatives to natural saturated fats like butter.
What's natural for humans?
Early man as hunter-gatherer would have lived on fatty meat, fish, eggs and occasional seasonal vegetables and fruits. Bread on a subsistence basis developed with agriculture, but it is very recently in evolutionary terms that sugar and refined carbohydrates became such a major part of our diets. The human body is simply not geared to process such a diet, and can’t evolve to do so in just a few hundred years.
Nevertheless, sugar producers and food processing companies are pushing more and more sugar and refined carbohydrate products at us. It’s cheap and very profitable, but the consequences in overall population health are clear to see. The NHS is in financial meltdown yet so much could be saved if people ate real food and not sugary carb-heavy junk.
Cholesterol
About 80% of cholesterol is produced by the liver, and only a small proportion comes from diet. If we get more from food, the liver cuts back to compensate. Cholesterol is everywhere in the body and particularly the brain. As with fat, if it is so essential why would we want to reduce it?
Yes, cholesterol is present in plaques at the sites of constricted arteries, but that’s not to say that cholesterol is the cause of CVD. Cholesterol is there because the body is trying to alleviate the symptoms of chronic inflammation caused by other factors. There is in fact no systematic evidence that high cholesterol actually causes heart attacks – CVD fatalities are just as likely to be associated with normal cholesterol as elevated cholesterol.
Total cholesterol is fairly meaningless as a marker. It’s the components (the lipid profile) that are important. HDL-C ‘hoovers’ the bloodstream and should be maintained, and triglycerides (associated with carbohydrate consumption) should be reduced. LDL-C is also of limited value since it contains both small dense particles (bad) and large ‘fluffy’ particles (good).
If you eat low-carb high-fat then HDL-C is boosted, triglycerides are reduced and LDL-C is likely to be dominated by the larger particles.
Statins
As soon as Ancel Keys’ ‘Seven Countries’ report was published, the drugs companies wanted to develop something that would reduce cholesterol. They found it in statins.
Statins undoubtedly lower cholesterol, but why would we want to do that? Cholesterol is natural and essential to the functions of the body, we just need to make sure we have the right lipid profile.
Statins are a blunt instrument. In lowering cholesterol they take out essential co-enzyme Q10 and dolichols as collateral damage. The drugs companies know this full well but don’t want to upset the cash cow.
Despite being of very limited value as a diagnostic marker, and despite there being no proof of a causative link between cholesterol and CVD, statins are being pushed at more and more people with less and less medical justification.
Statins are far from being free of side effects, ranging from muscular pain to memory loss and impaired cognitive function. They are a ticking time bomb that will one day explode in the faces of the drugs industry. And yet there have been proposals to administer them to all healthy adults! That is just insane.
Back to Type 2 diabetes
According to the National Diabetes Audit 2010-2011 only 27.5% of T2s achieve non-diabetic or prediabetic HbA1c numbers. It doesn’t say how many of the 27.5% are dependent on medication to do that.
39.9% have HbA1c between 48 and 58 mmol/mol; 25.8% between 59 and 86; and 6.8% 87 and above.
These figures could be drastically improved if the crazy recommendations to eat carbohydrates with every meal were dropped. No wonder the condition is so often perceived as an inevitable decline. Collectively NICE should be ashamed of themselves and could be regarded as culpable in promoting unnecessary suffering and early death in thousands of people.
There is a diabetes epidemic and the NHS is in crisis. How much does all the medication cost? How much does treating complications cost? Does anyone care?
I pay for my own test kit and I don’t intend to burden the NHS coffers with any diabetes-related treatment. If I can do it why not more?
What I would like to see done
- Instruct NICE to drop the Eatwell Plate and promote low-carb or lower-carb diets for diabetics
- Provide all T2s with test kits and as many strips as they require (within reason) from money saved from reduced medication and complications treatment
- Educate T2s on blood sugars, insulin, diet and how to understand their test readings
- If necessary scare them with what can happen if they don’t manage their condition
- Tell them that medication is not a silver bullet and they can’t just continue eating cakes etc. in the belief that the drugs will fix it (it won’t work for all – some people just won’t be told – but it will be a vast improvement on the current situation)
- Promote to the media that T2 is not caused by obesity
Some questions for health professionals
If you were diagnosed with Type 2 diabetes, would you follow the Eatwell Plate recommendations?
Would you take statins for the rest of your life? Would you prescribe them to your families?
Do you follow the Hippocratic Oath? Especially the bit about ‘causing no harm’?
What is the main objective of the pharmaceutical industry (hint: it’s not to make us healthy)?
How many members of NICE are independent of all connections to the pharmaceutical industry?
Conclusions
Being diagnosed with Type 2 diabetes has certainly been a life changer for me. Not because of any NHS advice but because it kicked me into researching it and working it out for myself. Just as well, because otherwise I would now be in decline and probably on an increasing cocktail of medication.
Within a year I have got my HbA1c down from 65 mmol/mol to 38, i.e. in the non-diabetic range. I am still diabetic of course but I am minimising the risk of any complications later. I did this with LCHF diet and exercise alone, no medication. As a consequence my weight, blood pressure and liver function are now also in normal ranges. The medical profession might consider my cholesterol to be high, but I know my lipid profile is good so I am not worried by my total cholesterol and LDL-C numbers.
As a body, the medical profession and government health bodies need to confront the pharmaceutical and food industries head on. They are making vast profits at our expense and slowly but surely damaging our health in the process. Medical professionals should promote truly independent research and not just accept what glossy brochures produced by the drugs industry say.
Thank you
If you have got this far, thank you for your attention, even if you are thinking ‘who the hell does this guy think he is?’.
This just started as the story of my first year as a Type 2 diabetic, but inevitably along the way I have developed a number of views on diabetes management and the guidance currently available. You may or may not agree with it but you cannot deny that my approach has worked. And if it works for me it can work for virtually everyone.
UK health professionals are obliged to follow NICE guidance, but if this encourages them to think a bit more about what this is doing for diabetics and how pernicious the influence of the drugs companies is, then that will have made my effort worthwhile.
Meanwhile I’ll continue to pass on my experience to others and hopefully help to improve the quality of some lives under this condition.
Last edited by sanguine on Sat Apr 25 2015, 12:05; edited 1 time in total
