Diabetes UK is the UK’s largest and most prominent diabetes charity. Have a look here and you will se the charity proudly proclaiming that: We stand up for the interests of people with diabetes by campaigning for better standards of care.� However, I’m doubtful that Diabetes UK is fulfilling its brief in this respect, seeing as it continues to suggest that diabetics should include starchy carbohydrates which every meal (see herefor more on this). You’ll see that Diabetes UK’s advice on this matter starts like this: At each meal include starchy carbohydrate foods such as bread, pasta, chapattis, potatoes, yam, noodles, rice and cereals.�
Yet, these starchy staples break down into sugar, and some of them can release their sugar quite quickly into the bloodstream too. And if we eat them in quantity, like we often do, that only adds to their disruptive effects. Now, what rationale is there for diabetics to include at each meal� foods that are disruptive to blood sugar? Here’s at least some of Diabetes UK’s ‘logic’ on this: The amount of carbohydrate you eat is important to control your blood glucose levels.�
This is perhaps the vaguest and woolliest sentences I have ever read. What does it mean? I suppose what Diabetes UK would like people to take it to mean is Diabetics need to eat starchy carbohydrates with every meal.�
However, I reckon there’s another, far more relevant way of interpreting this sentence which goes something like: The more starchy carbohydrate you eat, the more out-of-control your blood sugar level will be, the more ‘diabetic’ you will be, and the more likely you are to start to take medication for this or to need to increase your medication regime.� Remember the advice to eat generally sugar-disruptive starchy carbs with each meal comes from the UK’s largest diabetes charity which, it says, campaigns for better standards of care for diabetics�.
What sort of care is it referring to, do you think? Because on the face of it, it doesn’t look like nutritional care is part of its remit. And if that’s the case, maybe what’s being referred to here is medical care including medication.
Now, that would help to explain why Diabetes UK recently had a bit of a PR push on the idea that many diabetics are not taking their medication as prescribed. See this story from the Guardian in the UK for a typical instance of how this story was reported. The story, details the hundreds of thousands that are not taking their prescribed diabetes medication, and warns of the ills that may befall them as a result.
If Diabetes UK were so very concerned with the health of diabetics perhaps they could start by giving some decent nutritional advice for a change. How about starting by telling diabetics that the more starchy carbohydrate they eat, the more likely they are to require medication, and the more of the medication they are likely to need over time.
Elsewhere, I read that Douglas Smallwood, chief executive of Diabetes UK, has said it is a “tragedy” that many diabetics do not take their prescribed medication. My opinion is that the real tragedy here is the fact that Diabetes UK gives advice which makes it more likely to need that medication in the first place.
Those of you who clicked on the link to the Guardian newspaper and read it may have noticed that the Diabetes UK research was, in fact, partnered by the Association of the British Pharmaceutical Industry. Now, looking on the Diabetes UK website I can find no mention of where the charity derives its funding. Under ‘Corporate Partners’ Diabetes UK states this (and only this):
UK funds research for a future without diabetes while teaching children and adults to live with diabetes today. Our corporate partners provide vital and valued support to our work.
In the UK, 2.3 million people have been diagnosed with diabetes and more than half a million people have the condition but don’t know it yet. These figures are set to double by 2010.
Diabetes can develop at any age and those with friends or relatives with diabetes will understand how difficult it can be to learn to live with the condition.
People are being diagnosed with diabetes at an alarming rate; each year 100,000 people are diagnosed with Type 2. One in 20 of your employees, colleagues, friends and family will develop diabetes in their lifetime.
Lots of scary stuff about diabetes there, but no detail at all about who the corporate sponsors are and to what extent they fund Diabetes UK.
I was, however, able to find a letter in BMJ from 2003 that draws our attention to the need for charities and patient advocacy groups to declare their funding [1]. In this letter, the author states: Diabetes UK received around �£1m from 11 pharmaceutical companies manufacturing diabetes drugs but this is not mentioned in the annual report.�
I don’t want to come across unduly cynical, but is it right that a diabetes charity should have a less-than-transparent financial relationship with the drug industry. And is it right that this charity should be giving nutritional advice that, at the end of the day, looks likely to benefit the pharmaceutical industry. And after all of this, should it then go on to partner with that pharmaceutical industry in ‘research’ highlighting the need for people to take their diabetes medication. Or did I miss something?
References:
1. Hirst J. Charities and patient groups should declare interests. Letter BMJ 2003;326:1211
I think the insinuations you make in this post about the motives of Diabetes UK are obscuring a valid point about their failure to review their advice in good time. The very fact that they continue to make recommendations in spite of the weight of evidence is a crime, regardless of the motives. I argue here that organisations in general (and I accept this is a broad term) pay far too little attention to the case studies that abound on the internet, and because of this, the notion of low carb diets as a better approach for diabetics has taken too long to get through.
Points scoring by trading study-based opinions is all fine and dandy… and about as useful as trading biblical quotations to support any view you hold. But the numbers of despairing, ill-informed poorly controlled diabetics pitching up at diabetes forums, doctors’ surgeries and into early graves tells its own story about the general advice being handed out: it’s broke. Fix it.
Sara Spiers hits the nail on the head when she frankly admits: “The diet recommended for people for diabetes is the same diet as recommended for everybody else a healthy well balanced diet including all of the food groups above in the correct quantities.”
The same diet as everybody else? Hang on. Haven’t you missed something here? There’s a clue in your organisation’s name. We’re not the same as everyone else in dietary matters.
Look at it another way. How would we regard official advice from a charity representing alcoholics that its subscribers imbibe the official number of units of alcohol recommended for everybody else?
It really is that obvious.
I have followed the arguments. I have to say that the bad advice meted out by DUK is only what is given out as a “good diet” for diabetics by the NHS dietitians! To compound the poor advice, no diabetic education is given in many areas and T2 diabetics are denied the wherewithal to educate themselves on how such dietary advice affects them. To wit, test strips! Give some basic education on testing properly i.e. at what times in relation to their meals, and it’s not rocket science for them to see how various foods affect them personally, because there is no “one size fits all”, some people can eat certain carbohydrates with little affect, whereas another person will find the same choice shoots their BGs sky high.
In the forum I run http://www.diabetes-support.org.uk/forum/Blah.pl? there is ample evidence that restricting starchy carbs benefits BG control. This is mirrored throughout the myriad diabetic forums across the internet. If so many (literally hundreds) diabetics are seeing the benefit of managing their carb intake then the evidence simply mounts against the dietary advice advocated by the NHS and DUK.
Dr Katharine Morrison (who’s presentation was cited earler) is a member of the same forum and her advice is for T1s also to manage their carb intake more carefully. Indeed, I find that eating less carbs = less insulin intake = better control. My Hba1c has been under 5.7 for the past 5.5 years which is pretty darn good for a T1!
I think it’s time some properly administered trials took place on 1. lower carbing and 2. efficacy of testing!
I’ve just been diagnosed with Type 2 Diabetes and had a long discussion with the Dietician this week. I too was advised to eat carbohydrates in each meal, as well as protein and low fat. It’s very confusing to know what is the best thing to do!
I would be wary of advice from any organisation working hand in glove with Big Pharma, and I see this on Diabetes UK’s website:
Corporate acknowledgments
Diabetes UK works with companies from a range of commercial sectors:
Alliance Pharmacy
Cambridge Health & Weight Plan
Canderel
Co-operative Group Pharmacy
DietFreedom
Eli Lilly
Everyclick
Exhibition Services
FEXCO MT representing Western Union
GSK
Heath Lambert
HBOS
Jelly Belly
Kellogg’s
Lifescan
Lloydspharmacy
Merck Pharmaceuticals
MullerLight
Northern Rock
Novo Nordisk
Pfizer
Pindar Graphics
Prosidion
Roche Diagnostics
sanofi-aventis
Scholl Retail
Shredded Wheat
Slough Estates
Specsavers
Splenda
The Big Badge Company
United Co-operatives
Rather a lot of drug companies there!
I’ve been busy finding some fault with the British Heart Foundation’s advice today:
See http://aboutsalt.blogspot.com/2009/02/british-heart-foundation-bhf-is-mainly.html
And this is the page from which I got the Diabetes UK list of corporate acknowledgements http://www.diabetes.org.uk/Get_involved/Corporate/Acknowledgements/
Diagnosed Type II in 2007, I’ve been asking HCPs to explain the reasoning behind the eat starchy carbs mantra without success.
I’ve been doing some research online and found a paper presented by Joan Walker of Leicester Royal Infirmary, at The Nutrition Society’s symposium in 1964 on Carbohydrate consumption in Diabetes.
She said that in 1955 when oral meds were first used, people with diabetes were told to restrict carbs to 110g – 150g , that during the first ten years of insulin it was 100g or 120g and that during WW2, UCH Diabetic Clinic published ‘Diabetes and Food Rationing’ recommending 100-185g, in 1941.
So I am wondering when it was decided that people with diabetes should high carb ?
At the same symposium, John Yudkin of the Nutrition dept of Queen Elizabeth College, UoL, presented a paper etitled Patterns and trends in carbohydrate and their relation to disease. He said that sugar not fat was the culprit giving people diabetes and heart disease.
Since WW2, the consumption of carbohydrates has increased hugely.