I got an interesting email over the weekend from a 56-year-old type 2 diabetic. He was diagnosed at age 42. He initially managed this as he was advised: with a high carbohydrate, low fat diet. He moved to ‘healthy’ grains that were ‘less refined’ and ate sourdough bread. In his own words: “And despite all of this, I saw no improvement, in fact I gained weight to around 90 kg before changing my diet at the start of the year.” The man in question ended up reading the book Primal Body, Primal Mind by Nora T Gedaudas after hearing her featured on a podcast.
After reading Nora’s book, he followed most of her advice and then slowly extricated himself from the wheat and grain-dominated foods that he “was supposed to eat to obtain energy and remain healthy.” He started eating animal fats for the first time in years and gave up alcohol. Here’s his email to me:
I had my 6 monthly diabetes check-up last Wednesday. The diabetes consultant was really happy with all of my figures on cholesterol, triglycerides, blood pressure, weight (I’ve lost another 4 kg since February without really trying), kidney and liver function are excellent – in fact he was really impressed and asked me what I was doing to get these improvements.
Simple, I said, I’ve stopped eating wheat in all its forms and grains in general, I avoid rice and all potato products. I eat animal fat and the only oil that I use is extra virgin olive oil. Breakfast is typically a one-egg omelette and with a small amount of bacon, smoked salmon or Parma ham. I have spinach or other leafy greens and tomatoes. Lunch is often not taken as I do not feel hungry until 6.00 pm when I have my evening meal. Another small portion of meat and plenty of veggies. The only fruit that I have are a few blueberries, wild strawberries (when they are available) and raspberries – and I mean a few.
I sleep better than ever, don’t feel tired and have lost weight. I really ought to exercise though, that is the only flaw in my regime.
“No, you MUST eat some carbohydrates” he said.
“I do, I told you, I eat plenty of vegetables.” I said.
“No, no, starchy carbohydrates, you NEED them”
“Why do I NEED them?”
“For energy, your body needs carbohydrates for energy” came his concerned reply.
“How do you think that I’ve managed to survive since you last saw me then? And, you told me how pleased you were with all of my readings – doesn’t that suggest that I’m doing fine without refined, starchy carbohydrates?”
He had no reply other than to repeat to me that I MUST eat carbohydrates for energy.
I urged him to read Primal Body, Primal Mind by Nora T Gedgaudas and made him write it down. I could see that he wasn’t convinced. So, I told him that the bullshit that he’d been taught by the food industry-research funded nonsense that the Government taught him is causing all of the major health problems that he has to deal with every day.
I also said that I throw a fat-fuelled log onto the fire in the morning rather than the carbohydrate kindling throughout the day to keep me provided with energy and avoid the feeling of hunger. Again, nothing seemed to penetrate that simple head of his; it was full of the guff that he’d been taught not to question.
I decided to post this story because it represents to me many facets of a growing theme in the interactions patients have with their health and healthcare professionals. This is the sort of scenario I’m talking about (I’m using diabetes as an example, but the themes can apply to lots of conditions):
1. someone gets diagnosed with diabetes and takes conventional advice to eat a high-carbohydrate, low fat diet.
2. the diabetic finds it difficult to control blood sugar levels effectively, even with sometimes multiple medications.
3. the diabetic starts reading information on the internet and in books which explains why a high-carbohydrate diet is (generally) a disaster for diabetics and what works better (a diet richer in fat and adequate protein).
4. the diabetic decides to take matters into their own hands, changes their diet, and their blood sugar control and general health improve through the roof.
5. when their doctor finds out that their patient is eating a ‘fad’, ‘low-carb’ or ‘Atkins’ diet, they either elect not to engage with this, or positively dissuade the diabetic from taking this approach.
In this particular case, the doctor shows a mind-numbing ignorance about basic physiology (assuming he’s been quoted correctly): No-one needs to eat starchy carbohydrate (or any carbohydrate) for energy. For a start, fat is a suitable fuel for the body. Plus, sugar can be made from other dietary elements (e.g. protein) in the liver.
I fear that we doctors are going to have to ‘get with the programme’ by ensuring we are better educated about the impact of nutrition on health. And another thing we could do better, I think, is not to dismiss our patients who have been motivated enough to educate and help themselves, and in so doing have experienced significant improvements in their health and wellbeing. Isn’t it by listening to patients that we doctors get to know what works and what doesn’t? And won’t this information and experience be invaluable to us when we come to advise other patients?
The age of the internet means patients can quite easily know much more about their health and health management than their doctors. Rather than dismiss what they have discovered, I suggest we doctors embrace these experiences and learn from them. That is, of course, if we care about our patients getting the best advice and support possible.
I am a Dietitian working in the NHS. It horrifies me to think that so many people no longer trust the medical and lifestlye advice they receive from their Health Care Professionals. Have we become so blinkered that we fall for the pharmaceutical research strap lines hook, line and sinker? Why do we repeat the mantra all advice we give must be ‘evidence based’ when there is so much conflicting ‘evidence’, lack of research on nutrition (you cant patent a natural product!), questionable outcomes, and definitely no ‘one size fits all’ approach to patient treatment. We actually know so little about the genetics of Type 2 Diabetes, it is becoming clear that the label ‘Type 2′ could cover any number of genetic differences that cause issues with glucose metabolism.
On the other hand we have to remember that Diabetes UK produced a much more common sense guideline to nutritional advice for people with Diabetes in 2011. It clearly stated that there is evidence of short-term benefits of lower carb approaches and long-term benefits? we need more research! Diabetes UK no longer promote eating ‘plenty of starchy carbs’ with your meals. As a Diabetes Specialist Dietitan I now feel more comfortable to explore lower carb dietary approaches with my patients, but as another Dr stated on here, if you are going against the grain of your professional peers and do not have solid evidence (randomised control trial studies) to back you up, there is a chance of reprimand. So we must use clinical goveranance and work with our HCP collegues as a team to share the outcomes of our interventions and provide clear messages to patients. I try to be honest with my patients and tell them i do not have all the answers and that advice will change over the years no doubt. I only have a range of lifestlye interventions that i know have worked for other people and seem to show benefits in research. I do not want to put their health at risk and will monitor them to check they are getting all essential micronutrients and that cholesterol, kidney and liver function are not effected.
The sad truth is that many people are habitualised to a large consumption of products i would not consider to be food at all. Processed, cheap foods are hard to break away from – we need a culture change. People need to engage with health care professionals to get support in making sensible lifestlye changes, and health care professionals need to be flexible in the approaches they use and get a nutritional professionals advice. The message ‘low carb’ is no healthier than ‘healthy eating’ if the overall nutritional quality of the diet is still poor and this has not been addressed in a hollistic way with patients. ‘Dont eat bread’ is not a helpful message on its own! I feel that the tools in my box are growing and I will embrace different dietary approaches with an open mind.
WOW, a significant response from a NHS dietician. Thank you.
This needs to be publicised further and with your kind permission I would like to copy and paste this to the Diabetes UK forums.
You make a lot of very good points, and I can appreciate that working in an NHS environment brings it’s own limitations in what you can say and do.
Thank you Amy….looking forward to your reply…
Roy Wood
Thanks for you reply Roy.
I am happy for you to share my post with other forums. I have only just really started looking on Diabetes forums and was shocked to see how many people were dissatisfied with the nutritional advice they have received from their health care professionals. Unfortunately there is a lack of nutritional training for non Dietitians e.g. GP’s and Practice Nurses, so the wrong messages do get given. The value of having a Dietitian on a medical team or for training is sometimes overlooked. However, even us ‘nutritional experts’ need to open our minds and engage with social media a bit more to find out what people with Diabetes are actually doing and thinking. We only see a small proportion of people in clinic. There are a lot of motivated people out there finding out for themeselves what works for them and I personally find that very interesting. If Dietitians were more engaged with social media we could support a lot more people and perhaps dispell some of the myths about our profession and the type of advice and support we provide.
How refreshing to see professional healthcare givers commenting on this issue. I have only recently been diagnosed with Type 2 diabetes. My diabetes nurse told me I was unusual as I was not overweight and had a healthy lifestyle. She also told me that because of this it was unlikely that I would be able to bring my glucose readings down within three months. She warned me that I would probably end up taking Metformin tablets.
I’m delighted to report, having begun following a low GI diet and added cinnamon and chromium supplements to my daily multivitamin and omega oil supplements, that my fasting blood glucose reading is down from 7.1 to 5.3 – in just two weeks!
I have also increased the amount of exercise that I am doing. I’m am sleeping better and have more energy than before.
I know healthcare professionals come under a lot of pressure from pharmaceutical companies, but I think for the good of all of us they need to become educated about dietary controls/assistance for balancing blood sugar.
Thank you Amy,
My apologies for the late reply, but we had a death in the family that has taken some time.
Anyway, I have just today posted your message on the Diabetes UK forums and expect some response.
Thank you for your agreement to publishing your missive, and to a subsequent poster, Jan, for her equally balanced comments.
Roy Wood
Amy,I applaud your attitude.
It’s far from common, although I have met a few dieticians who don’t encourage a high carb diet. It’s still rare. I’m a low carb diabetic. a genetic T2. 4th generation in a direct line. Overweight, but not obese. I find, even 10 years after diagnosis, that I keep my HbA1c in the 5s, using minimal Metformin and much reduced carbs. I have been told by a diabetes consultant that I’m obviously someone with a rare gene, because I haven’t “progressed” to needing insulin, which most people seem to after a few years I’m convinced it’s not eating carb “fillers”. And that I’m not rare.
I’m equally convinced that too many people, non-diabetics as well as diabetics eat unnecessary quantities of carbs. Just go into any cafe and see the piles of sandwiches, cakes and pastries on sale and see how many people who drop in for a cup of tea, buy something to eat. This is the culture that needs changing, back to where it was during my childhood, where a homebaked cake for tea was common, but the portion small.Crisps and other “packet” foods were rare and sweets rationed. A visit to a cafe, probably included a cake , but was a rare treat. Nowadys it’s an everyday event. I go to a cafe and buy a cup of tea of coffee, but don’t eat, unless I came for lunch, when I have a salad.[ not a pasta or rice based salad, one based on leaves!] I have yet to find anyone who can tell me what the symptoms of carb deficiency might be, or which specific carbohydrate is required to correct them.
What a lovely article, but the responses are what has overwhelmed me. Having lived more or less low carb for the last 10 years or so, not because I was obese, (half a stone – a stone on occasion over my “happy “weight) but because it felt right, and I felt better, and I love the food! Sadly my dad is type 1 diabetes and I am watching him die. He and my mother (both 76) eat so badly, constantly cakes, and chips etc etc and he compensates with more and more insulin. Of course he is now obese and virtually immobile, but of course both his dietician and diabetes specialist tell him its OK to eat carbs. I have sent them a copy of Dr Bernstein’s book in the vain hope they will read it and maybe inspired or even curious: he has a methodology for treating type 1 with low carbs and more frequent insulin (its a different intervention from normal type 2 advice in LCHF) .But I have little hope, because of what they have been told by their medical professionals. The people who should be helping my dad, are essentially helping him to die, and in misery!