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.
It took us 2.5 generations to get to this point, and it is likely to take twice that long to reverse course fully. As other wise people have noted, old ideas don’t die because newer ones have more merit; they die because their proponents do. In this situation, you add powerful economic interests (Big Pharma, Big Food Processors, Big Ag) who want to maintain the profitable status quo, and even 5 generations to return to a correct understanding for the world at large seems optimistic. Of course, give then rapidity of global climate change, our food options might be drastically reduced by then.
BRAVO, Dr. B! if only your colleagues had your clarity of mind (it must be the carbs)….
Type 1 diabetes since 1971. After I dropped to under 40 grams of carbohydrates a day, I had my first hemoglobin A1c under 8.5 (US measure — I’m not sure if it’s the same scale in Europe and elsewhere) in some years — still too high, but an improvement. My board-certified endocrinologist was pleased until I told him how: he insisted that I get at least 100 grams of carbohydrate a day. I did better on lowered carbohydrates than I’d done on the synthetic amylin derivative sold as Symlin, which is expensive and causes constant nausea (in return for slowing digestion and spreading out blood sugar spikes from eating).
This is awful. At one point in med school, you learn some of the effects of insulin. You learn about ketogenic and glucogenic amino acids and the biochemistry of glycerol-to-glucose conversion. So the default hypothesises ought to be “it’s the carbohydrates consumed” and “you don’t need dietary carbohydrate to survive”.
I have combed through PubMed and found lots of literature that supports the carbohydrate-insulin-obesity-diabetes connection by the means of physiological experimentation. How could one come to the conclusion that it’s the fats? Every paper I read makes me “understand” it less.
Last week, a long time acquaintance died from complications following bariatric surgery. I knew that around 10 years ago when she was really struggling with her weight and “diabetes,” she followed an Atkins diet for a while and was feeling good and losing weight. I heard later that her doctor had become concerned and insisted that she go off the Atkins diet. A few years later, I encountered her at a home tour/cocktail party where I witnessed her taking her blood sugar, shooting up with insulin, then going to the cocktail table where she loaded up on carby snacks and desserts. What a tragedy. I am the same age as that poor soul and in spectacular health. The difference – I was also following an Atkins diet 10 years ago and have remained low-carb and healthy, avoiding the “diabetes” that has plagued many of my family members.
20 years of diabetes and carbs equaled 20 years of insulin and weight gain. Less than a year of Atkins equals over 60 lbs lost and no insulin needed. Simple as that.
It is a genuine tragedy, when patients improve their health by taking matters into their own hands and then their doctors attempt to talk them out of what they’re doing, by coming up with brainless … I was going to say reasoning, but it’s not even that, it’s just mindless repetition of current “wisdom” (even though it completely goes against what they have learned about basic physiology in med school). My closest friend has cured herself of diabetes after nine years on metformin, by adopting a low starch diet. She feels better than she has done for years. Why would anyone attempt to argue with that? Fortunately her own doctor has not argued; he wisely said “Well, however you’re achieving it, just keep doing it!” (But he refused to take it upon himself to suggest her approach to any other of his diabetes patients.)
I think the current “wisdom” about eating “plenty of starchy carbohydrate” arises from two factors:
1. Ever since the advent of farming about 10,000 years ago, most of the world has subsisted on some form of starchy carbohydrate as a staple. However, millions of years of evolution preceded that, when people weren’t eating much of it, and yet they survived. In fact we know from studies of bones that hunter-gatherers who lived before farming began were typically healthier than the farmers who came after them. Just because people *do* eat starch as a staple, it doesn’t mean they *should* – and yet it has become like a mantra, like that doctor above, “but you MUST eat starch for energy …”
2. Possibly it stems from a basic misunderstanding about the differences between normal energy metabolism, metabolism in a Type 1 diabetic and metabolism in a Type 2 diabetic. I’m talking about “ketosis” and “ketoacidosis”, especially in terms of diabetes. Ketosis – the breakdown of fat to provide energy – is a normal part of metabolism which is going on all the time. Ketoacidosis, where the products of ketosis build up to undesirable levels, can be dangerous, and is what leads to diabetic coma. However, ketoacidosis is unlikely to be a problem in a Type 2 diabetic, even if they adopt a low-starch diet. The body has ways of preventing ketones from building up to too high a level; and when you’re burning fat for fuel, you tend to lose weight, as the diabetic man found, “without really trying”. (What’s not to like?) I’ve met at least one medical professional who definitely didn’t understand the difference between ketosis and ketoacidosis, and suspect there are plenty more – and these are the ones who are going to give dire warnings to sufferers of diabetes who go on low-starch diets.
I’ll never understand why people insist and persist in thinking that #carbs are the ONLY food the body gets #energy from, compared to #fats, #carbs are an extremely low energy yield food substrate, fats yield 5-6 X MORE ATP than carbs.
With inefficiencies & conversion losses, one 6 carbon glucose molecule yields just 28 to 30 ATP, but one 18 carbon stearic fatty acid molecule having only twice the caloric density at 9 cals per gram versus 4 for carbs, and only 3 times more carbon atoms yields 147 ATP.
I suggest ALL doctors be REQUIRED to crack open their medical, biochem & physiology textbooks and get RETRAINED in the known & correct science they missed or were NOT given in med school.
Hi John
Great to see more good news re the many benefits of lowcarbing. Not only does this method work extremely well for diabetics, it also saves the NHS a fortune in medication costs and dealing with serious complications. One day all diabetics will be given the option to lowcarb by the NHS. The saturated fat argument causing heart disease has been proved false. The so called healthy eating food pyramid is anything but. The obesity epidemic proves it. Keep up your great work, the more healthcare professionals probe the bent science, the better for all, whether diabetic or not. Good diet and exercise must be a better way than ever more medication
This is an excellent blog around an excellent email Dr Briffa and a truly exceptional way to get the message across. The story mimics my experience very much.
I am 53 and was diagnosed T2DM around age 38 or 39, when symptoms had been present and developing from around 1995.
I too was specifically warned of the folly and danger of ‘the Atkins route’. Looking back I think this advice mostly referenced the high protein aspect of the plan because no patient would ever be so stupid as to go down the high fat avenue.
I tried physically activity coupled to a diet that favoured a high fibre balance, some raw, and used pulses for staples. That helped.
My progress varied. Control did swing a bit as did my resolve.
Four years ago I became intuitively concerned about the surfeit of vegetable oils and fats in my diet. I cut back on these to counter the potential surfeit of omega-6 polyunsaturated fats. This step truly reduced the incidence and occasions when I would have the spring removed from my step by muscular lethargy that can accompany poor diabetic control.
More latterly I have begun feeling so much better I rarely even prick my finger to test for levels of glucose. In the last year I have gone out of my way to eat more fat. Not just any fat, but fats of animal origin. I go out of my way to only cook with butter, ghee, lard, or dripping, and I am happy to be lavish with butter and extra thick double cream. #
I do not worry about heart disease or my ‘cholesterol’ either. I’ve read yourself, Kendrick, Colpo, Groves, Taubes, McCully, Graveline, Ravnskov and others. I am in no doubt, eating fat is good for me, as is cutting back on carbs, and cutting back on polyunsaturated fats.
It’s a shame it took fourteen years to figure and a shame the primary care professionals involved in my care set my initial trajectory away from the changes that could help most.
This story is similar to mine – I have sadly learned to just nod in agreement when they rattle off the things I should do like eat lots of whole wheat pasta and breads. It would be so nice to see more doctors break from the brainwashing they receive in medical school and take note of all the testimonials of those who have recovered their health with dropping grains and starches from their diet and offer better advice to those of us with diabetes. I find it hard to trust what they tell me anymore at all.
The myth that you ‘need carbohydrates for energy’ and the brain ‘needs glucose’ gets repeated all the time along with the myth that saturated fat causes heart disease and weight gain. No progress is going to be made until these myths are overcome. Because saturated fats are believed to cause heart disease and fat in general to cause weight gain, we are told that we must eat carbs for energy. Most doctors are not going to change that advice because advising patients to eat more fat for energy instead of carbs is totally wrong when they believe that the saturated fat is going to kill their patient.
My own experience of this was when my family GP told me he had read the book ‘Good Calories, Bad Calories’ by Gary Taubes. He could also see how much my health had improved on a low carb, grain free diet, yet he still insisted that I should eat wholegrains and limit my intake of saturated fats.
The sad thing about this story is that it isn’t unusual at all, and represents almost the default way in which successful T2 diabetics are treated by the NHS. Since I was diagnosed 18 months ago, I’ve been told at every appointment to “eat more carbs” and to “stop testing your blood” (even though I pay for my own meter and testing strips). During that time I’ve managed to lose 70lbs and get my HbA1c down from 10.2% to 4.9%, but only by ignoring almost every single piece of advice given to me by my HCPs.
I’m lucky in that I have a decent education, and that I’m prepared to research my own condition and challenge the “authority” of my Doctor(s). I pity the hoardes of uniformed T2s who blindly follow the generically poor advice that they receive from the NHS.
Forgot to say that I eat <25g of carbohydrates a day, and run half-marathons. I haven't died yet.
Hear Hear Stephen! I belong to a diabetes forum and we come across this attitude from Drs to our members time and again. We mostly counsel them to tell the Dr they are “managing their carbs” and to nod and agree with the Dr and go away and continue doing what they know works. Sad I know, but not everyone is up to challenging the Dr they have seen up to now as omnipotent.
As a type 1 I know very well that keeping my carb count low makes all the difference to my post prandial results. Increase carbs, count them, match the injection and you can’t avoid a high post meal spike. Decrease them. match the insulin and you see a much flatter profile.
I think doctors often put prevention (and the ’cause’) in the ‘too-hard’ basket…imagine having to go from the usual ‘prescribe-a-drug-in-a-10-minute-consultation’, to having to actually identify the cause and working closely with an individual…Doctors high salaries aren’t high enough for that kind of stuff?! (how do I portray sarcasm in text?)hahaha…things might change if we start paying doctors based on ‘results’ (i.e. patients cured). Imagine that?!
I have been eating low carbohydrate for years and had 2 children with no problems in pregnancy. I learned to say nothing about my diet because any time i mentioned low carb diet i was told i had to eat carbohydrates for energy. Total rubbish. It would make life so much easier for people if it was acknowledged by professionals. After all, we are the people who have daily practical experience in the matter.
Thank you so much Dr Briffa. You rock my world and your book and blog have changed my life.
I also had the journey from the ADA diet to low carb. A friend, who is a very astute doctor, introduced me to this way of eating and I’ve never looked back. My PCP and I simply don’t discuss it. He’s content with my progress over the last few years: A1c down from 13 to 5.1, meds completely gone, eating very well, no neuropathy or kidney problems. His nurse practioner grinned when she showed me my recent test results.
I think it’s tragic, even criminal, that lifestyle changes are discounted and drugs are encouraged. I do know people that would rather take drugs and eat sweets, but I think the consequences of that path should be thoroughly explained. Maybe some day…
I’m just glad my doctor cares enough about me to not argue. 🙂
My father and grandfather died of complications of “diabetes.” My grandfather died after an amputation and my father was nearly blind when he died of congestive heart failure. My brother and I have successfully staved off “diabetes” with our low-carb diets, which we started nearly 14 years ago. We had come to the conclusion that a high-fat, low-carb diet, not the high-carb, low-fat, low-calories diets (including vegetarian and vegan regimes) was the answer to our blood sugar/insulin issues. Sadly, our older sister, who had just been diagnosed as “Type II” has not been so fortunate. The low-carb diet has not helped her resolve her issues. After 14 years, she is still overweight and takes metformin and has taken Jenuvia. Recently, her fasting blood sugars are often as high as 300. She seems to have a serious “dawn effect” as the sugars do decrease during the day and show no difference no matter what she eats. She has tried a ketogenic, VLC diet, but has had no success and her last HbA1C was 10. We are all completely baffled on why the dietary approach isn’t working and would appreciate and suggestions that readers might have.
I always ask the people who tell me that I must eat carbs [I’ve been very low carb for YEARS!}, what tthe name of the carb deficiency disease is and what are its symptoms. Inparallel with Kwashiokor as a protein deficiency and scurvey as a Vitamin C deficiency. they usually turn on their heel and walk away.
I had an Uncle who was a true diabetic, way back in the 1940s/50s. He was always told he couldn’t eat anything containing sugar and starch, or at least if he did, he must only take minute portions, or buy special diabetic-formula sweets/chocolate etc. I remember this because he visited us often and he never ate bread and spuds. He wasn’t obese I recall! So medical thinking has changed, and I would say it’s because the insulin dosage these days, allows diabetics to consume more starch. Sadly the ant-fat message is being pushed ever harder. On ITV, they even have two ‘female Centaurs’ talking about ‘low-fat’. It makes my blood boil!
So, I want to thank Dr. Briffa again, for getting me back onto an ‘Atkins’ type diet, when I bought ‘Waist Disposal’. Since then I have devoured as much information as possible, on both sides of the argument. Starchy carbs for me are now a distant memory. And my extra weight is following suit
This is so encouraging, both the posting and the comments. After being told my A1c was 6.9 in March, and sent to the dietician and told 6-11 portions carbs a day, I realised I basically had to manage this myself. My GP has said I need to eat carbs for energy, but goes quiet when told that in 4 months of low carbing my A1c was 5.6. But I still need the positive encouragement from articles like this, and begin to see familiar names cropping up in the comments (Peggy Holloway- love your comments). Thanks everyone!
Just came across this: http://www.cbsnews.com/8301-505269_162-57505149/modern-wheat-a-perfect-chronic-poison-doctor-says/?tag=contentAux;mostShared
My diabetic nurse told me the same that I need carbs to regulate my blood glucose, when I explained I cannot eat carbs she told me she was putting that I was a difficult patient in my records!
I am waiting for the day when they give out correct info then more lives would be saved!
Brilliant site Dr Briffa, the low/no carb approach is the way to go forward ! It certainly works for me.
Now what is the difference between God and a GP ?
God knows he is not a GP
Dr Briffa excluded of course !
This is especially ludicrous advice given that, if asked, the doctor would probably say that cutting out fat from the diet was a good idea because it is so ‘high in calories’. Hello?! Calories = energy!
I’m 12 years diabetic – 7-8 years of starchy/low fat-salt-sugar & I was becoming crippled. 4 1/2 years of low carb & I am fit & well.
I’ve just been to the nurse for diabetic blood tests – I mentioned low carb & she said “they2 were becoming aware of the value of low carb for diabetics. When will someone at DUK listen ???
Diagnosed type two about three years ago, and thanks to my wife’s research at the time I was put on low carb, someone who can butter a crisp does not have a hard time going low carb. Within ten days I had gone from off the scale high sugars to nearly normal, I had lost weight and was running nicely.
We have followed your blogs religiously and been aware and shared your frustrations over “the system” and we to have tried to spread the low carb message with a few positive results. My son became type2 after a serious head injury and controls by low carb. My daughter became type 2 and was put on the usual junk regimen only to become type 1. This is the bit you will not believe. SHE WAS TOLD AT OUR LOCAL HOSPITAL TO FOLLOW A LOW CARB DIET. And the beauty is it works. Their is a further side to this, I have spent a lot more time than I would like to at the hospital recently and when I have been an in patient I get the following sort of message. ” diabetic? Do you want the diabetic menu or the ordinary one”. “Yes sir the policy now is to try and let you follow your normal diet as near as possible and not disturb something that works”.
It may not be that champagne moment just yet but you certainly earned a glass of your favourite tipple.
I do have a question as well. I have cancer and am receiving chemotherapy, the anti emetics involved contain steroids and these throw my sugars to fasting levels of up to 18 mmols in the morning and they can stay high all day, the results are far more unpleasant than any of the treatment , swimming in the air is the best description, does anyone have any ideas that might help, the obvious ones are not acceptable I am on a enough pills and needles.
Please all take heart from what is happening in this area.
Tony Wilkins
Stephen, you must be dead and just don’t know it. It’s the only logical explanation! LOL
I am classed as MORBIDLY OBESE, with a BMI of over 50.
I’ve recently (within past 4 weeks) had my very first “Healthy Heart” check up. My cholesterol was 5.1 – exactly the same as my younger (slim) sister and my younger (slightly overweight) husband, yet the advisor told me “we MUST get this down”. So she gave me some “healthy eating” leaflets.
The advice included:
“eat plenty of starchy foods, such as pasta, bread, cereals and potatoes”
“For most meals include generous portions of rice, pasta, potatoes or bread”
“For snacks, try eating tea bread or plain/fruit scones”
I read the advice, and promptly binned it. Since the early 70s (from childhood) I was on high carb low fat eating plans, and all that happened was that I managed to hit 25 stone, with potential for even more expansion as I was following the NHS/Food Industry guidelines and getting fatter by the week….
So I now take all their ‘advice’ with a huge pinch of salt.
“Starchy foods such as bread, cereals, potatoes, pasta, maize and cornbread are an important part of a healthy diet. They are a good source of energy and the main source of a range of nutrients in our diet. Starchy foods are fuel for your body.
Starchy foods should make up around one third of everything we eat. This means we should base our meals on these foods.”
The above quote comes from the Live Well section of the NHS website. How long will the government continue peddling this tripe.
Peggy, you and your sister should read Dr. Bernstein’s book. He gives advice for Type 2s also. He advises a very low carb diet. Your sister may be at the point where she needs to start insulin. Dr. Bernstein talks about tiny amounts of insulin for some Type 2s on a low carb diet. Good luck to your sister.
I am a GP in Australia. We don’t all think we are God. I’ve managed so far to get 4 T2s to a non-diabetic state by stressing a low/no carb approach. (Doesn’t sound like a lot, but it is 4 more more than any of the other 20 GPs in our practice). One patient even went away, had some family problems, went back to his old lifestyle, and his HbA1c went back to 10.2. At follow-up after a year, he said “don’t worry John, see you in 3 months” He went back to low carb and his next HbA1c was 6.2. We are expecting it to be well under 6 next time. He even has his regular beers, and occasional treats like ice cream.
My problem is that I tend to be regarded as part of the loony left by my colleagues. Discussing statins with one of them, I mentioned all the evidence against their use and the general evidence of lipids not really being a problem. His reply was that there was always some kind of conspiracy theory. Another was quite happy to tell a patient to stop calcium supplements as there was evidence they could have an effect on heart disease, but in the next line she told her to have a low fat diet, and she must take her Lipitor.
We are also under the threat of being investigated. If the authorities here decide you have done something wrong, it is up to you to prove yourself innocent, which is the complete opposite of the usual judicial process. You can see that we tend to be a bit circumspect in our recommendations. I don’t really care any more, being near retirement, but tend to tell patients where to find the information, especially Dr Briffa’s site, read as much as they can, and to come back and discuss with me what they have found. Then they can make up their own minds what lifestyle they wish to follow. However I agree there is a frightening level of unwillingness in the medical profession to even consider changing things that so obviously have not worked.
Superchip- there are some of us who have seen the light, but it is very difficult to get patients to rebel against everything they have been fed as gospel for years. Most specialists, who are perceived as somehow being “better” doctors than GPs, are particularly entrenched in their views, and will feed patients the current fantasy.
Medicine is a bit like a supertanker, it is going to take a long time to stop or alter direction
My father had a similar experience. Years ago he had a heart surgery and was diagnosed type 2 diabetic. He followed doctors advices and his A1c an weight got worse. Then he triend the Dukan diet, lost weight, and his A1c went down. Then, advised and scared again by his doctors he went back with convetional advice… and got worse again.
After that, we talked and i tried to explain how LC could be a better idea for him. I gave him Mark Sisson book, and Taube’s GCBC… and going back to LC made him lost more weight and improve his A1c. The corellation was very clearly visible on his diet and lab tests timeline !
I’m still not certain LC is best for everybody, but it’s good for a lot of people.
Tony,
You might consider trying ginger tea as an alternative anti-emetic (if your consultants don’t blow a gasket!). See further information at http://en.wikipedia.org/wiki/Ginger#Ginger_tea especially the ‘Preliminary research’ section.
My husband is Type 2, and we’ve become recent converts to low-carb, having tried the ‘conventional’ advice without great success with blood glucose control. Going low-carb has made a hugely positive difference in just a few short weeks (he’s now off Metformin and blood pressure medication) and as long as the triglyceride results don’t throw a spanner in the works we’ll keep on the way we’ve started. That’s me too – I’m not diabetic but can see some positives to my following this lifestyle.
All the best with the treatment.
Deniz
Two years ago I was 190 lbs and I was diagnosed with Type 2 diabetes. I started researching the appropriate diet to combat this disease. I noticed that when I ate carbs any amount, my sugar level would shot sky high. So, I stopped all carbs and focused on fresh veggies, fish, and protein. One year ago I was diagnosed with Fatty Liver so I have reasssed my eating habits. I eat fresh food nothing packaged. My A1C was 5.4, 2 months ago, and my triglycerides went from 175 to 70 with my diet change. My mother died from liver disease, bless her heart, I do not want the same destiny.
They say the proof of a pudding is in the eating. The other day I went to a local clothing store, to buy 3XL shirts and smaller trews, to replace all my 4XLs! Loving this, although it’s costing me a bomb in clothing, even at ‘Smatalando’ prices!! I do need to get in more walking to tone up the muscles, but a worn-out knee is holding me up there! Roll-on my replacement operation!
If fats are ingested as part of meal they might, we might reason, disperse about the chyme and do what fats well, and coat the things they come into contact with. So clumps of carbs and proteins may get coated with an envelope of fat. In the presence of fat digestion of all macronutrients would likely require the involvement of emulsyfying agents – from bile. I had a runaway thought; if the supply of bile is modulated in some way then whatever influences the modulation of supply of bile then that same factor could modulate digestion – so the transfer of digested food across the gastrointesinal divide could in itself be modulated : I wondered. Maybe food in the gastrointestinal tract can be ‘buffered’ with ‘assets’ being passed over in keeping with demand. But if the mediator in this regulatory aspect is bile then fat is a likely cofactor in the process – thus infering the prospects of regulation are decreased in the absence of fat. Without requisite amounts of fat, or fibre, (or some of each) any carbs are likely to be digested quickly leading to the complications of hypoglycemia and/or hypoinsulinemia. The GI and GL concepts point to this being the case.
The hormone cholecystokinin could be a starting point for curiosity over modulation of the supply of bile needed to emulsify fats present in chyme, but curiosity quickly leads to involved endocrinology that tiees thee mind in knots, for the modulation of the feeling of hunger vs satiety seems to be involved endocrinology. Nonetheless if nature is sophistcated enough to detect the presence of food in the digestive tract then nature is liikely sophisticated enough to regulate the haste or steady pace by which those nutrients are passed over the divide. Modulation, in the case of the ancestral ape-diet, would have been enforced by a very fibrous diet. In the transition phase in which fats were scavenged from marrow there is every reason for digestive modulation to become attuned to a fat-rich diet.
If fats are ingested as part of meal they might, we might reason, disperse about the chyme, do what fats do best, and coat the things they come into contact with. So clumps of food in the chyme involving carbs and proteins may get coated with an envelope of fat. In the presence of fat digestion of all macronutrients would likely require the involvement of emulsifying agents – from bile. I had a runaway thought; if the supply of bile is modulated in some way then whatever influences the modulation of supply of bile then that same factor could modulate digestion – so the transfer of digested food across the gastrointestinal divide could in itself be modulated (I wondered). Maybe food in the gastrointestinal tract can be ‘buffered’ with ‘assets’ being passed over in keeping with demand. But if the mediator in this regulatory aspect is bile then fat is a likely cofactor in the process – thus inferring the prospects of regulation are decreased in the absence of fat. Without requisite amounts of fat, or fibre, (or some of each) any carbs are likely to be digested quickly leading to the complications of hyperglycemia and/or hyperinsulinemia. The GI and GL concepts point to this being the case.
The hormone cholecystokinin could be a starting point for curiosity over modulation of the supply of bile needed to emulsify fats present in chyme, but curiosity quickly leads along the way to involved endocrinology whose complexity ties the mind in knots, for the modulation of the feeling of hunger vs satiety appears to be involved endocrinology.
Nonetheless if nature is sophisticated enough to detect the presence of food in the digestive tract then nature is likely sophisticated enough to regulate the haste or steady pace by which those nutrients are passed over the gastrointestinal divide. Modulation, in the case of the ancestral ape-diet, would have been enforced by a very fibrous diet. In the transition phase in which fats were scavenged from marrow in bonethere is every reason for digestive modulation to become attuned to a fat-rich diet.
I don’t have diabetes, but I do have problems eating too much carbohydrates. For a week now, I have been eating a grain and starch free diet, and I feel great. But will I be able to stick to it?
I am very active and do lots of sports, so the absence of carbs is a worry. I will have to see how it goes. I have been pretty active this weekend with 6 hour mountain climbs in the Scottish Highlands, mountain biking, running and horse riding, all with minimal carbs. And I don’t feel the sugar low I was dreading.
I also feel mentally much more positive and clearer. It is however a worry that I am eating more eggs, cheese (unpasteurised) and nuts. Perhaps I will give myself heart disease?!
I used to eat lots of oats and wholemeal in the belief that it would “mop” up the unhealthy fats in my body. Now that I have eliminated me, I am seeking subsituties. Linseeds? Omega 3 oils? Berries? Red wine?
Thank you for sharing – interesting story. I know a few diabetics that believe a “high carb, low fat diet” is good for health, they find it difficult to control their blood sugar and mood/energy is affected. I run Paleo camps in the UK and have been Paleo for 6 years but unfortunately still cannot advise.
My mum who was diagnosed with high cholesterol 8 years ago was put on statins. Then about a year ago she was told her blood glucose level was high and she was in danger of becoming a diabetic. In April, she attended one of my Paleo camps for 5 nights and has since avidly followed a Paleo Diet. She is now off the statins which was causing her a lot of joint & tendon problems and went from 73kg in April to now 64kg. The statins were causing her pain to even walk. Despite doctors trying to convince her to stay on the statins, I passed on your website to her, Dr. Briffa so she could print out information and find a doctor who would agree for her to come off the statins.
Now, at 64 years old, her blood glucose level, weight, energy, mood, digestion, sleep has been the best it’s been in her whole life.
Janet (2 Oct) writes: “Ketosis – the breakdown of fat to provide energy”… I think this is a basic misconception, however common. I am inclined to believe prof Koeslag:
http://tinyurl.com/lwjtqm
Considering it takes perhaps 300 calories of carbs to prevent ketones forming, obviously the body can take the vast majority of calories as fat without developing ketosis.
Instead, ketosis is the (exclusive) sign of gluco-neogenesis for reasons explained in the footnote to the link. As I understand it, a normal insulin/glucagon response to normalised blood glucose levels will halt this process when normal glucose levels are reached – in type 1 diabetes, this may not happen, and the gluconeogenesis will go on at full rate, blood sugar levels rising without limit, and fat as well as protein stores melting away – and in the process, wreaking havoc on the electrolyte balance.
Thus, ketosis is just evidence that the dietary carbs are low enough to necessitate gluconeogenesis – which is not dangerous in itself. But in type 1 (and possibly after high alcohol consumption), the total lack of insulin response is lethally dangerous.
My asthma/allergy specialist never asked me what changes I did that got me off 17 years of taking preventative medicine except for this hygienist whose son suffers from all that. I told her about the grains being so harmful and she stopped to think, “……my son does eat that al the time and always wants a big spaghetti bowl of pesto and nothing else.” But my other doctor I don’t want to go back to because he and the head nurse just argue that I need to eat low fat, yet they are both overweight.
1. Hear hear, Dr. Briffa!
2. I laughed. I laughed so much at that email — in a good way. Laughing along with the writer.
I’ve had similar experiences, although not stuck with a healthy low-carb high-fat Paleo-like eating plan consistently. Well, I’m doing so more now, with my own spin on it (a hybrid with Paul McKenna’s “4 Golden Rules” about only eating when you’re hungry with his rule 2 replaced by Andreas Eenfeldt’s Low Carb, High Fat when feasible (these words were somehow essential for me to psychologically buy into the plan).
I’m finding that it’s feasible a lot and I’m feeling great. Just got back from the gym, etc.
I admire the email writer for his great compliance and Nora Gedgaudas rocks — nice lady too.
I have been low carb for several years. I have a genetic form of T2, which I might have avoided if I’d known about carbs earlier. Now 10 years down the line, I use 2 x 500mg Metformin per day and keep my HbA1c in the 5s.
Initially I lost loads of weight, but I’m extremely weight loss resistant [3 days Atkins Fat Fast doesn’t work for me]
However I’m complication free. Luckily my Nurse approves of my diet. I’d not change even if she didn’t. I haven’t ever seen a consultant as a patient, I rarely see my GP, I simply request a prescription and he checks my blood results[ HbA1c 5.7, Total cholesterol 4.2 , HDL 1.9] and gives me the scrip.
As far as I know here’s even a paragraph in a leading Dietetics text-book, which states that the minimum daily requiement of carbohydrates is ZERO.
I had a thoutght whilst wwatching a TV programme about Stonehenge and wonder if early farmers didn’t ferment most of their cereal crops into alcohol and feed the rest to their livestock. Much healthier than eating them.
I wouldn’t ever allow myself to be persuaded into a course of action, which I know to be harmful. I exercise at least 6 hours per week and never feel hungry. Tired Yes, but hungry NO! and I’m in my 60s
I once got tested for high cholesterol by my doctor and it was so high, she wanted to put me on statins. She said that my ratio of good to bad cholesterol was still normal, but she felt unsafe about my high number. I explained to her that I had just spent a week vacationing and cheating in Vegas and I wanted a retest. She said it would take about 2 mos to make any difference.
I came back in 3 mos after going back to my very low carb diet. When the results came in I got a message on my phone that whatever I was doing I should continue because I had dropped 70 points. You’d think the doctor at this point would call me and demand to know what kind of miracle provided this extreme difference, but no.
She did later tell me that i have the highest good cholesterol that she has ever seen in a person.
Doctors aren’t in it to make you healthy, there is no money in that!! Keeping you unhealthy, RX dependant and coming back makes MONEY! It’s the all mighty dollar!
What surprises me is that I don’t know how is the rest of europe, but at least here in Spain, doctors’ advice for diabetics is to avoid carbs.
I was diagnosed with typ 2 last year,HbA1c was around 10 and don’t ask about cholesterol..My diabetes doc said,i should eat more whole grains,fruits,low fat and do more exercise.
After 2 months my sugar wasn’t really better,i was ready to take whatever they gave me.
Then i found on the internet Dr.Bernsteins book.
Guess what?My HbA1c is now 5,3 and the cholesterol is also getting better.
I don’t know if such a diet is good for a normal person but definitely for a diabetic.
And don’t forget the exercise.
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!
I have just returned from my GP practice where I saw the nurse to receive nutritional advice.
Three years ago I was told my blood sugar was high and I was overweight. I have used a high fat low carb diet ever since. I lost a lot of weight and my blood sugar stabilised a bit. It was never perfect, post prandial BG has never been ‘normal’ I have continued to be a bit overweight. But my following the diet has never been perfect.
Recently the surgery got in touch and asked me to participate in a government initiative about men of my age and health checks. They found high triglycerides, cholesterol, HbA1c etc. BUT, I have had a very stressful 6 months and I know that my diet has been slipping and I am falling into the low carb trap of continuing with hi fat AND letting sugar slip in as well. So I was not surprised. I agreed with the doctor to spend 3 months getting in shape and have retests. Part of the deal was seeing the nurse for the nutritional advice.
I bit my tongue all the way through all these consultations, except today when the nurse suggested eating healthy carbs, and agreed with my observation that they would constitute a major part of the diet that was being recommended. I remarked, mildly I thought, that I felt eating lots of carbs would put up blood sugar and I would perhaps be better avoiding them.
The nurse announced she was not happy with the consultation continuing and asked me to leave, handing me some leaflets.
I came away with an overwhelming sense of a system in denial, and the very good and committed staff being put in a horrible position of promulgating advice which is not coherent.
Overall quite disturbing.
I was gestational diabetic and was required to see a nutritionist for my insurance to cover my pregnancy/delivery. She told me I should eat carbohydrates for a healthy pregnancy, which I knew was wrong. But, I did as she instructed for one week, and my BG was consistently high. When I returned to my OB/GYN, he told me, “You know not to listen to what the nutritionist told you. You know what to do.” I had been on Atkins at the time I found out I was pregnant, so I modified my food intake to be around 50 net carbs per day. My blood sugar was consistently under control. I was required to report my glucose readings at each doctor’s visit – the midwife thought I was lying about my BG, so she would periodically do “random” blood tests. She was always surprised to see that I was telling the truth.
My son was born at 8:05 a.m. and that evening, the hospital brought me the “diabetic” meal for dinner. It consisted of salisbury steak with gravy and mushrooms, mashed potatoes, green beans, a slice of wheat bread, and a cup of mixed fruit (apples and oranges). I couldn’t believe this was the diabetic meal and told the nurse that if I ate this, my sugar would sky rocket. She said, “That’s what the nutritionist recommends.” I told her that I was going to prove a point. “I’m going to eat all of this, and when you check my blood sugar later, you’ll see that eating like this could kill me.” When she arrived to check my blood sugar, it was over 300. She rushed out of the room stating that she needed to get me some insulin. When she returned with the insulin, I refused to take it. She left and got my OB/GYN.
When he came in, he asked what was going on. She explained to him that my blood sugar was over 300 and that I need a shot of insulin. He smirked, looked at me, and said, “What did you do?” I said, “I just decided to prove a point that the nutritionist doesn’t know what she’s talking about. I ate the so-called diabetic meal.” He said, “You know better than that.” He told the nurse not to give me the insulin, that I knew how to control it. She was clearly shocked.
The doctor left, and she asked me how I was going to control it. I said from now on, I would have my husband bring my food in for every meal, which he did. She would follow up with a glucose test and was consistently in awe that my sugar levels were normal. For the next 2 days, my husband brought my food in for me.
The moral is – the government does not want to acknowledge that excessive carbohydrates are not only bad for you but they also promote Diabetes. I think it’s because most people in the government are themselves carb addicts and don’t want to change their own lifestyle to set a “good example” for everyone else.
‘The moral is – the government does not want to acknowledge that excessive carbohydrates are not only bad for you but they also promote Diabetes. I think it’s because most people in the government are themselves carb addicts and don’t want to change their own lifestyle to set a “good example” for everyone else.’
Hi Lisa,
I think there is something in what you say.
I am also convinced that we need to ‘follow the money’. In all sorts of ways various people and organisations have huge sums of money bound up in everyone buying and eating lots of carbs, lots of people ‘needing’ expensive medications, and professionals with their careers bound up in all this.
Also, there is a credibility gap, I am not sure how it has happened, but the people shouting about eating carbs are regarded as sensible sober and wise, anyone mentioning Atkins and low carb is a nut and a quack.
The whole situation is quite extraordinary, but there are some signs of change, the internet helps a lot because ordinary people are using it too find out for themselves – the truth will out. Also there are some good medics – Dr Briffa and co.
Peter
My mother is a type 2 diabetic. She sticks to low-carb diet and snacks through out the day. She began this about a year and a half ago. She is less sluggish and has managed to lose about 60 lbs. Exercise is not a part of her lifestyle.
I believe in this man’s testimony. I, too, do not put 100% stock in modern medical science.
I know this has been pointed out before but the list of “corporate acknowledgements” hidden away on the Diabetes UK website still makes horrifying reading:
Abbott
Bayer
Boehringer Ingelheim
Boots
Bristol Myers Squibb
Bunzl
Bupa
Celotex
Everyclick
First Capital Connect
Insight
Lilly
Lloyds Pharmacy
Merck Serono
Merck Sharp & Dohme Limited
Novartis
Novo Nordisk
Nursing Times
PAL Technologies Ltd
Sanofi-aventis
Takeda
Tesco
Truvia
Now, why might so many drug companies be interested in supporting a society that advises diabetics to “choose starchy foods as the main part of all meals and snacks”. It’s hard to imagine.
My parents (both slim, healthy low carbers in their 70s) have the pleasure of watching several of their friends being killed by this advice. Sadly their friends have put their trust in their doctors and won’t question the conventional advice.
I was diagnosed as type 2 a few years ago. Blood sugar control was a struggle and only marginally working. 9 months ago I was diagnosed as having a gluten intolerance. Following a gluten-free diet, which tends to be carb light, has resulted in a (desired) 7% loss of body weight and bloods returning to “fully controlled” levels.
In my personal experience, there’s something to be said for ditching the carbs.
David
WOW just what I was searching for. Came here by searching for online college
I got diagnosed with Type 2 Diabetes around 6 months ago. My HbA1c was 8.1%, fasting blood glucocse 9 mmol and after the glucose tolerance test I ended up with 26 mmol … .
My doctor only gave me some information material about the food pyramid and portion size. I should get at least 30% ob my calories from carbohydrates … . I followed my doctors recommendations but didn’t show any improvements after 3 months. My fasting blood sugar was still way to high and my after meal blood sugar wasn’t good either. My HbA1c “improved” to 7.9%.
I decided to try a low carb diet. My second follow up appointment surprised my doctor. I had normal fasting blood glucose, my HbA1c was 5.2%, I lost 11kg of weight (only with minimal exercise like walking my dog for 30 min daily). First my doctor mentioned I should keep doing what I do because it seems to work. But he was curious and asked me what exactly I was doing. After I explained everything to him he was upset. I’ve to eat carbohydrates – they are essential for me … .
In the meantime I changed my doctor, the new one is more open to “new” approaches.
What a great story, which I’m told, is being repeated over and over throughout the UK’s GP surgeries.
Thanks again Dr B for putting it all together in a nice easy to digest format.
Keep doing what your doing, you have them (the government) on the back foot. How much longer can they ignore the facts, they are losing all credibility now and becoming a bit of a laughing stock. Bit like the emperor and his new clothes, they just can’t/won’t see it.
Take care,
Rich
BRAVO, Dr. B!