Why is the dietary advice given to diabetics so often so woefully inadequate?

I’m not really one for anecdotes, but feel compelled to share one with you. In my practice on Monday I saw a small boy, whose parents were seeking nutritional advice. Less than three weeks ago their son had been diagnosed with type 1 diabetes, which for him right now necessitates him having insulin injected 2-3 times a day.

Once he had been diagnosed and stabilised on insulin, this boys parents were duly dispatched to the hospital dietician for advice about what to feed him. The advice they got was depressingly predictable: that they should not worry too much about sugar and that he should eat plenty of starchy carbohydrates. The parents has duly obliged by feeding him a diet replete with bread, pasta, rice, rice cakes and breakfast cereals.

Anyone that takes any interest in nutritional at all will likely know that these are foods that, generally speaking, cause considerable surges in blood sugar ” precisely what should be avoided in individuals who have diabetes. Oh, and to cap it all, the dietician recommended that the boy have a bedtime snack of Hob Nob biscuits.

Not surprisingly, his parents were having difficulty controlling their son’s blood sugar on this dietary regime. Blood sugar levels, they noted through finger prick testing, were prone to both highs and lows. After the Hob Nobs, for instance, blood sugar levels would skyrocket to 20 (ideally, blood sugar levels should not rise above about 6 or 7).

Obviously, I felt compelled to set the record straight about what to this boy’s parents should feed their son if they want to stabilise his blood sugar levels and minimise his insulin requirements. This means keeping a much tighter reign not just on sugary foods (like biscuits), but also many of the starchy carbohydrates his parents had been encouraged to ply him with. I recommend that such changes are made gradually and that appropriate reduction in medication (e.g. insulin) be made concurrently.

A couple of years ago, I gave written advice to this effect in a newspaper. I got a very stern letter from a doctor telling me that I was endangering the diabetic concern because diabetics ‘need carbohydrate’.

Well, I dispute this notion that diabetics need carbohydrates. The reality is that carbohydrate (sugar) can be made in the body from other fuels including protein. And anyway, a diet largely devoid of starchy carbs and foods with added sugar need not be particularly low in carbohydrate. Vegetables are essentially carb, are they not, as is fruit. Beans and lentils are also a decent source of carbohydrate. The difference is, these foods are generally slower sugar releasing and more nutritious than the crappy carbs so often touted for all, including diabetics.

Some doctors and dieticians seem to think that carbohydrate control is pointless: why not let them eat what they like and let them jack up a bit more insulin if need be? No doubt this rationale is music to ears of the food companies that make the rubbish foods so often advocated. And I expect the manufacturers of insulin are suitably delighted too.

However, the less carb a diabetic eats, the less their need for medication (including insulin), and the less likely they are to suffer from the side effects of excess insulin. And the better their blood sugar control is likely to be too. That means less likelihood of diabetic complications such as kidney disease, nerve damage and blindness. Can we really afford to take such a laissez faire approach to carb consumption, when it likely has important implications for health and an individual’s chances of survival?

To my mind, the fact that health professionals can and do advise diabetics to eat foods that are known to disrupt blood sugar levels is a testament to the guile and persuasiveness of the food industry. It also says something about the professionals who not only ignore the science, but seem unwilling to exercise any common sense either.

However, it seems not all health professionals are similarly ‘blinded’. About 3 years ago, when the Atkins’ diet was all the rage here in the UK, I spoke on Channel 4 News in broad support of the diet. They pitted me against a dietician from a London teaching hospital who trotted out the same old line about the high fat nature of such a diet being bad for people (despite a singular paucity of evidence to this effect). However, when the cameras were no longer rolling she told me that a diabetologist where she worked advocated the Atkins’ diet for his patients. She went on to tell me that, despite his enthusiasm for low-carb eating, the doctor concerned was unwilling to publicly support this nutritional approach. One can only guess as to why. Did he think his peers would think him a crank? Would funding for his research suddenly dry up? Would drug companies no longer invite him to attend or speak at conferences about diabetes and its management?

Whatever the reason, this story reminds me of how much medical practice is influenced by factors such as herd mentality, politics, commercial considerations and fear for one’s ‘reputation’ ” all things that shouldn’t, in my view, be arbiters in the care and advice we offer our patients.

Because I am not really one for mincing my words, I had some strong ones for the parents of the diabetic boy with regard to the advice he had received. My reaction is partly borne out of frustration at how misguided nutritional advice for diabetics often is. This is not just a political issue: lives are at stake after all.

144 Responses to Why is the dietary advice given to diabetics so often so woefully inadequate?

  1. Neil 3 October 2007 at 7:49 pm #

    Sounds pretty typical. Eat what you like including starch etc and ‘treat’ the inevitable high blood sugar with insulin. And if thats not enough, keep raising the insulin. Of course you’ll run the risk of developing insulin resistance/Type 2 diabetes in addition to to being Type 1, but at least you can console yourself with the knowledge that you followed conventional dietary and medical advice.
    Just a couple of quotes to finish…

    “the first thing we teach medical students at Downstate Medical Centre is that there is no biological requirement for carbohydrate”

    “there is no dietary requirement for dietary glucose”

    from Richard Feinman Professor of Biochemistry, (obviously an advocate of low carbohydrate eating)

    Wonder where it all goes wrong after that.

  2. chris 4 October 2007 at 7:12 am #

    Shame on you doc – hiding behind a so called patient! Has the site been quiet and you are trying to provoke an argument or some more hero worship.

    A diabetic child needs to be seen at a paediatric unit with specialist staff – not in general practice.

    So why not share with us what you adviced and how practical that would be with a small boy and a family – cant wait to hear!

  3. Dr John Briffa 4 October 2007 at 7:52 am #

    Have another read Chris – you appear to have missed the point: the boy had been medically managed and then referred to a dietician who had recommended he eat a diet that is intrinsically upsetting to blood sugar control (this is all in the original post).

    I’m not trying to provoke an argument – there really can be no argument: the advice this boy was given was woeful and likely to damage both his short and long term health. So much for specialist advice….

  4. chris 4 October 2007 at 9:38 am #

    Maybe you have missed the point – people frequently see a prof who they confuse – i get called doc / nurse etc!- if these people had see a paediatric dietitian it is more than likely they would have been referred to a special course to learn about insulin adjustment and carb counting / adjustment. You should know more than anyone patients can be very selective – they are probably struggling to come to terms . It was wrong of you to slate the person concerned – she has no defense here. Certainly dietitians are in at the beginning not after insulin treatment has been established !

    You havent given us any insight into your plan – do u use very low carb intakes for kids

  5. Dr John Briffa 4 October 2007 at 10:24 am #

    Oh, I see – you’re suggesting that this woeful advice may not have come from a dietician, but someone the parents believed was a dietician, but wasn’t? What a brilliant defense of your profession – claim that the advice didn’t come from one of your own! Trust me when I tell you that these parents were in no doubt at all that the advice came from a DIETICIAN.
    How do you define ‘very low carb intakes’?

  6. chris 4 October 2007 at 10:39 am #

    John – u are making accusations here remember about an Dietitian – I feel this is highly innappropriate for a member of the medical profession. Of course I will defend my profession wouldnt you especially as you are being somewhat selective.

    Well are you using something like atkins – maybe less than 30-50 g per day.

  7. Dr John Briffa 4 October 2007 at 10:49 am #

    “Of course I will defend my profession wouldnt you”
    Well, actually, Chris, no I wouldn’t, because I don’t believe in defending the indefensible.

    I’m not interested in upholding the reputation of my profession – I’m interested in giving individuals the best health advice I can. But, I suppose we all have different priorities….

    No, I don’t particularly restrict carbohydrate per se. However, I do advise restriction of those carbohydrates that have high glycaemic index and particularly glycaemic load.

    What I certain don’t advise is that a diabetic eat a diet based on the very foods diabetics cannot handle well in the body. As a dietician, is there anything about this approach that you take exception to?

  8. chris 4 October 2007 at 11:15 am #

    no just your tone ! You condemn every type of health professional on here – Dietitians are very ethical individuals who are well trained and have a very practical approach.

    Oh but we have been here before. This is an inappropriate place to criticise other professionals particularly those who cannit defend themselves.

    That young boy needs to be seen by a diabetic paed dietitian who will follow up long term with a team who can monitor him.

    Can I ask u something – how did you validate your questionnaire in the book or is it something others have used ? I came out as a gatherer by the way !!!

  9. Dr John Briffa 4 October 2007 at 2:07 pm #

    Chris – dieticians can be as ethical and ‘practical’ as you like – but if they persist in giving erroneous and potentially harmful advice, what is wrong with saying so? Please tell me why this is not a forum for such information? Why should individuals not be warned of supposedly well-meaning advice that may harm their health and hasten their demise?

    Why do you believe that this boy needs to be seen by a diabetic paediatric dietician, when it was a dietician that gave him the thoroughly inadequate advice that was the trigger for this blog post? What is the logic in that?

    The questionnaire in my book is based on observations to be found in the scientific literature (see chapter 12) and clinical practice (see chapter 13). Though quite what that’s got to do with the theme of this post and the comments that follow is anyone’s guess. You’re not trying to shift the focus away from this debate, are you? If not, then can I respectively ask you to stick to the point?

  10. chris 4 October 2007 at 4:43 pm #

    John – without the medical records or the dietitian how can you comment – had she actually finished working with – having been part of a team years ago it takes weeks to educate parents, school, teachers, grandparents etc. I hope the parents know u are discussing this child on an open forum. .

    Diabetic experts who work in the field have experience with diabetic kids and that is vital. They will arrange weekend camps for families – this is a huge lifestyle change for all the family so they need a team – docs, daibetic nurses, dietitians and psycologists. They also get the opportunity to mix with other diabetic kids and families.

    I asked the question because it doesnt fit in any where else – suppose I could have emailed u as I have others ! this was discussed months ago so u probably wouldnt have replied.

  11. Dr John Briffa 4 October 2007 at 5:26 pm #

    I don’t need the medical records to know that the diet advised by the dietician in question was wholly inappropriate for a diabetic. Sound though even you now seem to be open that the initial advice was wide of the mark.

    If you are suggesting that I have breached confidentiality, how is that if I have not revealed the identity of the patient or his parents and there is no way for anyone to to discover this for themselves?

    Seeing as their anonymity is preserved, what, precisely, do you see as the issue?

  12. chris 4 October 2007 at 5:39 pm #

    well actually I would not like my kids to be discussed on here and used to promote someone else.

    It is rather difficult to comment on the diet Rx for that child because you have only given very general info! That is not a cop out either – very sweeping statements. I do think however your comments re diet and diabetes are just generalisations.

  13. Sue 5 October 2007 at 10:08 am #

    Chris, you are so off the mark. Congratulations Dr Briffa we need more professionals like you who actually know what they are talking about!

  14. Sue 5 October 2007 at 10:10 am #

    Forgot to say, dieticians are not well trained. They just keep repeating the party line!

  15. Maggie 5 October 2007 at 10:49 am #

    I was diagnosed with diabetes in 2003 and within three weeks was put on insulin, later the specialist nurse admited that it was probably too soon. Since then I have struggled with my weight and blood glucose levels.
    I saw a dietican and was told to eat bread, potatoes, pasta or rice at every meal and that the Atkins diet was not for diabetics. Also the specialist nurses I have seen, the doctor and my practice nurse have all told me to eat those carbs. After reading this post I’m changing my diet.

  16. Stuart Williams 5 October 2007 at 11:16 am #

    I am a type 2 diabetic(diagnosed 1999) using a low carb diet & insulin to control the condition (last HbA1c reading 5.8).
    This regime is that prescribed by my doctor (for diabetes only) Dr.Richard K Bernstein author of the book ‘Dr Bernstein’s diabetes solution’.I have a young nephew who is a type 1 diabetic & also uses Dr.Bernstein’s regime,my nephew’s HbA1c readings are better than mine.

    When you talk to dietitians about the regime you generally get a reaction which can best be described as a combination of hostility,’jalousie du metier’,& fundamentalist ideology.

    Where is the evidence that a high carb diet enables blood sugar control in the non diabetic ranges?

  17. D 5 October 2007 at 11:22 am #

    Children need calories to grow and therefore having a diet mainly consistent of fruit, veg and pulses will not provide adequate calories to grow. Starchy carbohydrates are needed to help provide the calories needed for growth.

    It will be interesting to see how well the boy in question thrives now that his family have been ‘re-educated’.

  18. joe corrigan 5 October 2007 at 11:30 am #

    I am a type 2, insulin using diabetic living in the Netherlands. I am managed at a diabetic centre which is hoped to be the model for future diabetes control throughout the Netherlands.The first thing I was told on recieving my insulin was that it would make me fat! The dietary advice was lots of carbs(6 sandwiches a day), gess what? I got fat! As a result I’ve lost all faith in Dutch diabetic experts and my control is in my own hands. Carbs from cereals have always given me dreadful heartburn. It’s taken me 50 years to realise accepted dietary advice is , for me , probably fatal. Dr. Briffa is the way forward for diabetics. It seems only vested interests argue otherwise.

  19. Emma 5 October 2007 at 11:51 am #

    I have just read this dialogue between John and Chris…..this is quite mad – Chris I think you are missing the point and it does not really sound as though you know what you are talking about or even have experience in the area of treating diabetic patients. I have been a type 1 diabetic for over 15 years now and I wholeheartedly agree with the advice that John is advocating. Having experienced how my blood sugar levels respond to a plate of rice or pasta as opposed to a salad or vegetables with protein, John’s advice to avoid starchy carbs is totally appropriate and accurate. I also was advised to ensure that I always ate starchy carbs at every meal when I first became diabetic, and this sort of diet requires huge amounts of insulin and produces widely fluctuating blood sugar levels. This is one of few artivles that I have seen that advises type 1 diabetics to follow a low carb diet and I am so pleased to see it! Thanks John

  20. Richard 5 October 2007 at 1:07 pm #

    Highs and lows in blood sugar can affect a persons ability to think straight and can lead to irregular behaviour can’t it! Something I witnessed working in a hospital. And the dieticians I worked with were not exactly shinning examples of health in my opinion.

    John I think you talk sense.

  21. chris 5 October 2007 at 1:13 pm #

    oh here we go again – dietitian bashing. Many diabetics see a dietitian and are well controlled . As for training you obviously have not a clue – ask the doctor what his quals are please! I RUN SEVERAL GP CLINICS AND MY AVERAGE HBas are in the low 5s – ah dont know what I am doing!
    Many diabetics also choose to ignore what they are told and end up in trouble.

    No one is advocating high carb diets – I really do not know where u get this stuff from – most dietitians use low GI and carb counting. In the real world most people cannot sustain a carb free diet – god knows I have enough evidence for that but have no means to publish it!

    D – of course kids need carbs to grow but the right ones. They will not get enough calories!

    It is interesting that every man and his dog is an expert when it comes to food! At least they think they are – quite alarming one thinks.

  22. deborah 5 October 2007 at 2:07 pm #

    Over 30 years ago my nephew was diagnosed type I, the general advice to diabetics then was Very Low Carbs! But lots of protein, fruit and veg; this child was only Iyr old, but he grew into a strapping man, on lentils etc!! And controlled his blood sugar easily.
    The hunter- gatherer lived on mainly meat and fruit, not even a lentil, how did he manage without a sandwich ????!!!

  23. Linda 5 October 2007 at 2:15 pm #

    D says ‘carbohydrates are needed to help provide calories needed for growth’ The growth you get from carbohydrates is mainly outwards i.e. you get fatter! Excess sugar/starch in the body is turned to fat. You need protein to help you grow.

  24. ally 5 October 2007 at 2:38 pm #

    easy as he didnt live very long. I am observing all this and from what I can see all you people are perfect – don’t you ever eat anything you shouldnt! I find that quite hard to believe!

    My sister was referred to a dietician with her daughter and all I can say is that he was very helpful and informative.

    10,000 years ago is hard to equate with now – we have adapted and moved on. I dont want to be a hunter – would rather go to tesco!

  25. chris 5 October 2007 at 2:41 pm #

    Richard – what exactly do you mean by not being a picture of health? Can I ask what you do and how you come to form such an opinion?

  26. annemarie 5 October 2007 at 3:56 pm #

    Its is a common MYTH that all dietitans advocate these sort of diets. This may be so for less experienced (non specialist) dietitans but I very rarely meet an experienced one working with complex diabetes who still uses the old “healthy eating/eat plenty starches” model.

    I myself (15 years experience) work with type 1 and type 2 patients on insulin and have NEVER recommended these blanket “high carb diets” of which you speak. I work with moderately low amounts (low GI) which can be modified for weight loss using carb counting (type 1). I also am quite happy for the only carbohydrate source in (type 1 and type 2) a meal to be from fruit or vegetable/lentils or beans. Why add starches? Crazy!

    For type 2 patients on insulin, high carbohydrate amounts are an absolute disaster!!!! We have done a study on reduced HbA1c using these diets and the resultant weight gain (as a “side effect” and are now using reduced carbs with reduction in insulin (and other factors to reduce insulin resistance) in weight loss groups.

    Please get your facts right about what we are telling people.

  27. chris 5 October 2007 at 4:16 pm #

    oh and ps dietitians don’t tow any party lines. If you actually knew anything about dietitians, how they train and what they do you might have a suprise – the nhs is full of inovative projects run by them. I think you are just influenced by sites like this.

  28. Neil 5 October 2007 at 4:29 pm #

    Part of the problem lies with differing viewpoints as to what constitutes a low carbohydrate intake, in grams.
    And secondly whether ” low glycaemic index” carbohydrate is better than high, if the total hydrate is identical.

    Personally I feel the average diabetic would do well to steer clear of grains, cereals, root veg and rice/pasta of any ilk.
    And fruit such as grapes and oranges which contain a lot of sugar (or form of sugar)

    I agree with Chris that in the real world, many pepole cannot stick to a long term eating regime, where i would differ is in that low carb as above should be the ‘Gold standard’ advice. If people fail, as they do they may wind up with bronze, but if they aim for bronze, which i would contend is what happens now, then non adherece reults in the wooden spoon.

    I don’t doubt that there are diabetics who do well in terms of HbA1c despite eating more total carbohydrate than I believe advisable, and Chris’ results in the low 5s are to be applauded.

    I believe that any dietary advice for diabetics should have as one of its principal aims, the reduction of medication as far as possible.

  29. Caromora 5 October 2007 at 4:45 pm #

    My oldest son was diagnosed as Type I diabetic when he was 18 years old in 1975. He was put on a low carb diet and told to avoid sugars and starches, but eat plenty of meat, vegetables, and low carb fruits. He has now managed his diabetes for 32 years and is the picture of health.

    My oldest daughter was diagnosed with Type I diabetes in 1998 when she was 35. She was told to eat anything she wanted, plenty of bread, pasta, rice, etc. and just make it up with insulin. Someone also told her that eating that way and using insulin would make her fat. She decided to just eat that way and leave her blood sugars fairly high. She did stay thin; however, just 9 years later, she started dialysis for her failing kidneys this week. She also has neuropathy in her feet. I think if she had listened to her brother and me, about eating low carb, she would not be having these side effects/

  30. chris 5 October 2007 at 5:00 pm #

    actually linda carbs don’t make you fat only if you eat too many and probably the refined types – when combined with excess fat in cakes and crisps – yes they do.

    I eat carbs at every meal and I am not fat and none of my family is either – in fact I think my sons would be malnourished without them . It is very difficult to feed kids enough calories just from protein and fat – rather unpaletable too!

  31. ulla 5 October 2007 at 5:34 pm #

    I was a student nurse in the sixties and clearly remember when dishing up meals to diabetic patients I had to give plenty of meat & vegetables, but only one or two potatoes “size of small hen’s egg”. Bread 1 thin slice (only brown)
    Also my grandfather who died in the seventies at the age of 82 had been an insulin dependant diabetic most of his life and never suffered from any complications. I remember at family dinners he would always eat mainly meat & vegetable, rarely potatoes and he always had a slice of black ryebread. (he lived in Denmark) Interesting how dietary advise has change though not for the better.

  32. Kristine 5 October 2007 at 5:38 pm #

    My husband was diagnosed diabetic 6 years ago and was given a book describing the type of diet he should eat, I threw it out and changed his diet to low carb, he had perfect blood sugars and his doctor told him he was his ONLY diabetic patient that he didn’t worry about! His diabetic nurse told me to my face that even though she could see what we were doing was correct, (she even took my book away and did the diet herself losing some weight for the first time in many years), she couldn’t advocate it as she’d spent years training to specialise in diabetes and this was completely opposite to what she had learned. Amazing eh? Great head in the sand thinking.

  33. Catherine Collins RD 5 October 2007 at 10:45 pm #

    Now this is an interesting dilemma. You are a medical doctor who claims that the dietetic advice given by a Registered Dietitian breached your expectations of how a newly diagnosed diabetic child should be treated. You claim that the diet given lead to erratic blood sugar control. You mock the advice to eat a variety of foods – including complex carbs – within the diet as ‘depressingly predictable’ advice given by a dietitian. As a registered member with the GMC you surely have a moral – if not ethical – duty to take issue with the ‘harmful advice’ you consider was given by the dietitian. To do otherwise is immoral – and in breach of your GMC ‘Good Medical Practice’ guide http://www.gmc-uk.org/guidance/good_medical_practice/GMC_GMP.pdf
    para 6 page 9.

    So, Dr Briffa, report the dietitian to the HPC (www.hpc-uk.org) for misconduct. You are claiming that they put the patients health at risk. If proven too have done so, said dietitian will lose their RD status.

    But of course, you won’t. Because all the above copy is sensationalised to fit a newspaper feature/ webblog to highlight the sophisticated reasoning of your ‘medical’ status and – in your opinion – ‘inferior’ knowledge of the dietitian. You distort the anecdote to reinforce (if needs must) your rather tedious – and historically incorrect – mantra of all carbs bad: non-carbs good (yawn).

    You selectively omit (or were you not aware) how the ‘honeymoon’ period of early diagnosis can make blood sugar levels, and insulin requirements, unpredictably variable – irrespective of diet.

    You mock the dietetic advice to base the diet on a variety of foods, including complex carbs. So how do you explain how your personal opinion is at variance with the dietary recommendations from every diabetes organisation in the world, plus international organisations such as the WHO/ FAO/ ECRF and the US FDA/NIH. Indeed, only last month the the new ‘healthy eating’ model relaunched by the Food Standards Agency was remiss enough – if I interpret your views correctly – to include a substantial amount of carb as part of their new healthy eating educational tool. http://www.food.gov.uk/healthiereating/eatwellplate

    But finally, I note you are on the GMC register, #3479883, but appear to be neither on the Specialist Register, nor on the GP Register, so media nutrition is your specialty. But I suppose that your claim to be a ‘leading nutrition doctor’ is qualified somewhere other than Tatler magazine?

    I guess those familiar with the names of Professor Tom Saunders, Professor John Garrow, Dr David Bender, Professor Marinos Elia, Professor Alan Jackson, Dr Pat Judd, and Dr Kevin Whelan would dispute this. But of course, we are all entitled to an opinion, whether or not it agrees with yours.

    I presume this email will eventually be removed, as per previous. Thank Heavens for Google Cache

  34. Dr John Briffa 6 October 2007 at 8:37 am #


    You have misrepresented my views on carbohydrates. Where have I stated (or even hinted at) that all carbohydrates are bad? In fact, even in the comments posted here (see comment 7) I am clear that the type of carbohydrate is important.

    Just because organisations such as the FSA support a diet rich in high GI/GL carbohydrates does not make it good advice, does it? See here: http://www.drbriffa.com/blog/2007/09/19/uk-food-standards-agency-continues-to-mislead-the-public-on-the-value-of-starchy-foods/

    You may believe there is ‘safety in numbers’, but this sort of advice (i.e. standard dietetic advice) is being exposed for what it is: not scientifically based, and moreover, potentially harmful to health.

    And in light of this, you and other members of your profession seem happy to dispense this advice. And as is so common, instead of debating the point using science (or at least common sense), you make the issue personal.

    You wouldn’t perhaps be trying to deflect attention from the real issue here, would you?

    Nowhere in your quite voluminous post have you, it seems, been able to mount a cogent argument to support the dietetic advice highlighted here. Though, of course, you have plenty to say about me that has nothing to do with the issue being debated here. My advice to you is to concentrate on the message here (not the messenger).

    Less invective and more rational-minded discussion might help stop the reputation and credibility of your profession from sinking even further.

  35. chris 6 October 2007 at 9:02 am #

    read the posts again !

  36. Sue 6 October 2007 at 11:19 am #

    Dieticians – don’t want to admit they are wrong. If you are diabetic low carb is the best diet for you. Protein, fat, vegetables and low-sugar fruits is all you need. We don’t need carbohydrates in our diet except for a very limited amount. If we need more the body is able to make it from protein via gluconeogenesis. Diabetes is easily controlled when the advice you get is correct!

  37. Liz 6 October 2007 at 12:46 pm #

    Wow! Stirring stuff.
    Recently doing a dietary analysis on a client, I noticed that the evening meal was labelled “for a diabetic” but contained a large amount of white rice. I queried this and was told it came from a diabetic cookbook (the client’s partner is diabetic).

    Looking at it from a biochemistry standpoint it didn’t make sense. Sure, diabetics need to maintain blood sugar levels but not in stratmospheric amounts. A plate of veg or salad would have provided the same amount of sugar/starch without the blood sugar surge. So it’s not logical to advocate consumption of a lot of starchy carbs though this does seem to be the advice that a lot of people are given.

    Lowering starchy carbs does not mean Atkins, as the consumption of pulses, vegetables and fruits keeps the overall carb level up, with the added benefit of all the vitamins and phytonutrients these foods provide. So it’s difficult to see why the consumption of starchy foods is emphasised so much. Perhaps it’s a confusion between raising blood sugar levels quickly and the total amount of sugar that is provided by foods. It’s as if people think that starchy foods give a “safety margin” so that hypogycaemia does not occur.

    Thinking through the biochemistry and giving specific detailed dietary information to each client could avoid this confusion – the best plan for evey diabetic is an eating plan that gives balanced amounts of sugar and all the other nutrients they need, which won’t be the case if the focus is on white bread and white rice.

  38. Jasmine Challis 6 October 2007 at 2:05 pm #

    ‘Vegetables are essentially carb, are they not’ – not : by and large, if we are looking at accuracy most are mostly water with a carb content of 2-5g per 100 grams. The exceptions are obviously potatoes/sweet potato/beetroot etc where there is up to 15g or so sugars/starches per 100g. Many diabetics find that fruit has an impact on blood sugar levels greater than that of other low GI carbs. Many people struggle to implement advice as it was actually given first time around. It is very easy to criticise and sensationalise. You imply that carbs are bad and do not in your original statements mention GI nor that there is a huge range within the ‘families’ of cereals/breads etc. May be you did explain this to the family, I wasn’t there so I can’t comment. Protein is an expensive alternative to carbohydrate but I guess the family can afford the portions required – tho whether a small child could eat enough is a separate issue. Presumably you will monitor his growth on this diet on a regular basis to ensure he continues to grow adequately.

  39. Catherine Collins RD 6 October 2007 at 3:46 pm #


    You state in your reply to me:

    “You have misrepresented my views on carbohydrates… that I recommend low GI and GL carbs…”

    yet your original copy at top of page says:

    “…a diet replete with bread, pasta, rice, rice cakes and breakfast cereals…. know that these are foods …cause considerable surges in blood sugar ” precisely what should be avoided in individuals who have diabetes”

    Hmm. I think you will find that there are a great many of these ‘offending carbs’ that have a low GI. Never mind, lets pass on the contradictions for the moment

    You then reply:

    “Less invective and more rational-minded discussion might help stop the reputation and credibility of your profession from sinking even further”

    I agree. Absolutely. I do hope that you will start to take your own advice soon as your relentlessly snide attacks on dietitians says much about your ‘professional approach’ both in terms of knowledge and personality.

    I merely highlighted that your opinion in the opening copy is counter to the prevailing medical knowledge on the management of diabetes – which is to include regular, modest amounts of carbohydrate within the diet. You choose to exaggerate this message to promote opinion, and of course can do so. It’s your website.

    But as long as your cheap ad hominem attacks on Registered Dietitians continue, you can expect assertive responses.

    But please, instead of this rather pathetic sniping at another professional, I suggest you do something about it – professionally. That would give you something really interesting (for a change) to write about.

    The HPC takes professional irresponsibility very seriously, in fact, just as much as the GMC does for docs. In fact I do believe we share common ground. The GMC states for example, that a doctor must not:

    “misuse information about patients”

    “Keep your professional knowledge and skills up to date”

    “Recognise and work within the limits of your competence”

    as well as

    “Be honest and open and act with integrity”

    “Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk”

    “Never discriminate unfairly against patients or colleagues”


    If you are seriously concerned about a dietitians practice, then report them. Your tedious ad hom sniping is beginning to irritate.

    Feel free to reply as is your wont. I’ll afford you the last word.

  40. chris 6 October 2007 at 5:23 pm #

    who says the focus is on white bread and rice – this discussion is getting very confused as it always seems to on here!

    Sue/liz – just remember that dietitians do not dole out the same plan to every patient – which is what you seem to think. We have learnt alot over recent years since bs monitoring has become available – it would be interesting to see if those with complications are the result of times when monitoring was not used! I cannot recall a study that has looked at this specifically.

    Of course the carb intake will be limited but it is one by assessment and individual requirements. It is important to look at lifestyle etc .

    Dietitians have experience of many patients not just a few anecdotes from here or from many of the wacky websites advocating low carb regimes – written by car mechanics and teachers !

    One of the keys here is early diagnosis that has a huge effect on outcome – the gps I work for tend to do BS on every patient who has bloods done.

    I am not sure what the doc was trying to provoke here because he does this from time to time.
    He has overstepped the mark this time and the ethics of using this small boy to promote himself is a disgrace.

    A huge study in the west country is certainly showing that compliance to a low carb diet is a problem and that overall control is similar in those eating more carbs. Many of my own patients have good control but the key is portion control – no one is advocating huge portions of refined carbs – not sure where this comes from!!
    There will always be those who will not listen – just like those who carry on smoking.

    An important point to note is that dietitians generally have access to medical records which is a distinct advantage – even if the doc doesnt think it is important – being able to see all the results and advice previously given by all health professionals means you are not relying on patients memory.

  41. Michael 6 October 2007 at 10:28 pm #

    Bravo Dr. Briffa!

    More people need to speak up about how insane the low fat / high carb diet advice is for diabetics.

    My dietician and registered diabetic educators gave me the standard diet advice that the ADA recommends, the low fat / whole grain approach.

    I patiently sat through several sessions of this advice and tried to make it work. According to this advice, each meal was supposed to be between 30 to 60g of carb.

    Even 30g of carb will push my BG near 200.

    I tried all the low glycemic stuff and even developed a taste for beans and barley. Lower glycemic ratings only slow it down a bit, if the food is starchy or sweet, it will raise bg too much, too fast.

    Anybody with a meter can figure this stuff out.

    All carbs raise blood sugar.

    The ADA is fixated on a low fat diet as somehow being heart healthy and good for cholesterol and triglycerides. It may be the current mainstream theory, but it is not supported by facts.

    My own experience and several studies show a big IMPROVEMENT in triglycerides and cholesterol with low carb.


    Since you can’t have a low fat, low carb diet, the ADA is actually advocating a high carb diet.

    A low fat, high carb diet will force blood glucose levels far above normal, and since high blood sugars begat high blood sugars, a diabetic’s BG will not fall to normal by the next meal.

    Oh, and the ADA says to be sure to get your eyes and feet checked every visit to the doctor.

    If you follow the ADA diet advice, you better check your eyes and feet at every visit as your feet, eyes, kidneys, etc are inevitably going to hell.

    (last A1C 4.8% – almost normal)

  42. Michael 6 October 2007 at 10:33 pm #


    Glad to hear that there are some good dieticians out there!

  43. Sue 7 October 2007 at 3:27 am #

    Lets just blame the patients memory!

  44. chris 7 October 2007 at 7:04 am #

    sue – taken out of context – the point I was making was that it is important to have the medical records!

    The ADA has nothing to do with dietary advice given in the UK! Read the posts again!

  45. Dr John Briffa 7 October 2007 at 7:38 am #

    Catherine Collins RD

    You claim that I wrote: “…a diet replete with bread, pasta, rice, rice cakes and breakfast cereals…. know that these are foods …cause considerable surges in blood sugar ” precisely what should be avoided in individuals who have diabetes”

    And add: “Hmm. I think you will find that there are a great many of these ‘offending carbs’ that have a low GI. Never mind, lets pass on the contradictions for the moment”

    No, let’s not pass of the apparent contradiction Catherine, let’s examine it in more depth. Actually, what I wrote was this:

    “Anyone that takes any interest in nutritional at all will likely know that these are foods that, generally speaking, cause considerable surges in blood sugar ” precisely what should be avoided in individuals who have diabetes.”

    So, it seems you have selectively quoted my original statements (by removing ‘generally speaking’) to make it seem my comments were inaccurate and contradictory, when in fact they weren’t.

    It seems the cause of the ‘contradiction’ was not what I wrote but your intellectual bankruptcy.

    Also, you have failed to concede that I have never advocated that all carbs are bad (as you originally claimed). Could you do so now?

    Let’s get something clear: I have no issue with dieticians per se: it’s the advice they often give I take exception to. Dieticians could be the sweetest, nicest, best ‘trained’ people of the planet, but that does not excuse them giving bad nutritional advice.

    Your defense of this advice seems to be based on a personal attack of my own character and is laughable. Except no-one’s laughing – especially not the countless individuals (some of whom have posted here) who have suffered at the hands of traditional dietetic advice.

    You have had the opportunity here to make your case using science, logic and reason, but have failed yet again. Instead, it appears you have attempted to shift the debate away from the matter at hand, and prefer just to ask questions of my character and professionalism. And then you accuse me of ad hominem attacks. I’m assuming the irony is not lost on you.

    Could you not find it in yourself, Catherine, to focus less on me, and more on seeking to give your patients the best advice you can?

    Thank you for giving me the last word, but there really is no need. Do please take the opportunity to post again (if you actually feel you have something worthwhile to say, that is).

  46. Hilda Glickman 7 October 2007 at 1:57 pm #

    I WONDER IF ANYONE WILL BOTHER TO READ THIS AFTER SO MANY RESPONSES! What a lively site! Anyway what are carrots, parsnips, peas, fruit, swede etc if not carbohydrates? Eating refined sugar in any form is just wrong and to say we have moved on from 10.000 years ago is just stupid. Our genes do not change that quickly! We are not biogically adapted to consume factory made processed junk like bisciots , refined cereals etc. Blood sugar can drop dramatically just by cutting out the refined carbs and junk. However it is not about opinion it is about research so why not go into Pubmed and look at all the research in this area . Although anecdotal evidence is not as good, it can be a place to start. Hilda

  47. chris 7 October 2007 at 2:09 pm #

    oh I see that means discussion closed does it?

    I really do not see the point of anyone posting here unless they tow the party line – oh sorry that is what you acuse dietitians of doing !!

  48. Dr John Briffa 7 October 2007 at 3:43 pm #

    Chris – are referring to this comment: “Thank you for giving me the last word, but there really is no need. Do please take the opportunity to post again (if you actually feel you have something worthwhile to say, that is)”?

    If so, it seems you are struggling not just with basic scientific concepts and common sense, but the English language too.

  49. Michael 7 October 2007 at 4:51 pm #

    >>The ADA has nothing to do with dietary advice given in the UK! Read the posts again!

    The party line seems to be the same all over the world.

    The “official” diabetes dietary advice given in most of the world seems to favor low fat with only moderate carb restriction.

    If the low fat theory were correct, then the Atkins style diet would not work.

    Anybody with a blood sugar meter can test how well it works.

    I don’t understand your automatic defense of other dieticians.
    Science is only moved forward by questioning the status quo.

  50. chris 7 October 2007 at 5:36 pm #

    John – I do not know why you have to be so personal and insulting ! The trouble is I suppose the messages are sometimes a bit rambling! John people ask qustions on here and they never seem to get answered

    What ever a health prof says on here is a waste of time because you are not willing to listen.And you have ticked me off several times for posting anecdotal info! I also think that you perhaps remove parts of posts too! You also choose to ignore any research that may be published that might go against your way of eating. I am struggling with the purpose of this website – book promotion etc I suppose and of course all the others who have web sites that one can link to.

    Hilda – anyone can research pub med of course but maybe some people struggle with the idea that we should be eating what people ate 10,000 years ago. I am sure they probably ate very poor food indeed – what would their life expectancy have been about 30ish! I have no intention of going back wards. Because whether you like it or not we don’t know everything about people 10000 years ago. I agree completely with you about the rubbish people eat – people still shock me!

  51. helen 7 October 2007 at 11:24 pm #

    Chris for someone who obviously has an education you don’t seem to use your brain too well. No one here is saying no carb they are all saying low carb & all dieticians I have ever heard talk on the topic of diabetes or even high blood pressure do recommend pasta, rice, potatoes, cereals & breads to their patients. I was one of the high blood pressure people told to eat in such a way to have 70 to 80% of my diet cereal based needless to say medication & a huge weight gain were my only consolation at least I was eating right! the perfect diet I was was told when I kept my food diary & they couldn’t understand why my blood pressure & weight were going up. Well obviously like you they didn’t use their brains & only repeated what they had studied at diet school!! I now have no high blood pressure, no medication & no exess weight I have been on a LOW CARB not no carb diet now for over 5 years it is very easy to stick to & I am never, hungry or tired I have not even had a cold in all this time so much for your wonderful diet of cereals & starches. I have proved the human need for carbs is driven more by money in other peoples pockets than a need for health. Saturated fat & protein the two essentials of life – unless of course you are a rabbit or some other herbivore!

  52. chris 8 October 2007 at 6:27 am #

    Hilda is right – people do not read this. I have never said not to eat fat – but one thing is quite clear that alot are getting fat from rubbish – that is the main issue. Low carbing is difficult to sustain for most people – anecdotally alot of my own clients have tried atkins and found yes they lost weight quickly but could not sustain it. People lose wt on low carb diets because they consume a low calorie intake in total and this has shown up in many of the assessments i have done based on their food diaries. In fact the BBC diet trials found the same thing and I believe a trial published last week in the US found that atkins came out badly in a review of popular diets. It does not suprise me in the slightest – in fact i ahve found it is dying out and people are more interested in GI/GL.

    The fact is that most who post here are advocates and perhaps do not accept that diabetes and other conditions can be controlled by a low GI/Gl diet if they get the right advice. I think that the dietitians who have posted here are angry with the doc for the way he has portrayed this – it was completely innappropriate on an open web site and besides who knows if it is true!

    By the way if you were eating 70-80% of calories from carbs where on earth did you get that from – we have never used that in the UK. comments on here and other sites refer to encouraging sugary foods for diabetics – god knows where they get that from – in practice that is def not the case. The ADA appears to be very out of date .

  53. Sara Neill 8 October 2007 at 10:30 am #

    It seems to me that Dr. Briffa, clearly a busy man, has replied to your points courteously and very patiently. He speaks and writes clear, simple and good English yet you seem, as ever, completely unable to understand what he is saying. Indeed, I (and it seems other readers) get the feeling that you are absolutely unable to take in what he actually says, substituting instead your own view of what you think he believes and taking issue with that. And if a reader agrees with him or argues with you they are “unqualified” or suffering from “hero-worship,” and the only thing that will satisfy you is if they lay out their whole life story before you – apparently so that you may use that to say they don’t know what they are talking about. Only your qualifications matter, it seems, and only you know what is right.

    So, let me tell you something about myself. I have degrees in librarianship (which implies I can read), in art (which implies I can both observe the world and use imagination in a very practical way) and have a Sports’ Council qualification saying I am fit to teach dance and exercise – a course that included some anatomy and physiology (which implies I know a little about the mechanical functioning of the body).

    I also have a very long history of ill health, dating from a cocktail of drugs I was given for a incorrectly diagnosed illness over forty years ago, when I was twenty. I, literally, have not been well since and, by now, I know my condition and its effects very well indeed.

    Believing that the NHS is the best thing ever done by and for mankind I believed too in modern medicine and over the next thirty years, as each symptom arose, I visited my then current G.P., accepted his or her diagnosis, and took the drugs I was given. I became more and more ill, until in 1993 I nearly died. The NHS saved my life – but still got the diagnosis wrong. I continued to deteriorate. My career went down the tubes, followed soon by most of my relationships as I became unable to socialise. Having danced (ballet) until my late forties, I now was in too much pain to exercise. I became very isolated and very depressed. G.P’s merely shrugged, or told me I was a “worrier.” I even joked to my current G.P. that “doctors see me coming and ask themselves what they can misdiagnose next.”

    In desperation, ten years ago I finally turned to a nutritionist (by sticking a pin in a list of alternative practitioners – I was that desperate) and she turned my life around. She, and a series of similar therapists since, have now got me to a point where I can function again, and am in much less pain. If I had continued to rely on properly qualified doctors, and if I had not had a very loving and supportive husband able to pay, I would without doubt be dead.

    During this forty year odyssey I have met many very concerned and caring people both within and outside the NHS (as well as being a patient, I worked in an NHS hospital for some years and loved it there). Unfortunately, I have also met some very arrogant and uncaring ones. Few of these people – even the nice ones – has ever admitted s/he might not know what was wrong with me, and only one has admitted he was wrong.

    I have been trying to fight off Type II diabetes for a while now, and for this reason checked my own blood sugar several times a day for several years. This way I learned that those few proponents (like Atkins and Briffa) of a low carbohydrate diet to control diabetes are right: refined carbohydrates and/or processed foods, cause, in me, huge blood-sugar swings, while a high protein diet of plain food, cooked at home by me or my husband, keeps blood-glucose level and just about low enough.

    Now, surely I cannot the only person in the world who reacts in this way to high GI foods? Some, I’m sure, can eat a high GI diet without damaging themselves; we are all different and it seems you are one of them. However, I can’t. That is my experience. My experience is also that a high carb diet is what my local diabetic practitioners recommend. Experience may not be a qualification you recognise, but it is what we all learn from. It is a very valuable defence, used by all animals. Any animate being that doesn’t learn from experience is deficient in some way.

    My local hospital dietician recommends a high carb diet for diabetes, while my local diabetes clinic follows the route of “Some sugar is O.K. You can eat more or less normally. Just watch the alcohol.” I dread going there for any reason now – they have been wrong on this and so many other things.

    I told my husband, an architect, about your concern that Dr. Briffa is not supporting his profession and he was horrified. “Any professional knows that he should put doing a good job first. That is what matters and is the best support he can give his colleagues.” I’d add that I’m sure legally it matters, too. Any doctor proved in court that his first concern was for his profession and not for his patients would lose his case.

    Personally, I feel I have suffered very much, for a very long time from a profession that hangs too closely together and acts defensively. Putting patients first is what doctors and dieticians should be doing. That means listening to them and learning from them, as well as keeping up to date. For example, there must be many thoughtful and caring dieticians who notice and are worried by the effect of a high GI diet on their patients, and who therefore ask questions, even if that appears disloyal to their colleagues. Mind you, good and wise colleagues would value these questions, not dismiss them. The doctors and dietician caring for the child that Dr. B saw, if they are good, will wonder why his parents needed other help. On the other hand, if they are bad, they will say the parents weren’t making the child stick to the diet so it was all their fault. I’ve come across far too many prepared to blame the patient. After all, how often has one heard about doctors who say that, if a patient says s/he doesn’t drink, they assume the patient is lying and drinks several glasses week? Or that they smoke more than one ciggy?

    O.K. That’s me. Now I’ll come to you.

    You demand answers and justifications from us bloggers so now I want some answers from you.

    Do you work in the NHS, or are you in private practice? Are your patients referred to you by properly qualified doctors? And are those within the NHS or not?

    How many of your patients are diabetic? How many of them on a high carb diet are doing well? For how long? How many of them develop diabetes-related diseases despite your advice and care? And how quickly? Do you know the answers to these questions? If you don’t, can you go through your records and find them?

    You seem to despise Dr. Briffa, despite his courtesy and willingness to engage politely with you, and you appear to have decided he is a venial man, who puts his beliefs before his patients. If he is that bad, and his supporters are, as evident on this blog, so misled, why do you bother to engage with us?

    Does it make you feel better? Or superior?

    Why do you waste so much of your time, his and ours?

    Are you trying to convert us? Heal us? What?

    How is it that you have so much time to waste?

    Why aren’t you spending it on your patients, or on keeping up to date with the latest dietary research?

    Are you in the pay of the drug companies? (And if you don’t like the implication of this question, remember it is similar to an accusation you have levelled at Dr. Briffa.)

    How and where did you gain your qualifications? And how do you keep up to date on developments in your field?

    And I do wonder if you listen to your patients or, if you do, if you are able to understand what they say to you? After all, you find it so hard to understand what is said on this site.

    I know I’ve said it before, but I am so glad I am not one of your patients.

    God preserve me from those who know they are right!

    Finally, if I were in your shoes, I’d be worried by my obsession with this one man. You behave like a rejected lover, entirely unable to achieve objectivity.

  54. Sue 8 October 2007 at 10:54 am #

    Chris, What dietary advice do you give your diabetic patients? Have any of your type 2 patients reversed their diabetes with your advice?

  55. chris 8 October 2007 at 11:17 am #

    sara – now where do I start .

    The only reason i looked at this post was because someone alerted me – hadnt looked at it for ages. i actually have a few days off lol!

    I have never met the person in question – what i do not like is actually his obsession with my profession – just remember he started this – what does he expect that alot of hard working people will just let all of you trash them! This whole story may or not be true but imagine being the person in question – she may be misrepresented! Think about that !

    I am sorry that you feel the nhs has let you down – it does happen but with respect I too have also seen a number of clients that have seen alt practitioners and been given woeful advice. The problem here is that most times there is no one to report them too! Quite often alot of their CPD is reliant on the internet!

    I actually have no intentions of displaying my quals on here but i am reg with the HPC , BDA and a sports dietitian. The HPC ensures you keep training – look at their website – it is a statutory requirement for all professions.

    I have over 20 years experience working in the nhs and now freelance and whilst you may not want to believe me a recent audit of my gp clinics has shown that my patients ahve an average HBa in the low 5s. They get individual advice after we have done a dietary assessment using Dietplan as the program. I think that you have to accept that low carbing may work for some but alot of people cannot do it.
    Just look at the psotings on here – everyone thinks they are right – cannot just accuse me of that!

    Message boards are soleless really and can be taken out of context – i have a good relationship with my patients – alot of them live close by and there is something about the people around here if they are not happy they will tell you!

    ps how can I be in the pay of drug companies – I am not allowed to prescribe – in fact as an RD I am not even allowed to sell supplements – just think about that one for a mo!

  56. Kate 8 October 2007 at 1:00 pm #

    I’m a newly qualified dietitian and I have to say that I find this whole topic deeply depressing. Why? Because it completely misses the point.

    Who out there honestly believes that the whole story is to advise our clients on the correct way to eat, let them follow our amazing advice and then their blood sugars will be stable, their lives will be happy and we will all live happily ever after?

    For goodness sake giving the advice is the easy bit and reading the posts I think that the diets that we are all avocating are actually quite similar.

    The difficult bit is empowering patients to take responsibilty for their own diabetes – especially in a climate where the expense of blood testing strips is considered unnecessary, supporting them when they are struggling to eat healthily or are depressed from struggling to cope with the life changes brought on by a chronic medical condition. And maybe even understanding that food is often one of people’s few joys in life.

    With all due respect to everyone that works privately – the patients you are getting are already the highly motivated minority.

    Can we now please discuss what to do with 20 minutes on a hospital ward with a hypothetical patient with a BMI of 40, advanced diabetic neuropathy and who gives you a “perfect” diet history although the nurses tell you has been eating “all sorts of junk” on the wards. Let start with the statement “What would be the most useful thing for me to talk to you about today. . .”

  57. Hilda Glickman 8 October 2007 at 1:26 pm #

    Hi, I can understand what is going on here . Dieticians are highly trained and need very good A levels before starting training. They have been taught well and the exams I am sure are very challenging. However some of what they have been taught is out of date. They are somewhat kept down by the medical establishment who either exclude other therapists or include them and subjugate them. No wonder they are upset. THen come along other alternative therapists who make headlines and headway with treatments not advocated by them or by the establisment. THe problem is that dieticians are not ‘allowed’ to think for themselves unlike other practitioners. They have to toe the party line as far as I can see.They cannot recommend supplements and stay in the NHS.

    I never treated my friend who is a diabetic but she went to Slimming world and went on their red day diet- mainly protein and veg. Her blood sugar dropped dramatically, she lost 3 stones and her GP was delighted. THis of course is just anecdotal but all the anecdotes are piling up! Just because the food exists does not make it healthy. The problem is that dieticians appear to be in cahoots with the food industry. One client I had ( am not a dietician) told thsat as she has MS she had to eat 3 tabs of margerine a day and so I phoned her dietician who told me that if I said anything against margarine Flora wouls sue me!!!! Great!

  58. Hilda Glickman 8 October 2007 at 1:28 pm #

    P.S. With regard to Chris, I don’t think sarcasm or unpleasantness helps would should be a scientific debate.

  59. Hilda Glickman 8 October 2007 at 3:53 pm #

    Chris – You write that you are ‘sure’ that people ate badly 10,000 years ago after . HOW CAN YOU BE SURE? Where is your evidence or research data? Yes, they did live only about 30 years, but they had to contend with the rigours of their harsh life. The species managed to survive until now. In fact they ate a very wide variety of plant foods , much more than now,and it is easy for researchers to look at bones throughout the ages to see how well nourished these people were with densely mineralised bones.

    After the Industrial revolution when there was a mass exodus away from the countryside into the towns, there was a problem of how to keep people fed. They used processed flour so that it did not go stale or be able to support the health of weevils and bugs ( or mankind either) and lots of fat for calories. We had huge connections with the West Indies hence the promotion of the sugar industry. so sugar was added to the flour for more easy calories which do not go off. THese things have been seen as staples and are today despite the fact that now we can feed people in a better way. Incidentally after the INdust Revolution the health of the population deteriorated dramatically. If you look at cross cultural studies, 20 years after processed foods are introduced into the diet, the health deteriorates. Try reading Weston Price on this.

    Lastly, the debate is not really about carbs or not. It should be about processed or not processed foods. Pasta , white rice, most breads, cereals (not porridge), sugar in any form and all that is made from these are processed junks foods.

  60. Michael 8 October 2007 at 5:43 pm #

    >> what i do not like is actually his obsession with my profession – just remember he started this

    Not an obsession.
    He sees the same thing that many of us see.
    A profession that is busy giving bad and health damaging advice.

    It does not matter how well intentioned or hard working the dieticians are.

    Doctors used to treat ulcers with surgery, but now know better and use antibiotics to kill the helicobacter pylori bacteria that are the cause of the ulcers.

    The first researchers to observe that standard medical treatment of ulcers was misguided and WRONG were not disrespecting the hard working ulcer surgeons who were busy performing unnecessary and harmful surgeries.

    Engineers have learned a great deal from examining bridge failures and other disasters. The engineers who examined the wrecks were not disrespecting the engineers who had created the imperfect bridges.

    The current low fat dietary mantra has been with us for decades.
    Meanwhile, obesity and diabetes are doubling decade by decade, and diabetics are getting sicker and sicker while trying desperately to adhere to advice that makes no sense.

    “Eat plenty of whole grain carbs and increase your blood sugar… and somehow this will help your diabetes”

    Does that make any sense at all?

    Evidence suggests that some of the things that dieticians “know” to be true are not indeed true.

    There is nothing special about dieticians – it is true of doctors, engineers, and certainly it is true of computer programmers like me.

    Science based progress is not built by standing fast in the face of contrary evidence. It is built from disputing points of view being tested against observed facts.


  61. annemarie 8 October 2007 at 6:11 pm #

    I can assure you that not every dietitian is “out of date” .

    Can I also mention that (having today given a lecture on this and the evidence surrounding diabetes and diet ) that the current consensus statement to which we refer in practice was based on the EASD and ADA guidelines, NSF and extensive technical reviews and literature searches. The last statement was 2003. I do believe we need a review each 5 years.

    The point is not that Dietitians “tow a line” but that we work to a code of conduct and to globally accepted (at least by the esatablishment) consensus statements- produced by not only dietitians but researchers, biochemists and the medical profession. There is some room for flexibility in this..however else would we make changes?…but it leaves us in a difficult position when pushing the boundaries. There needs to be some regulation of practice for the protection of our patients. Im sure if we were all mavericks, sooner or later there would be complaints and outcries that we are shonks not working to evidence based research and up to date “facts”.
    I have already described how I practice. I know that this is how many others in my field do as well.

  62. chris 8 October 2007 at 6:31 pm #

    hilda – i agree with you it is not carbs or no carbs it is the whole problem with so much processed food. I have read all of the web sites and nothing convinces me that we can go back to a caveman diet. That era is gone and there is still alot we do not know – we need to concentrate on now!
    Actually that is what i have been saying – too much junk if u are working in this field you must be seeing the same.
    I have 100s of food diaries that are very depressing reading and the awful thing is people dont care!

    Studies during the war are interesting when heart disease dropped and they used very unrefined carbs, small amounts of protein and tons of veg – home grown not shipped half way round the world and out of season!

    The problem for me is that there are too many experts sprouting differnt ideas – is it any wonder people turn off!

    Kate i agree with you dietitians are in a very difficult position – being an ex chief I know what you mean. I work for some gps and and so still work in the nhs but am able to spend more time – primary care is a much better place to promote health and lifestyle change.

    Hilda – I certainly do not agree with your statement about dietitians training being out of date – the students are certainly taught to research and having taught at a uni on an allergy module they are certainly not an unchallenging bunch!
    Dietetic courses are also well supervised and are challenging – also for practising dietitians having students in a dept is good for all.

    It is very sad I think that people have no idea what dietitians do – generally they are a totally comitted, well trained and practical profession – seems like they are very misunderstood. The question of supplements is interesting – just think it is a huge money generator – if i suggest one i send a client to a chemist – alot of alt therapists are making alot of money out of them – a different agenda I think!
    I have had patients sold hundreds of pounds worth of rather unnecessary supplements.

  63. Neil 8 October 2007 at 10:09 pm #

    Chris wrote “Studies during the war are interesting when heart disease dropped and they used very unrefined carbs, small amounts of protein and tons of veg – home grown not shipped half way round the world and out of season!”

    The graph I saw had a decrease only over a couple of years 1939-41, but was followed by an even steeper increase after 1941. The decrease predated rationing, the post 1941 increase continued despite rationing. The 1939 -41 decrease was a blip which only temporarily reversed the trend upwards. So I wouldn’t say that the rationing type diet was successful where heart disease is concerned.

  64. Neil 8 October 2007 at 10:24 pm #

    Link on the British Dietetic Association homepage

    “Dietitians hail return of balanced diet plate” this is the Food Standards Association “Eatwell Plate”

    Check out the links on this page

    The FSA (and by extension, the BDA) recommend ONE THIRD of what you eat every day should be starchy food. And a further THIRD from fruit and vegetables. Thats 66% or your daily intake from carbohydrate, which (apart form the fibre, is all broken down to sugar in the body) Not to mention the carbohydrate in milk and beans and pulses. If they are talking about 66% as calories, then perhaps the caveat re fibre is irrelevant!

    By my reckoning, that adds up to the FSA and BDA recommending a very high carbohydrate diet.

    Thank God Chris Catherine and Annemarie that you don’t toe the party line as promoted by the dietitians professional organisation. They are doing you a tremendous disservice.

    Also note how on this page http://www.eatwell.gov.uk/healthydiet/nutritionessentials/fatssugarssalt/

    under the Healthy Diet tab, Fats are lumped together with sugars and salt. Totally illogical. Sugars belong with Starchy foods and fruit and Veg. Unless of course someone is trying to pretend that there is no connection between sugar itself, and sugar derived from the metabolism of starch fruit and veg.

  65. Hilda Glickman 8 October 2007 at 11:31 pm #

    Re supplements. The money made from these is miniscule compared to the money made both by the food industry and the drug companies. You cannot patent a natural product, therfore profits are relatively low. Many patients get well using supplements but no-one needs to spend hundreds of pounds on these. I do not think you can say they are ‘unnecessary’ unless you go through every one, see what they do etc.

    Just because there is a consensus (not globally accepted) does not mean it is correct. Have you heard of the ‘tyranny of the majority’

    Years ago in another life when I was a careers advisor in schools I did a project on dieticians. They moaned to me that no-one was interested in what they had to say about food and diet. This was before nutritionists came on the scene. It was nutritionists who put diet etc on the map and the current interest in food as a means of becoming healthy is due to nutritionists such as Adele Davis, Patrick Holford, Marilyn Glenville etc. Dieticians should be pleased that they have achieved this for them as the public really don’t see any difference between the two groups.

    Incidentally the lealets in doctors’ surgeries advise tat sugar is not harmfil. Who publishes them? The sugar bureau! Similar material is sent to health professionals published by the same people.


  66. Hilda Glickman 9 October 2007 at 12:01 am #

    In case the stone age diet is not familiar to you it is : meat, fish, chicke, nuts , fruit, vegetables,maybe yogurt, seeds, beans, lentils, herbs, clean water. THere are loads of different vegs that people dont touch. It is not just that refined carbs are bad . It is that they are not Good. BY that I mean that they contain few nutrients or antioxidants.We survived for thousands of years on this without pasta, noodles, breads, etc. Incidentally the huge increase in diabetes in the Asian population, particularly the vegetarians, is most likely due to the fact that they are abandoning their traditional diet of peas, beans, lentils , chickpeas etc and eating lots of pasta and pizzas instead.

    Low GI, high GI is just complicating the matter. We should eat the way we are biologically adapted to eat. However really I dont see any point in continuing this debate.

    The two factions here are on two totally different planets but what I would say is that most of the PATIENTS who have written agree that they have been helped by the low carb diet. Nuff said.

  67. Tiggy 9 October 2007 at 1:57 am #

    Mainstream dieticians don’t actually have much success with their clients, do they? I’ve known very obese people who saw dieticians and were very poorly advised on what to eat. I’ve also seen fat dieticians! They usually recommend eating mostly carbs and those high GI ones. They make little attempt to steer people towards unprocessed and unrefined foods or to educate them about insulin and low GI carbs. They also don’t sufficiently warn people of the medical dangers of being very overweight or having insulin resistance.

  68. chris 9 October 2007 at 10:26 am #

    neil – just remember the food plate is a tool not set in stone. I use it sometimes to talk around food groups – but it is not set in stone! It is actually no always useful talking pro, carbs etc – alot do not understand it!

    Tiggy – those comments are rather childish.

  69. Dr John Briffa 9 October 2007 at 11:25 am #


    “Tiggy – those comments are rather childish.”

    Are we to believe that your own comments, including your accusation that I have made the story up to ‘promote’ myself, are the height of maturity?

    Before you compose a post, do you ever stop for a bit of self-reflection?

  70. chris 9 October 2007 at 3:52 pm #

    john – this is typical of you -you started this by stating some anecdotal info , which you have chastised me for many times – what did you expect that dietitians would agree with you- you knew exactly what the reaction would be – now everyone on here is having a go at dietitians, their advice, their wt, info that might be given in a consultation etc. , their training , that they are in the pay of drug companies, food companies etc!

    All this has descended into is dietitian bashing and when soemone states a fact it is ignored – no point in dietitians bothering to post is there!

  71. chris 9 October 2007 at 4:22 pm #

    neil – there is a logic putting the fats and sugars together on the plate – I like to affectionately call the junk. The thing is people talk about fat being fine to eat – yes it is but it is a mixed message because some will interpret that as well it is ok to have crisps and cake and pies etc. That may sound a little simplistic but just remember that not everyone has access to the internet, wants to read about or understands anything about nutrition. As a tool it is useful when talking around food and food groups. can you imagine how complicated it would be otherwise – I spend alot of time talking to groups of various types of people a nd they do find it easy to comprehend. I do think the explanations on the FSA website are a little confusing in parts.

    As far as the war is concerned maybe if we had carried on with the type of food things might have been different but one thing is for sure the availability of all the junk that appeared after has caused us alot of problems

  72. Neil 9 October 2007 at 7:04 pm #

    Chris, OK maybe you and other dietitians use devices such as the ‘Eatwell Plate’ to go deeper into nutrition with your clients, but the only message most of the public get from the vast majority of the media and from the Food Standards Agency website is

    “Saturated fat bad, Sugar (starch and other carbohydrate) good”

    The FSA Eatwell site does not even acknowledge that a low carbohydrate diet is a valid alternative, and that the public has a right to be made aware of this fact. Its called Patient Choice.
    No diet suits everyone, low or high carbohydrate.

    And how many people actually have sessions with dietitians rather than getting their pre-packaged and often erroneous advice from newspapers and glossy mags.

    Simplification is fine if its accurate and balanced, which the Eatwell plate plainly isn’t.

    The low fat era has been around for around half a century, looking around it seems inescapable that it has failed and it’s time to end this faddy experiment, and give serious airtime to alternatives, rather than what Atkins got from the media, the usual ‘build it up then knock it down!!’

  73. annemarie 10 October 2007 at 9:44 am #

    I have to say that the FSA has very little to no impact on the education I provide for diabetes, it doesnt even rate a mention in the consensus statements.

  74. Dr John Briffa 10 October 2007 at 10:30 am #

    That’s good to hear.

  75. Hilda Glickman 10 October 2007 at 10:41 am #

    What we appea to be having here is a ‘paradigm shift’. Thomas Kuhn a philosopher of science said that science does not proceed by just adding on one fcat to another. It actually undergoes revolutions where what is accepted by scientis of the day are gradually challenged by other thinkers because evidence comes to light that the old theories do not fit the facts. THis happened with Newtonian and Eistinean physics when one no longer explained the evidence. Now we have the carb debate when I think eventually the low carb will take over. From others’ emails we can see that 30 years ago low carb was the in thing. However as the paradigm begins to change all the adherents of the old one band together and ridule those who have other ideas. Jobs are lost, some even put to death , eg Socrates!

    In fact unlike religion, this is all so easy to test empirically, isn’t it? Just try both on diabetics, But not ethical.

    Another point. I think that while nutritionists mainly see middle class people who are half way there re nutrition and can afford to pay and want to keep to a diet, dieticians struggle with the general public many very poor with little knowledge or committment – a much harder job than mine!

  76. Kate 10 October 2007 at 3:11 pm #

    Thankyou for that. It’s really quite a tough job and very few people outside the health service realise how much of it is made up of nutrition support i.e. dealing with those who are malnourished, often as part of palliative care. So it can be very demoralising to be publicly critisised so viciously over something that is almost a point of trivia.

    Most clients struggle just to cut out the junk and for them even if they are eating white bread it is better than chips. Maybe from that small step maybe the next one is half and half and then finally granary. And maybe from those small successful changes they may become empowered to try more.

    “Give a person with diabetes a fish, plenty of vegetables and a small portion of wholegrain cereal and he will control his blood sugar for a day, teach him about how different foods may affect his blood sugar, give him a blood glucose monitor and enthuse him with the belief that he can take control of his life and he will control his blood sugar for life.” (apologies for the gender specific language)

  77. danica 10 October 2007 at 4:17 pm #


    Needed to say a few words in this respect. My 10 year old son was recently (15th August 07) diagnosed with diabetes 1 which was a huge shock to me. He was injecting 8-10 units of insulin (novorapid) per meal and 15 units of insulin night time (lanctus). We saw a dietician at the hospital that advised a diet that seemed rather illogical to me at the time. Soon after the shock wore off i decided to bring out of the rusty chest, my battle gear and forge through thorny pages of medical books as well as diet books to see what, how, where and why. I started him on a low GI/Blood Group Diet, basically cooking and baking with spelt flour (sandwiches for school) and having more fish and ‘power’ veggies like spinach, kale and brocolli, i have introduced walnuts (which are insulin increasing for Blood 0) and reduced corn or anything with corn/maize (insulin inhibiting). I have devised a chart and notied his BM as well as food intake on a daily basis. On September the 24th 2007 he is off day time insulin and only on 4units lanctus night time. My goal is complete control with food. This is my experience I hope it can shed some light to anyone who is in a similar boat. Hope it enlightens.

  78. danica 10 October 2007 at 4:24 pm #

    Oh and i forgot to mention two more things…i really carefully choose the carbs i use (hmm it even rhymes), and may be its time that we start listening to our bodies as they hold the memory of what is good for us as individuals rather than what others say it is. So wake up beautiful people you are the holders of the key that unlocks you…

    Keep smiling


  79. Neil 10 October 2007 at 6:22 pm #

    Annemarie said ” I have to say that the FSA has very little to no impact on the education I provide for diabetes, it doesnt even rate a mention in the consensus statements.”

    Glad to hear the FSA is off your radar Annemarie, even if the British Dietetic Association support its stance.

    Kate, I’ve no intention of denigrating what can be a difficult job, as you say, nutrition in Palliative care is indeed challenging.

    May I recap, my turn to simplify now!
    Diabetes is a condition which features a higher than normal blood sugar and poor control of blood sugar levels. A blood sugar at the high end of the normal range in an adult equates to approx one teaspoon ( 5 grams) of sugar dissolved in the entire blood volume. To move into the beginning of a ‘diabetic’ blood sugar requires just 1.25 teaspoons ( 6.25 grams) of sugar in the blood, a mere quarter of a teaspoon increase.

    The body tries to maintain a normal blood sugar at all times. Higher than normal sugars are generally regarded as a harmful thing.
    So, if you have problems maintaining a normal blood sugar, which macronutrient significantly raises your blood sugar to ‘diabetic’ levels ? Which macronutrient increases the need for medication? Which macronutrient is not essential for life? Which macronutrient therefore is the worst for ‘diabetics’ to eat more than a small amount ? Answer Carbohydrate.

    Logically, a ‘gold standard’ diet for ‘diabetics’ should cause the least possible blood sugar rise above normal, and reduce (or totally avoid )the need for medication/insulin injections.
    You are never going to achieve that on anything except a low ( not no ) carbohydrate diet I don’t see how anyone can argue that a high starch (carbohydrate) diet is the one for ‘diabetics’ to follow.

    On that basis, a no starch diet with carbohydrate coming from green leafy veg and a little fruit would seem to be the one that should be promoted and taught to diabetics. I’m not talking about individual dietitians, I am talking about what the Health Services as a whole teaches diabetics.

    Problem = High blood sugar. Solution = eat food that will raise your blood sugar (whether low GI or low GL) ????? Then deal with the resulting high blood sugar levels with increasing doses of medication.

    That is a totally hare-brained approach and deserves to be consigned to history

  80. chris 10 October 2007 at 7:01 pm #

    well i did think i wouldnt comment but i will!

    neil I wish there was a way to talk to u one to one – this site does not reflect a dietitians job at all. Ash dr b to give u my email addy!

    Kate dietitians are very skilled and dont let this site make you feel demoralised. Only this profession can sort out the clinical problems, eneteral feeds, SCBU feeds etc – if you want to chat find me on BDA website as CYMRU!!! I am sick of this dietiatian bashing.

    Hilda – i am sure my patients would like to think they are the lost ones – I see plenty of so called middle class clients at the surgery and in practice who have no idea when it comes to nutrition. Dietitians are not left with just the disadvantaged ! Sometimes the ones who know nothing actually do better – they are not influenced by all the rubbish on the internet!

  81. annemarie 10 October 2007 at 7:55 pm #

    I shall start making a relationship with the FSA after they review their stance on aspartame…but that is a different story lol

  82. Sue 10 October 2007 at 10:07 pm #

    Chris, I think ‘all the rubbish on the internet’ as you call it has been fantastic for educating the public who are so much more informed now. When dieticians start dishing out correct advice then the bashing will stop.
    Look what Danica has been able to achieve for her son – and she’s not even a qualified professional!! You just need to look at diabetes intelligently and realise its the carbs (keep the low-starch vegies) that need to be given the flick and then get down to business. Diabetes + low carb = diabetes easily fixed or atleast managed correctly.

  83. penny 11 October 2007 at 6:05 am #

    im a diabetic type 2 i just wondered when looking on the back of a packet when shopping is it anything below 5g of sugar and saturated fats that im too have

  84. chris 11 October 2007 at 8:00 am #

    sue – that is a very simplitic approach , many diabetics do not find it that easy- just compare it to those who smoke and do not stop. I am concerned for that little boy – as how does she know whether the diet is deficient but that is her choice.

    The problem with internet is that anyone can put together a web site and look very credible and just about anyone can call themselves a nutritionist – you could. Just remember also that people are making alot of money out internet sites !

  85. Kate 11 October 2007 at 8:35 am #

    Chris – what rubbish on the internet – can you give me an idea of what you mean?

  86. chris 11 October 2007 at 9:23 am #

    trawl it – u wil find sites claiming to cure diabetes, supplements etc.
    There are sites run by engineers claiming wt loss – it goes on and on. There are also huge scams to make money out of wt loss etc.
    I was contacted a few weeks ago by an american who wanted a dietitian to endorse the wt loss program he had devised ! It was actually a hopeless attempt at planning a wt loss prog but he reckoned that he already had customers.

    You have to be very careful – I find that patients bring in info they have found and its not just nutrition its in very field of medicine.
    The internet is a fantastic tool but you just have to be careful – because you never know who and what you are dealing with sometimes! Also people are making alot of money – that I am afraid is a fact.
    On a lighter note we would all be lost without it but I do wonder sometimes if it is turning us into a nation of hypochondriacs!

  87. danica 11 October 2007 at 10:54 am #

    Chris your concern is quite sweet and I am very concerned about you. But to rest assured: my boy is absolutely perfect as i work together with the professionals and they have seen the day to day diary I keep of all his food intake. They have said:’ we are happy his diet is balanced’. The specialist said that they want to see us every 4 weeks as they as imprressed with the ‘honey moon period’. I tend to want this honey moon to last forever.

    So please take a deep breath, run a bath and indulge in some choclates….i hear thru the grape vine that serotonin is all we need!
    As I said we are all individuals and in desperate need to understand and listen to ourselves with the help of professionals in many fields…we don’t exist only in one plane i.e. physical. At times the body’s response is the last scream and stubborness and pigheadedness doesn’t necessarily equal progress. Those days need to cease and for that to happen the mind needs to be open without losing sight of self

    Keep smiling


  88. chris 11 October 2007 at 12:01 pm #

    Danica – I am glad that your son is being monitored – that is an unusual name ?

    Actually i am a very calm person – seratonin I have loads !!!lol

  89. danica 11 October 2007 at 1:04 pm #

    Good to hear Chris…Name is Slavic in origin meaning Morning Star – thanks for noticing!

    Still keep smiling

  90. Kate 11 October 2007 at 2:49 pm #

    Ah, that sort of rubbish. That kind of scam exists for all health problems, for example, I have MS and the adverts for people who swear that they can cure MS are legion.
    It’s tempting to click on the links, but each time it’s an e-book promising good health if you just pay x amount of money.

    I understand your frustration and why you feel that your profession is under attack – but if you look at the issues from the other side – that of the poor person who has to be strong enough to ignore the food pyramid, the ‘healthy cereals that will reduce cholesterol’ and also be brave enough to say to their new GP or specialist that this way of eating works for them, then you may understand our frustration with the kind of blanket advice that is handed out.
    GPs have targets that they must get in order to increase their revenue from the government. So off we all go to be weighed, have our blood pressure checked and those that are not of perfect weight are made an appointnment with the dietician.
    Generally, on average the advice that is given is -eat low fat, and use the food pyramid. Even the statin manufacturers give this advice on their patient leaflets.
    Yes, the people who read this blog are enthusiasts of low GI and we have come to this position through experience.
    So if Dr Briffa does criticise dieticians who hand out the same advice to all, then most likely we are going to agree with what he writes. But those who disagree with his approach, are unlikely to read his blog.
    It’s about time that the medical profession was a bit more honest about diet. There is no one-size-fits-all way to eat and often the only way to see if a different approach works, is to do a lot of testing and that costs money.
    Just look at the furore that happened when three different diets were put head-to-head a few years ago. You get medical doctors swearing that if you do the Atkins diet, that you will get a fatty liver and die of a heart attack and others who strongly believe that low carb approaches work for everyone. You will find people who feel ill on a low-carb diet and those who feel ill on a low-fat diet….and both will swear that their diet works for them, and of course it does.
    It’s tough swimming against the tide and I hope you can imagine how difficult it must be for diabetics to do this.

  91. chris 11 October 2007 at 4:45 pm #

    hi – not sure where you are but food pyramid – never used it!! I know ION use it and the in the states.

    Believe it or not but dietitains do take alot into account when planning a programme for a patient but it certainly is true that in many parts of the NHS there are not enough of us. The NHS will continue to employ dietitians because they know there is a standard of competancy and education. Many of the alt courses do not reach the same level. One of the frustrations for dietitians is the workload it is enormous – I have worked in the NHS and the number of patients requiring nutrition support is growing – alot of us are getting irritated by the lack of funding hitting dietetics and other prof like physios who are also competing with less qualified therapists. I personally feel there needs to be some tough regulation because there is no control – and if we are looking for tit for tat anecdotes I have loads!

    Dietitians have never said one size fits all – they use a one to one approach with individuals and beacuse dietitians are trained in the art of menu planning, etc they have a depth of knowledge. Even high powered graduates at our best unis have to learn to cook – a vital skill if you are a nutritionist. If you cannot then you shouldnt be one!

    Your comments abou the med profession are interesting – most dont have a clue whn it comes to food and nutrition. The docs I work with get a ticking off from me if they say something stupid to a patient ! We have a great working rapport but respect that i am the expert – i don’t tell them how to do their job . I am lucky that i work for two great GP practices that value my services and refer wisely.
    Studies are useful but I think expereince with clients is also as important!

  92. Neil 11 October 2007 at 6:45 pm #

    Hi Chris,
    happy have to have a natter over the net. Do you ever use MSN Messenger? If so then look out for njwilks@hotmail.com. Tend to have it on a lot as my kids have all left home but use it most days. great for keeping in touch with them!


  93. james 11 October 2007 at 10:04 pm #

    What a long set of posts, for those that think Dietitians are the bad guys, why not think of this:

    Who makes money from glorifying stories for the papers/their website?
    Who makes money out of trying to poke holes in the advice from the WHO/FSA etc?
    Who has a “no liability” clause on their website for the advice given on that website?
    Who doesn’t actually give “advice” but just tries and pick at others ideas and tells people what they shouldn’t do, not what they should do?

    If you really think poorly paid Dietitians are the bad guys you have to be ****ing mad! WHY would the WHO/FSA want to set bad standards, with only Briffa (not qualified in this field) standing up for the population?

    Going back to the question previously? Briffa will you report this Dietitian? You never answered the question – it’s put up or shut up really!

    For the record I’m not a Dietitian – I just have common sense!

  94. Sue 11 October 2007 at 10:47 pm #

    James, there are alot more people like Briffa who as you say are “standing up for the population”.
    Regards to Briffa reporting the dietician – what’s to report – the department that the dietician answers to will think he/she did nothing wrong as the advice given is in agreeance with theirs!

  95. chris 12 October 2007 at 7:16 am #

    just before i go to work !! The HPC takes competance very seriously and we have to work to a code of conduct – take a look!! Evan as a freelancer I have to abide by it unless I relinquish my protected title which I would prefer not too. I still think it is appaling using this to promote the docs views . He thinks we are attacking him but he started this and I felt i had to react to it and so did several others. James you are quite right – this is a business !

    Sue Dietitians are also standing up for the nation – and the views on here are certainly not the norm !

    neil I will add you to msn but am working today at the gps – might be around later!

  96. Dr John Briffa 12 October 2007 at 4:03 pm #

    It seems that as a defender of dieticians you have chosen to focus not on the issue at hand, but my me and my supposed motivations. This sort of diversionary tactic has been used before (see Catherine Collins’ and Chris’ attempts at the same above), and to my mind only serves to remind us how reticent some are to defend dietetic dogma using logic and science.

    It is noteworthy that neither you, nor anyone else, has been willing or able to provide a credible or robust argument for why many dieticians advise diabetics to a diet rich in foods known to destabilise blood sugar levels. You claim you have common sense. So perhaps you’d like to use this self proclaimed common sense to offer your opinion of, not me and the motivations you assume I have, but standard dietetic advice for diabetics?

  97. chris 12 October 2007 at 4:43 pm #

    and dr b what makes you assume that Dietitians have standard advice either ? The fact is that you started this debate with some anecdotal remarks – who know s really what the dietitian did?

  98. Richard 12 October 2007 at 5:27 pm #

    To generalise, I think dieticians greatly improve peoples nutrition, and they feel better for it. But often these people have not been eating well by any stantards (many people have been taught to eat marketed foods). The advice often given is an improved standard British diet. Though probably not an optimal diet.

    A friend of mine was diagnosed several years ago as being intolerant of lactose and gluten (she was recommended ibuprofen by her GP for the abdominal pain). A strong expression from her body to dump some common modern foods.

    We found dietry advice avaliable conflicting and hence very stressful. So it has been a great relief to find a simple answer, cut out (or in reality greatly reduce) modern and processed foods (these foods are often heavily marketed). And base a diet on more natural foods: fresh meats; seafood; friut and veg. No exotic powders or potions, it’s avaliable at all supermarkets (it makes shopping quicker by the way). Now I have time to worry about other things.

  99. james 12 October 2007 at 6:51 pm #

    John – I will always defend professionals from unfounded abuse, and as for using logic – was my comment about you “doing it for the money” and Dietitian’s “doing cos they care/are qualified/are in line with the WHO/FSA” not logic for you?

    I think you are a parasite who uses manipulation to come across as a good guy while raking in money from the diluded.

    I believe you know the truth about what you write and just use confrontation to build your reputation (and bank account) and that makes you a rather sick man. I really hope you overstep the mark one day and end up getting struck off.

    I really hope I get to hear you talk one day – what is the society you’re a member of for? Oh yes, Vets and dentists!

    Rant over.

  100. Dr John Briffa 13 October 2007 at 8:59 am #


    You’re comment that I am ‘doing it for the money’ is not ‘logic’, it’s opinion. You’re entitled to it, of course, but it is still just your point of view.

    My challenge to you was to use your self-proclaimed ‘common sense’ to explain the practice of advising diabetics to eat foods that are known to destabilise blood sugar. Can you do so now?

    And finally, I suspect I won’t be the only person to find your comments abusive and potentially defamatory (for instance, that I am a “parasite”, that I’m ‘doing it for the money’ that I am a “sick man”).

    Can I strongly suggest to you that you familiarise yourself with libel law in this country?

  101. Sue 13 October 2007 at 10:38 am #

    We all have to make a living – can’t live on air alone. If one can make a living providing valuable advice so much the better!

  102. chris 13 October 2007 at 2:43 pm #

    sue the logic behind that is ?

    People are making alot of money out of ill health – there is nothing wrong with that as long as it is done properly.

    The doc is upset that he has been criticised but just remember he is making money out of this site so it is important to keep it going – web sites are expensive to run.

  103. james 13 October 2007 at 4:04 pm #


    Just a quick update and to clarify any misunderstanding!

    I think, I believe, I hope. All personal opinion – I make no statement of fact and if anyone has taken my comments to be as such then I am very very sorry.

    Also, I did not say you were a sick man. I said that such a person would be sick if they took money on the basis of advice they knew to be misleading, as I would think someone selling a miracle cure for illness X would be. Again – all personal opinion.

    As stated previously – I have no knowledge of these things but find your comments inflamatory and against the norm (the norm being WHO/FSA) – hence my issues.

    Anyway – as I say I do hope I hear you talk some time in the future.

  104. Sue 14 October 2007 at 2:02 am #

    I don’t care if Dr Briffa is making money out of this site – he is providing a service and should be getting paid for it, especially since he is dishing out valuable advice.

    The fact is diabetes can be controlled with limiting carb consumption. Tell your patients that if they want to remain medication free the best way is to avoid sugar spikes by controlling their carbs. If they care about their health they will comply. Low-carb is the best option I believe because they still have lots of fat to keep them satisfied – thereby ensuring they keep to the diet. The alternative is low calorie, low fat, low GI (though still quite carby) which is harder to comply with as you feel hungry so are more prone to stray from your diet.

  105. Kate 14 October 2007 at 8:40 am #


    Sue – you’re attitude towards people with diabetes is at best patronising “if they care about their health they will comply”. People have a large number of factors influencing what they do in their life and giving priority to food and health isn’t something that everyone is able to do. Many people have little control over what is available to eat, or simply have much more pressing concerns. Those patients that tend to miss their appointments generally tend to be the ones that most need support – and they certainly wouldn’t be paying for a private consultation.

    In addition, whilst it is vital for the person with diabetes to keep their blood sugars low and stable we must also remember that the risk of someone with diabetes having a heart attack is similar to that of a person without diabetes who has already had one. Diabetes is also one of the most common causes of Chronic Kidney Disease. Therefore we should think very carefully before recommending high fat or high protein diets in this group. The low fat, moderate protein and low glycaemic index wholegrains diet is the one with the evidence to support it. We’re also completely ignoring in this discussion the absolutely vital role of physical activity in reducing insulin resistance.

    Remaining medication free is not really the ultimate goal – it is staying free of the long term complications of diabetes such as heart disease and damage to eyes, kindneys and feet.

    What most people with diabetes need is much more intensive support, but publicly attempting to discredit health professionals is not going to help with this.

    If anyone is interested in finding out more about the long term complications of diabetes then it is really worth reading about the UKPDS which was a 20 year study of 5000 people with diabetes http://www.dtu.ox.ac.uk/index.php?maindoc=/ukpds/

    There seems to be two of us posting as Kate but I’ve started. . .

  106. Linda 14 October 2007 at 10:41 am #

    I have learned a lot from Dr Briffa. I have followed it up by reading the other papers and journals, and a lot of other people say the same things as Dr Briffa, so he’s not making it up! It all makes sense to me – I read the information and draw the same conclusions. In fact I think there is powerful information available that alot of people choose to ignore.

  107. danica 14 October 2007 at 1:22 pm #

    What still amazes me in looking at some of the posts are the ego trips and the inability to focus TOGETHER CONSTRUCTIVELY on the real issues and how to make things not better but perfect. So much energy is put into proving some point or being judgemental of others. People should be seen and looked at as INDIVIDUALS with their own life stories i.e. genetics, emotional and mental state, environmental factors ….All that we do and are is inter-dependent and to strike a balance within this is a demanding and challenging task. We all need to bring valuable life experiences and knowledge in order to further enlighten ourselves and possibly give others ‘tools’ so that they can make informed choices for THEMSELVES. We have abdicated OUR sense of responsibility for OURSELVES to others for it is easier to blame than to constructively find a solution.

  108. Neil 14 October 2007 at 6:10 pm #

    Hi Kate (comment 105)
    talking of long term complications of Diabetes,
    see here for a view on the reporting of the results of the UKPDS


    ” The UK prospective diabetes study shows no benefit on macrovascular end points in patients with type 2 diabetes treated with sulphonylureas or insulin over 10 years
    The study shows a clinically important benefit on macrovascular end points from metformin in patients with type 2 diabetes that seems somewhat independent of the drug’s ability to lower blood glucose concentrations
    Nevertheless, many authors, journal editors, and the wider scientific community interpreted the study as providing evidence of the benefit of intensive glucose control ”

    and here for comments on the view (both pro and anti)


    The point being that the data is one thing, the variations in interpretation of the data by other academics,clinicians and in the press is another matter entirely.

    Neil (married to Kate #3)

  109. Michael 14 October 2007 at 6:14 pm #

    Your thoughts are well reasoned and well presented, but it would be good to keep an open mind to the latest studies.

    Regarding heart attack and kidney disease risk:
    >>Therefore we should think very carefully before recommending high fat or high protein diets in this group.

    What if heart attack risk is improved on a high fat, low carb diet?
    There seems to be some recent evidence to that effect, even if it seems counter-intuitive.

    Studies such as the Norfolk-EPIC are finding that:
    “Increasing evidence suggests a continuous relationship
    between blood glucose concentrations and cardiovascular
    risk, even below diagnostic threshold levels for diabetes.”

    It seems to be true – other studies do show the same results:
    “After adjustment for systolic blood pressure, cholesterol, body mass index, cigarette smoking, and use of antihypertensive agents, they found that glucose was a strong, independent predictor of mortality.

    There is mounting evidence from these studies and others that the CVD risk for diabetics is directly related to high blood glucose levels.

    Besides all that, low carb diets in fact improve HDL and Triglycerides tremendously and do not worsen LDL, leading to a healthy lipid profile.

    If the association between high blood glucose and coronary death is as strong as these and other studies say, a diet promoting a low A1C would appear to be heart healthy indeed.

    It would be even better if such a diet would improve lipid profiles.

    What kind of diet meets those criteria?

    Even if the result seems counter-intuitive, it deserves attention.
    Scientific progress is often counter-intuitive.

  110. Sue 14 October 2007 at 11:02 pm #

    We all know what the long term complications are of diabetes – even more reason for diabetic patients to comply with their diet.

    “People have a large number of factors influencing what they do in their life and giving priority to food and health isn’t something that everyone is able to do.”
    Of course they are able to do that. We all take responsibility for our own health. Just give your patients the correct advice in the first place so they don’t have an upward battle reclaiming their health.

  111. chris 15 October 2007 at 8:04 am #

    Sue – your comments seem to indicate to me that you are not listening. Compliance as you call it! will never be achieved in some people and Kate is quite correct that it takes weeks of seeing someone – diabetics never benefit from a one off appointment.
    One other important point to posters is that reading a paper or study is never a substitute for expereince and training – something you are not factoring in here. Some of the views are very idealistic!

  112. Sue 15 October 2007 at 9:24 am #

    I’m not saying you will able to get every patient to comply. They have to be willing to change their diet. Some patients just want a magic pill.

  113. Michael 17 October 2007 at 9:02 pm #

    >>One other important point to posters is that reading a paper or study is never a substitute for expereince and training – something you are not factoring in here. Some of the views are very idealistic!

    Myself and several other posters are diabetics who have learned what it takes to control this beast – in spite of the official advice we were given.

    Low carb works to control diabetes.
    I have experience to back it up. (A1C 4.8%)
    I have the anecdotal evidence from myself and other well controlled diabetics.
    I have provided links to studies with the same result.

    What is idealistic is clinging to a set of beliefs and practices when they continue to get poor results in practice and in research.

    If the training is incorrect, fails to get results and is contradicted by actual studies, what use is such training?

    The standard advice of trying to control blood sugars by eating a low fat diet is insane. It does not work.

    I think that the compliance problems that you see are a direct consequence of the poor results from the standard advice.

    It works so poorly that sane people give up on it.

  114. Kate 22 October 2007 at 9:19 am #

    “I’m not saying you will able to get every patient to comply. They have to be willing to change their diet. Some patients just want a magic pill.”

    Which is exactly what my complaint is about the advice being given here which is essentially “stick to this amazing advice that the incredible magician Briffa is recommending and your diabetes will be instantly improved easily and with no more dieting”.

    It’s just not that simple and it’s not just about getting people to “comply”. Sometimes it’s just about making small changes and about helping people to feel that they can take control and make those small changes.

  115. Dr John Briffa 22 October 2007 at 9:48 am #

    It’s also, Kate, about giving them the CORRECT advice, which often appears not to be the case with regard to conventional dietary recommendations, and certainly not the case here.

  116. Michael 24 October 2007 at 5:24 am #

    [Dr Briffa]
    “Anyone that takes any interest in nutritional at all will likely know that these are [starchy] foods that, generally speaking, cause considerable surges in blood sugar ” precisely what should be avoided in individuals who have diabetes.”

    I don’t see any magician or any magical advice.
    This is the most straight-forward advice I have ever seen.

    Avoid foods that raise blood sugar.

    The amazing thing is, this is terrific advice.
    It works!

  117. Kate 25 October 2007 at 6:26 pm #

    But you require carbohydrate for energy – muscles use their glycogen reserves and the brain needs glucose as a food. You can use a certain amount of fatty acids and protein can be broken down to produce carbohydrate (with the whole issue of kidney function), but at the end of the day the body needs carbohydrate.

    But that doesn’t mean we are advocating large amounts of high glycaemic index foods. Simply small portions of low glycaemic index starchy foods at each meal, spread evenly throughout the day.

    The other issue that I feel I have to mention is that of elderly, frail patients. In these patients the most important issues are symptom control and ensuring that they eat adequately to prevent malnutrition, and long term complications are less of an issue. In this group is is vital not to recommend too restrictive a diet. Not all patients with diabetes are the same and one size does not fit all.

  118. chris 26 October 2007 at 8:22 am #

    kate – that is quite right and having looked at this whole blog again people who post on here don’t see real people – as Dietitians we do. I actually find it rather irritating that so many experts have never been confronted with the problems people have to deal with. I also see alot of elderly people and people struggling with kids and jobs etc. So everyone is different and will have different goals to achieve health.

    This whole blog I feel was meant to be provocative so well done doc you did what you set out to do.

  119. Michael 26 October 2007 at 4:59 pm #

    >>But you require carbohydrate for energy – muscles use their glycogen reserves and the brain needs glucose as a food. You can use a certain amount of fatty acids and protein can be broken down to produce carbohydrate (with the whole issue of kidney function), but at the end of the day the body needs carbohydrate.

    “Required carbohydrate” is widely taught, but that notion deserves study. If it were true, then the Inuit people would die.

    Glycogenesis supplies enough blood glucose for Inuit to survive on a fat and protein diet all winter.

    In the case of diabetics especially, “required carbohydrate” is a myth.

    I get 20g of carb per day. If “required carbohydrate” were true, I would have catastrophically low blood sugar. In fact, I must use a fair amount of medication to prevent catastrophically high blood sugar.

    The only sensible requirement to include any carb is to get phytonutrients etc. from non-starchy vegetables.

    Telling diabetics to consume carb because they need it for blood glucose production is … not logical, and it leads to bad results.

  120. Michael 26 October 2007 at 5:29 pm #

    >>don’t see real people – as Dietitians we do

    I see a lot of diabetics.
    None of them are under control.

    >>never been confronted with the problems people have to deal with.

    Diabetics are struggling with an abundance of health problems caused by high blood glucose.

    If you prescribe low-fat / high-carb diets, you inflame the root cause of all these health problems.

    If you attack the root cause, the problems get better.

    Would you prescribe cholesterol injections for heart patients?
    Would you prescribe cigarettes for cancer patients?

    Why are dieticians pushing foods that raise blood sugar to people that are dying of high blood sugar?

  121. Kate 27 October 2007 at 12:51 pm #

    I hate to be picky here but are we all aware that in type 2 diabetes blood glucose, together with blood pressure and cholesterol, are proxy markers for the state of control of metabolic syndrome and that diabetes is also a disease of fat and protein metabolism?

  122. Michael 27 October 2007 at 10:42 pm #

    >>diabetes is also a disease of fat and protein metabolism..

    I believe you are referring to the dislipedemia and hypertension that often accompany diabetes, collectively known as “metabolic syndrome”

    dislipedemia = low hdl, high ldl, and high triglycerides

    Dislipedemia is often blamed on a high fat diet.. but this appears incorrect in light of many studies.

    “Conclusions: A carbohydrate-restricted diet recommendation led to improvements in lipid profiles and lipoprotein subclass traits of the metabolic syndrome in a clinical outpatient setting, and should be considered as a treatment for the metabolic syndrome.”

    “For persons on the low-carbohydrate diet, triglyceride levels decreased more..”

    From my own experience, the anecdotal evidence from the few other well-controlled diabetics I know, and the studies I have seen, all the markers of “metabolic syndrome” improve markedly when blood sugar is brought into the normal range (83mg/dl or 4.6mmol/l)

    I was originally put on Lipitor for my dislipidemia, but my lipids have improved far more from a low carb diet and very tight blood sugar control than they ever did when I took Lipitor.

    In other words, there is strong evidence that the dislipidemia and hyptertension are symptoms of high blood sugar.

    Treat the high blood sugar and the dislipidemia and hyptertension improve.

  123. Bobby Deans 28 October 2007 at 2:20 pm #

    Wow this blog was brought to attention to those of us thousands of diabetics who do low carb and are healthier, on less meds and use the meter to eat.

    We do Dr Bernsteins Diabetic Solution and believe we have the right to non diabetic blood glucose numbers thus we eat low carb, follow his program cause it works and because most of us got “bad” advice from our own docs and dieticans.

    They promote high grains/low fats/small amts protein. My diabetologist / dietitian had me on a program of 12 servings of grains a day, and I was to follow the Canadian Food guide.

    I did it, I complied with them, I was scared, I took 4 shots of insulin a day, my A1C was the lowest at 7.8.all those yrs on 155 units of insulin.

    I gained about 50 pounds, didn’t ‘cheat”, felt ill, was always hungry and the shame put on me for gaining weight by following the dieticans program was overwhelmingly.They always treated me like I was a liar.

    I then found out about the Dukes university program for diabetics, following Dr Atkins program. I went on it despite the dieticans from the diabetic clinic mailing me tons of ‘research: all outdated from 1998, this was 2003 when I started Atkins. They pleaded with me and said I would ruin my health. I had no health at this point eating their high grains etc.My drugs were $700 monthly.

    Within 32 hrs I had to stop my four insulin injections a day, I was at a blood glucose of 2.7, I have not needed insulin since then. 4 years ago.

    Within a month I had to stop my blood pressure drugs I had been on since 1987 as my blood pressure dropped so much. Then after another month I went off statins and never felt so good in all my life and then my cholesterol levels got better and better eating low carb. My trig and ratio were way down, my blood pressure average 112/72, now my A1C is 5.4 and I am aiming to 4.5 as Dr Bernstein recommends.

    He is even more restrictive than Atkins and advocates 6/12/12 carb count.

    There were thousands and thousands of diabetics around the world on the Atkins web sites and the Bernstein’s website who have got off insulin, got off meds, lost tons of weight and kept it off for years.

    Few of us have support from dietitians and doctors.

    But we are all accountable for our own health, we read and research and share ideas, we have members who are nurses, dietitians and doc now and they have changed their thinking to go outside the box and realize that allot of what they have been taught….to get diabetics to eat carbs is not the best choice as carbs kill diabetics.( Kate since you are a new grad you can have lots of influence, come read our sites and see how you can learn we don’t need carbs…. like you were taught, its amazing how much healthier we all are, like hundreds of thousands of us in total, are we all wrong) ( we will live longer as now we know how to eat for our illness)

    My diabeologsit finally told me to keep up whatever I was doing and he wished he could tell his patients to follow my regime but it is not what the Diabetic association’s recommend thus he cant as he would not be following the guidelines. He told me not to listen to the dieticans and do what I am doing.

    He also told me the wheat board and the big drug companies finance the Diabetic Associations.

    I quit seeing the dietitians as they want me to be accountable and take control of my health but when I do and did but didn’t do it their way they hauled out scare tactics, tried to shame me and talked down to me as though I was stupid,only handed me papers telling me how I would have a heart attack, my kidneys will fail and I will get osteo eating low carb.

    Now they shun me as they see me come in, 80 pounds lighter, no insulin, a non diabetic A1C, awesome chol numbers and drug free as I think they slowly are learning that diabetics don’t need their hi grain carbs and sugars and starches like they pushed,any carbs, we eat low carbs to get our veggies, salads and low Gi fruits like a few berries….but we all eat according to our meter.

    That is the key to live long and without complications….eat to what your meter reads.

    If dietican, doc and diabetics could have a dialogs without getting defensive or bullying or treating the patient with shame we would all be better off.

    Go to Duke uni site and read Dr Eric Westmans research on how great diabetics do by eating low carb.

    Find out how Alert Bay, a native community in northern Canada got off insulin and went back to their diet of hundreds of ys ago and eat fish, meat, eggs, seeds, grasses and all have good health and good A1C now….they eat low low carb….like we did before 1940.

    Diabetics were kept alive a long time ago by eating low carb.

    Why would we listen to any doc or dietican who is killing us promoting carbs when it is carbs that are killing us, its not your body, diabetics have the right to non diabetic blood glucose numbers and can achieve this healthy by eating to your meter via low carb.Think outside the box folks….It will save someone you love.

    Thanks for the opportunity to share.

  124. Michael 28 October 2007 at 6:15 pm #

    Bobby Dean – I am so glad you have found out how to survive healthy by managing your diabetes.

    Your experience of losing all that weight and getting off the cholesterol and blood pressure meds is exactly the same as my experience.

    I don’t think the dieticians are actually trying to kill us diabetics.
    They went to school to learn how to help people.

    I am however, perplexed how they can ignore the mounting evidence that what they were taught in school about managing diabetes is not just useless, it actually makes the problem worse.

  125. Michael 28 October 2007 at 7:34 pm #

    I am glad to have the ear of a few properly skeptical dieticians.

    Dieticians, like other professionals must be skeptical of the latest fads. To do otherwise would be unacceptable.

    Dieticians like other professionals, must also keep up with the latest research and also be (skeptically) open to new ideas.

    Be properly skeptical.
    Demand evidence
    When the new ideas are contrary to what you were taught in school, demand very good evidence.

    Dr Bernstein, Dr Mary Vernon, and Dr Mike Eades are all getting excellent results with diabetics.

    Regina Wilshire has an excellent blog that dissects many many current studies. http://weightoftheevidence.blogspot.com

    I cannot draw your conclusions for you.

    As a diabetic patient, I only ask that you examine ideas that are getting great results in clinical practice, and are backed up by empirical evidence from studies.

  126. Bobby Deans 29 October 2007 at 6:23 am #

    I use the term killing us as it makes people pick up their ears and of course they don’t want to hear that nor do they think that but they are so used to approx 80% of us not being able to get an A1C under 8 that I think they feel we are a wasteful cause and don’t think allot of us have gray matter between our ears.

    Have they ever stopped to think after a diabetic leaves the office
    and has been reprimanded for a high A1C and accused of not following the program and the person knows they have, the shame you add to an already shameful person. Diabetes is an illness of shame, so c’mon if you aren’t educated about the latest research get off the pot and be responsible, anyone working in the medical field is unethical if they don’t keep up to date and I too worked the medical field for 30 yrs so I am speaking about all of us.

    Its your responsibility to know what works, whats the latest and to treat the patient with dignity, that means find ways to help them get a non diabetic readings on their bg meter.Otherwise you are in the wrong profession. You are somehwat responsible for their complications.You promoted the high grains.

    I shudder to think of what I may have said or done to my clients feelings/body prior to me becoming diabetic as I too followed the rhetoric.

    I too was killing diabetics.

    I assume this kind doc here wasn’t always using low carb approach and now he has found what is working and diabetics who use low carb are trying to educate their health professionals all around the world so now you’ve heard about this info you now have the responsibility to go out and learn all you can about diabetics being successful thur low carb.

    Come join our board as see the thousands there who feel so healthy and have such good bg numbers their docs are astounded.

    Expose yourself to the info, mull it over, ask your diabetics what makes them go off their program, bet its hunger from all the grains and skim milk you push….. let your diabetics be your teachers and you will be amazed at what you learn.

    We don’t need to feel shame when we low carb as we experience what it feels like to be “non diabetic” in our health and we know the medical profession was wrong in giving us bad info and it wasn’t us who failed but the medical profession who failed us.

    I don’t think this is new, research has been done on low carb and good bg control and good chol for a long time now.

    The research the Duke did to give me to pass onto the dietitians at the metabolic center I attended was done n 1998, all scientific double blind studies, can’t beat that yet none of them there heeded the research.

    They just gathered up more of their own and mailed it off to me telling me I will soon be a dialysis patient and how ill I will be.They said within the yr I will be very ill. That was in 2003.

    There has been enough time to stop making excuses for those ill informed professionals who work in the medical field.

    A Dr oath is to do no harm thus they have the responsibility to keep with with research especially on diabetes since it is now so rampant world wide. WHY>>>> cause all the medical people decided to promote grains and our bodies were not designed to eat and process grains and starches and sugar. Do you think men 10, 000 yr ago sat around and drank tea with sugar in it, added yikes, skim milk which is high on the GI, then have a sandwich with some high sugar fruit for dessert.

    I was on the Serengeti dessert last yr in Kenya and asked the Masai chief what his people ate as he commented on how fat all the tourists were. He said as though I was stupid, well we eat meat, drink blood and milk from the cows, what do you think.
    I said do you have salads, veg, he looks at me and says if the women find grasses we have them, Sometimes some seeds, why???
    I said do you eat fruit, he stops and says no, why do we need fruit, we like to be strong and lean, we don’t like fat bodies like you Westerners.

    Then we went north to the Samburou tribe and I asked them as now I was curious, they too told me, meat, blood and milk from the cow. They said we look old and wrinkled cause we eat food from stores and it has chemicals in it and we don’t need that kind of food.He laffed about us eating salads.He said monkeys eat bananas.

    I can scan you the program the dietitians at the metabolic center gave me as I have it on my kitchen wall and it makes me really sad and hurt that they forced this on me and threatened to drop me from their program if I didn’t follow it.

    Thats why I say if I had followed it I would be dead quicker….to me thats killing me….

    but then it is my life and my body

    so maybe I am just


    maybe its not killing me….maybe it is just a slow type of accidental death due to their lack of keeping up with the research.

    The art of medicine does not keep up with the science of medicine, remember that and think of all the other times this occured. The Duke is known world wide for their research on obesity, diabetes etc and it was the doc there who told me that…..

    the art of of medicine does not keep up with the science of medicine. …

    like look at how statins are pushed, do they stop heart attacks….no…

    do they damage you….yes….

    To have a piece of rye bread I needed 28 units of humalog, that would kill most non diabetics.

    Now to have some salmon, ham sausage, mashed with some full fat ( none of the low fat garbage with added sugars)mayo and onion, on a bed of lettuce, a small amt of cottage cheese and strawberries and good ole chunk of cheddar to get some more fat in there, I need no meds and my BG are about 4.4 before I eat and about 4.4 two hs after I eat.My ldl chol is 2 , My hdl is 68.y trig is 98.

    Wouldn’t as a dietitian make you rejoice that I can do that with my 60 yr old diabetic body???After 15yr of following your program, going on massive drugs and gaiing massive amts of weight….I would think you’d give me a medal for figuring this out on my own with the help of Atkins and Bernstein and boards such as this.

    Can ya do that with the ADA, Cdn food guide or other high grain programs.We have tons of Uk’ers on our boards as they tell us there is no where in their medical system that professionals are educated with the latest info to assist them in low carbing so they get their support and help off the internet, thank goodness for places like this, the other low carb boards, some of us will live long and have no complications.

    If you cant think outside of the box then get out of the box and learn all the newest research.

    If it was your mom, or your brother wouldn’t you want the best so they can live long or would you want them to get complication’s sucking up the sugar and starch and sugary fruits and rye breads, Atkins big mistake for diabetics is he prometed you to slowly get back to “good” carbs like rye breads, oatmeal, fruits low on GI, etc and that is why people failed and regained weight cause for us who crave carbs as soon as they enter our body we crave them more and more and they bounce our bg up and down and so we are hungry and so we want to eat more. Grains for us are the KISS OF DEATH. Remember that for your diabetics.

    Its not going off Atkins that makes us regain, its the carbs, Bernstein says….



    you want to live to be old without complications you don’t eat fruit, period.

    You don’t need fruit nor grains.Man lived for centuries without all these fruits. Your body doesn’t process them right so get over it.

    His next webcast is Nov and you can go to

    I think it is to register and listen for free.

    He is like this kind doc here who takes big risks by telling diabetes to eat low carb, think outside the box, follow the guideline’s that were used in the early 1900’s and eat to your meter.Use the recent science to aid your body.

    If my meter reads 3.7 then I have a big bowl of cottage cheese and some berries,some tea with some milk, if my meter reads 5.3 then iI have just cheese, some meat, some olives, some tea with some cream,….so if I eat to my meter, I lose weight and I will live long.

    Oh and by the way I eat about 2000 to 2400 calories a day, I eat alot of food, on this program I don’t go hungry and I don’t stuff carrot sticks down my throat.

    I get allot of fat in a day so add allot of olive oil to my salad, add a few T of real butter to my veg and add some real full fat cream to my coffee.

    Whoever thought of skim milk….duh…. the sugar in that, yet do you know a dietican who doesn’t prescribe anything but skim milk!!! read the container for low fat yogurt, you will laugh when you see how much sugar they added to make it taste ok, they think we’re soooo stupid.

    Drink a glass of skim milk,then test your bg and see what happens, have some high grain bread and a banana and test your blood sugar. It will be high and those are the foods being promoted by most dietitians and thus it kills us.


    C’est la vie!

  127. Paul Anderson 29 October 2007 at 10:52 am #

    I have read through the thread with a mixture of interest and frustration.

    I find it hard to believe you, Chris, when you say that your patients achieve low 5 hba1c’s following your advice – whatever that is. Your references to patient non compliance, and lifestyle issues imply that for those patients, at the very least, they fail to achieve good control under your guidance. Perhaps you could indicate the average hba1c for those of your patients attempting to manage their condition without medication. For someone who supports the orthodox low fat approach you seem surprisingly reticent to give specifics: how many carbs, what fruits, etc and presumably if you don’t advocate large amounts of carbs/grains, ie a high carb load (regardless of GI) you must, by implication, be advocating a higher fat and protein content in the diet of your patients. Alternatively, are you advocating high doses of insulin with the corresponding risk of lows that will result in?

    A low carb diet may not be perfect but its surely better than the alternative – not just for short and long term health, but for eliminating cravings, weight loss, controlling (and reversing in many cases) symptoms of the metabolic syndrome and for a general sense of well-being.

    I have been surprised, when researching suitable diets and lifestyle guidelines, by just how little evidence there is to support the politically correct guidelines, whether it be the disasterous high carb/low fat dietary guidelines, the recommendations for alcohol intake, the 10,000 steps a day, avoiding dietary cholesterol, exposure to sunlight, etc. I have almost come to the conclusion that if my doctor recommends a particular course of action then the best approach for me is to do the exact opposite.

    I am coming to the conclusion that managing diabetes is both elegantly simple and frustratingly difficult. Good control is achieved by miniming intake of carbs, eating a diet that provides essential nutirents (especially protein and high quality fats, and burning up as many calories as you possibly can. Common sense suggests that blood sugar is either utilised by muscle or turned in to fat (unless it is excreted by the kidneys – it follows that having a lean body and exercising helps to keep BG and body fat down. I suspect, presonally, that more intensive exercise is preferably to lower intensity aerobic exercise. Taking a multi vitamin, and topping up with natural sunlight whenever the opportunity presents is also probably a goods idea.


  128. Bobby Deans 29 October 2007 at 3:46 pm #

    Paul, Dr B says anaerobic is best for diabetics.

    I just read an article how we got switched to low fat 30 yr ago was actually due to an accident of the then Surgeon general misinterpreting some research and he said this and we blindly followed after our guidelines were given by our country’s gov and medical people.

    Dr B even says when eating nutrient dense foods which are low carb foods, not high grains, you don’t need the multi vits as everything you put in your mouth is nutrient dense.

    By the way another nice side effect from low carbing was I got off my ys of vioxx and my arthritis has been gone for three ys as I eat only nutrient dense food and my neuropathy in my fee is slowly reversing.My diabectologist is shocked as its supposedly permanent.

    My EBCT shows my plague is decreasing as I live low carb, I mean what more evidence would someone want if the test case and guinea pig was you yourself and the lab results proved you were healtheir for it.

    If I came to the office of these dieticans here who poo poo low carb, what would you tell me.
    Well OK your are healthier but we want to tell you to eat grains at each meal, use skim milk, eat some apples and oranges and take some shots of insulin to cover this, yes you will gain weight from the insulin but you need low bg or it puts you at risk for heart disease…..duh…. I am already there in low bg range what I eat….but some of you can’t or won’t accept that and try and poison my body, thus as I say are trying to kill me.
    I challenge those nay sayers here who spend their energy arguing the doc here, argue me, argue those of us who have healed ourselves low carbing and know if we don’t our diabetes is always waiting in the corner to rear it’s ugly head but we finally have a tool to truly manage it, feel full and not deprived and not hungry and all the lab work to back us up.

    I am not here to make money, sell anything, only to try remove some of the bunk some of you have in your head to try and get you to see that a confident medical professional will always research for the newest best info and will always use their patients as their teachers and for those who are so full of shame and failing will give them guidelines they can actually achieve, You can’t get an A1C of a non diabetic eating grains, low fat and tons of fruit.You just cant so do you feel good setting your patients up to fail???

    I doubt it,

    we go into this field as we are caregivers and should do no harm so help right now today with researching these ideas of low carb and success for diabetics and then help educate your patients who don’t want to feel the shame but do want to live to be old and no complications.

    Some of you dismiss diabetics as non feeling people in your office who are dumb, cheat, don’t care, lie……non compliance, what a lovely word to project blame onto the victim of your mis information, those of you who toot high grains, low fat, lots of fruit are the ones who are cheating your patients out of ys of life, are lying as the research has proved you wrong for ys now and are dumb for not opening your eyes to the likes of this doc here, Atkins, Bernstein but most of all those thousands of us around the world who have finally been able to manage our illness without massive amts of insulin and drugs.

    I hope I have just nudged you enough to begin to research and think outside the box so some of your patients get better info and can live longer.
    It could be your mother.

  129. Glenice 30 October 2007 at 12:34 am #

    Everyone, please read a new book out called Good Calories, Bad Calories, by the famous American Science Journalist Gary Taubes. There you will find all the evidence you need with references and informaton as to how the medical and nutrition establishment took the wrong turn in this issue. I think this book will change things, albeit it already has a lot of American mainstream at loggerheads, but there is simply no refuting this incredibly intensely researched book, it is simply mind-boggling. Dr Briffa I am sure you have heard about this one by now?


  130. Kate 31 October 2007 at 8:10 pm #

    The Big Lie “”If you tell a lie big enough and keep repeating it, people will eventually come to believe it. ”

    So just keep on repeating that there is no evidence for the current dietary and lifestyle recommendations for diabetes in the hope that people that do not have access to the literature will simply believe that this is the case.

    The other big lie that keeps being repeated here is what dietitians and medical professionals actually recommend. The term high carbohydrate is used repeatedly as if this is the basis of the diet.

    Dietitians are trained to asses evidence. We’re not just taught what diet to recommend. We’re expected to look at the evidence available and critically evaluate it. So no – wonderful pasted in monologues about how some wonderful guru with a book to flog turned your life around aren’t going to impress us a great deal.

  131. Michael 1 November 2007 at 5:29 pm #

    As I understand it, the current standard practice is to push a low-fat diet to everybody, especially diabetics.

    Is this correct?

  132. Dr John Briffa 1 November 2007 at 6:14 pm #


    You suggest that the notion that current dietary recommendations for diabetes is not evidence-based is a ‘lie’.

    You also state that: “Dietitians are trained to asses [sic] evidence. We’re not just taught what diet to recommend. We’re expected to look at the evidence available and critically evaluate it.”

    In light of this, perhaps you would be so kind as to actually present the scientific evidence which supports the carbohydrate-rich, low-fat diet usually promoted to diabetics?

    You appear to have a scathing view of individuals who have told you that they find carbohydrate control has been effective in controlling their diabetes.

    If a client of your were to share a similar experience with you, what would you tell them? Would you feel compelled to point out the error of their ways, and what evidence would you provide to support your stance?

  133. The other (non-dietician)Kate 2 November 2007 at 1:40 pm #

    I have read your last comment about three times now and I can’t see that it adds anything to the debate here.

    So what would you recommend to someone with metabolic syndrome or type2 diabetes? It’s all very well to say that you critically evaluate the evidence, but you don’t state your conclusions.

    For example, here is a client, a couple of stone overweight who is adamant that they exercise and follow a low fat diet, but can’t shift the weight.
    What then would you recommend to them?

    I was pretty lucky back in 1999, when I went to see my GP and we talked long and frankly about diet and cholesterol. My cholesterol was awful and didn’t respond to any of the statin drugs and I was pretty fearful that I would die of a heart attack in the next ten years. He told me to go and buy a book, which turned out to be the Atkins diet book. He warned me that the diet would seem very strange and yes, it did.
    But to my amazement it worked. It was so wonderful to be free of indigestion and to see my HDL levels rise and my triglycerides to be out of the ‘danger zone’ oh, and to say goodbye to brown rice and pulses.

    There are so many adverts on television and the internet for low-fat, high grain cereals which promise to help lower cholesterol levels and call themselves ‘healthy’.
    But for people like me, they aren’t.
    Am I wrong?
    In your and Chris’s books, I would be. You both are trying to tell people who post here, that they are gullible and misinformed.
    Dr Briffa’s diet advice is very sensible. There is nothing ‘wrong’ with any of the advice that he offers, but all you seem to want to say here is that he has no right to criticise dieticians, despite the many accounts from people here who have been given advice that has not worked for them.

    Haven’t you read any of the posts from the diabetics who have been offered this advice?

  134. Bobby Deans 2 November 2007 at 4:01 pm #

    Kate et al cannot hear us diabetics who have proof as they are the professionals and we are just the patients. in some professionals view.

    .. especially those who feel inadequate,they fell we don’t have gray matter between our ears, so the professional who s inadequate likes to have power and control.

    I worked psychiatry for 30 yr and have seen this thur and thur.

    My bet is if I went into their office and told them this success I have with low carb,they would argue me, despite my lab results, would try and take power and control back by trying to manipulate their way down my throat and when I would refuse they would find some way to dump me or they would create such a hostile unwelcome attitude that I wouldn’t return to their office.

    This is what my experience’s have been with both local dietitians and those from the metabolic centers I have attended.

    And Kate yes they do promote high carb low fat. They promote here the Canadians food guide. I actually have kept their program on my wall by my fridge for the past 4 yr and every once in awhile I look at it.

    I was told to have 7 to 12 servings of grains a day. I mean I loved that, I had cereal with a banana(half) for breakfast, a sandwich with a tomatoe and some mayo for lunch and some meat ( no bigger than the size of a deck of cards), some veg, some potatoes and some salad with some low fat salad dressing which is laden with sugar and some fruit.

    For three snacks I was to have some fruit, some grahman wafer cookies etc.

    To keep my A1C around 8 for their program I had to take 58 units of Humalog prior to each meal and 58 units of long acting insulin prior to bed, also 2000 mg of metphormin a day.

    I had an A1C of 9 most the time and once 7.8. They were so happy and told me more than 50% of diabetics cannot achieve an A1C under 8.

    Go figure,

    you would try to kill me offering me more carbs than I eat now.

    so I want to stay alive long

    so I stay away from undereducated dietetians about what works for diabetics,as they dont know and dont get it yet tis soooo simple, diabetics cant process carbs, it gives them hi BG, so stay away from them….duh….isnt that simple in your mind???

    I don’t want to die young…but oh ya lots of diabetics listen to you folks as we all love grains, those comfort foods that make our bg go up, we get a bit sleepy, more relaxed ( they increase seritonin actually)and feel like a kid again, we learned these foods sooth us so we love it when you say to eat them, but sadly, yes for many of us they kill us. if you can eat them, remain slim, have great cholesterols and bg then go for it. I envy you.

    PS: boy you had a good smart doc who thought outside the box. most our UK members on our diabetics boards tell us how stupid and uneducated their dietitians and Dr were about low carb which is why they come to a north American board, they got hammered for eating Atkins and improving their bg and blood lipids and didn’t find allot of support over there.Less than we did.

    Tonight Gary Taubes has a radio interview about his new book, we are all quite excited as the medical community needs a good stirring up to make them think thru more how not to do harm to their patients. Try tuning into http://www.npr.org tonight and listen to him on a radio show.
    ‘Thnx Dr B here for putting up with all this slander in order to try educate the uneducated.
    Too bad the young’uns wont take a step towards independence and think outside the box.Kate says the dietitians scoff us when we learn from a book, didn’t she learn from a book????

    We have classes here for diabetics and are all handed the same “diet”, it is the Cdn food guide and are told we can even have some sugar…..thats an individual assessment???.
    low fat diet is same….its all garbage, you have a long career ahead of you Kate and just think of the aweosme impact you could have and how good you will feel knowing you truly helped people cope and eat well for their illness if you would just allow yourself to hear some of us and do more research and not get stuck with your head in the sand like some of those others here. Wish I could sit down face to face with you, you could know me and hear me and try and help your patients just like me to feel better and live longer by eating more protein, more fat ( no trans fats which are in those salad drsgs and crackers you tell us to eat)and no grains, all my carbs are from veg, salad, berries, about 30 gr or so a day.

    My brain loves me for this way of life!!

  135. Bobby Deans 2 November 2007 at 4:38 pm #

    try this info for starters:


  136. Michael 2 November 2007 at 7:21 pm #

    >>So just keep on repeating that there is no evidence for the current dietary and lifestyle recommendations for diabetes

    Oh, I never said there was no evidence.

    I said there is plenty of evidence that the current low fat recommendations are harmful to diabetics.

    low fat = high carb, there is just no way around that equation.

    For diabetics,
    high carb = high blood sugar there is just no good way around that equation either.

    High blood sugars kill us diabetics.

    While we are dying, our kidneys, eyes, hearts and limbs are all taking an awful beating from the high blood sugars.

    The ironic part of this madness is that the justification for avoiding fats is to control cholesterol and blood lipids, and that doesn’t even work.

    “Conclusions: A carbohydrate-restricted diet recommendation led to improvements in lipid profiles and lipoprotein subclass traits of the metabolic syndrome in a clinical outpatient setting, and should be considered as a treatment for the metabolic syndrome.”

    Even more ironic, it appears that the association between elevated cholesterol and risk of coronary disease may be a secondary association. That is, elevated cholesterol may not be the cause of coronary disease.

    Elevated cholesterol is another symptom of high blood sugars. Elevated blood sugars are strongly associated with increased cardio disease – even at A1C below the diabetic threshold.

    “The risk for cardiovascular disease and total mortality associated with hemoglobin A1c concentrations increased continuously through the sample distribution.”

    Avoiding fats and dying of high blood sugars is just madness.


  137. Bobby Deans 3 November 2007 at 4:57 am #

    one more excellent educational site to learn about low bg and low carb and long time:
    so much info out there and so many closed minds in the dietitians/medical profession….so sad, it will come and it will be mainstream and in 20 yrs they’ll think about this conversation and wonder how many they harmed pushing low fat, hi grains.

  138. Michael 5 November 2007 at 10:09 pm #

    [Dr Briffa to Kate and other dieticians]
    >>In light of this, perhaps you would be so kind as to actually present the scientific evidence which supports the carbohydrate-rich, low-fat diet usually promoted to diabetics?

    I’m waiting for the evidence also.

    Gary Taubes was just interviewed about his new book on the radio.
    http://www.npr.org/dmg/dmg.php?prgCode=TOTN&showDate=02-Nov-2007&segNum= 4&mediaPref=WM


    He said that he started by looking for the evidence supporting the usual low fat diet recommendations.

    There is a lot history and politics, but ultimately, Taubes said he could not find any good science.

  139. bobby deans 21 November 2007 at 5:45 am #

    Yes his book is excellent, I got an email from the Dr at the Duke university asking me what I thought and excited that finally at last a good research has been done and not by a Dr selling a diet book as some people then dont beleive it.
    This book blows away this low fat stuff.I think it will take alot for dietitians and medical people to get used to the idea for a few yrs before they allow the art of medicine to catch up with the science of medicine and they will stick to their low fat hi grains myths, thus still kill diabetics quicker.
    Those of us who are no longer ignorant have known this for a long time but the good ole regulars think we are the fringe, soon they will be the fringe but in the meantime think of all the harm they have done. Sad isn’t it.
    Keep up the good work Dr B.

  140. david Wilson 17 June 2008 at 11:42 pm #

    Since BG testing became easy and painless, thousands of diabetics like me have been able to find out for ourselves what works for us – and how unbelievably stupid the standard high carbohydrate advice is. Within a few weeks of starting to test, it become absolutely clear to me that high carb meals create high post-prandial peaks which persist for hours. It took some months before I reluctantly had to accept that I wasn’t likely to get reasoned, evidence-based advice from the professionals, and that in its absence I would be obliged to design my own treatment.

    The approach I adopted was to set an arbitrary ceiling of 8 mmol/L, and eat whatever meals produced peaks no greater than this. In practice, that meant carbs per meal of below 12-15g. or thereabouts, with rather less for breakfast. The results have been excellent by all the standard tests, i ncluding the ones like HDL/LDL, triglycerides and blood pressure which are relevant to heart and artery health. The latter are particularly interesting, because dietitians solemly assure me that my low carb, high monounsaturated fat diet carries a high risk of heart disease!

    Meeting a group of dietitians at a conference in Dundee recently,I asked them to explain the reasoning behind the standard advice, and was given two reasons. The first was that it would be quite impossible to expect people in general to make massive lifestyle changes in the face of a currently symptomless ailment (an ethically somewhat dubious conclusion). The second was that in postwar America, for a decade or so, dietitians had advised a low carb regime, but that this had to be reversed when it was found to be associated with a high incidence of cardiovascular illness. I find that unconvincing, because given the traditional american diet of that time – very big meals high in saturated fats and sugar- I imagine that their idea of a low carb meal would still be pretty substantial by our standards. Moreover, if they had compensated with additional fat intake, this would certainly have been mainly saturated fat; the olive oil era was still decades away.

    Reading your eye-opening blog and comments, I’m very glad to hear that I’m not alone; we must number tens of thousands in this country alone. So – why can’t we get together in some way, to share our experiences, to pass on advice about what works, and maybe form a pressure group to get a fundamental change in dietary advice for diabetics?
    Forgive my forwardness, but is there a remote possibility that
    would you might be able and to initiate something on these lines? You are better placed than most to be the catalyst. I believe the response would surprise you.

    David Wilson

  141. Rita Schembri 18 October 2008 at 1:07 pm #

    Dear Dr Briffa,
    I admire you for being honest and sincere to your patients, but unfortunately human nature that the ones who don’t agree will never admit that you could be right in your opinions about low carb diet for diabeties. Diabeties is heretitory in my family and therefore I try to watch my diet, since I am overwieght (most of my life). Doctors have always told me to lose wieght to cut out carbs (starchy food) and as much sugar as I can……so to me this is common sense what you are saying for diabetics. It is also for controlling high cholestrol, which I have. I don’t understand why CATHERINE and CHRIS keep attacking you personally when you are only giving your view point…….

    We live in a world of ‘freedom of speech’ yet when you do the other so called ‘PROFESSIONALS IN THE SAME FIELD’ start throwing accusations and so on to make you look like you are out of line. On this site we have read many many patients agree with what you have written, we are not as ‘professional or trained’ as (CHRIS OR CATHRINE) but we do our own research to learn, the difference is we don’t have the document that says we have done research and read alot and discussed with many other people.

    These days many people who are not so called ‘Qualified” can be there on doctors (to a limit) as we (the patient) live within ourselves for our entire life so therefore we are the best to work out what has been good for us and what has not.

    I myself keep a diary and take notes of what I take or do (not just physical health but also mentally and emotionally) mind you I don’t even have to do it every day. I am now 50, and know myself pretty well due to all the information, courses, books I have read.

    I say to CATHERINE, AND CHRIS……please do not underestimate people (especially patients as we have much more education available in this day and age to know what is good for us and what is not. Years ago before computers we never were able to learn as much but now many of us have developed more common sense to see who really cares and the ones who are just concerned about their job.

    Thank you Dr Briffa and I hope more people support you for being honest and sincere to patients and to all people!

    May God Bless you in all that you do!

    Rita Schembri

  142. John Stone 18 February 2009 at 11:01 pm #

    I believe I have come across the dietitian known as chris before, but using a different name. A non diabetic that spends a great deal of time informing diabetics of impending doom. Scurvy, cancer and osteoporosis is the usual war cry. A sad stance for a healthcare professional.



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