British doctor laments the pharmaceuticalised management of diabetes

Des Spence is a UK general practitioner (family physician) who writes a weekly column in the British Medical Journal. Dr Spence does not shy away from pointing out what he feel is wrong with conventional medical practice. He regularly, it seems to me, has the independence of mind and balls to take a swipe at what we doctors do and the faults of the medical system.

In his latest column, Dr Spence turns his attention to the management of diabetes. This is a subject that is close to my heart, because I know only too well that this is a condition that so often responds well to the appropriate diet (in my opinion, that’s one low in carbohydrate). Yet, it is often the case that the dietary advice given to diabetics is woeful: diabetics are often encouraged to emphasise carbohydrate over fat, which almost inevitably ensures problems with blood sugar control and reliance on medication.

Dr Spence’s frustration is not centred on the dietary management of diabetes, but the pharmaceutical approaches to it. Specifically, he questions the wisdom of doctors increasingly using an increasing array of medications to lower blood sugar, when there is essentially no evidence that this actually translates into clinical benefits such as a reduced risk of heart disease or death.

Dr Spence goes on to write:

Worse, there is evidence that these new drugs cause harm. Rosiglitazone has already been withdrawn; pioglitazone has been linked to bladder cancer; and exenatide and sitagliptin double the risk of acute pancreatitis. All this is an example of the scientific illusion that is so called evidence based medicine, where research is just mechanically reclaimed statistics pulped into junk educational nuggets—mere marketing by another name.

Here’s what Dr Spence describes as the ‘drug industry’s business plan for diabetes…’

1. Conduct questionable research and control the original data.

2. Schmooze the politicians, health regulators, and patient groups to suggest undertreatment and need for “urgent action.”

3. Recruit tame diabetologists, massage them with cash, and get them to present at marketing events that masquerade as postgraduate education.

4. Pay doctors to switch to newer drugs in dubious international postmarketing “trials.”

5. Seek endorsement from the National Institute for Health and Care Excellence to bully doctors to treat diabetes aggressively with drugs.

He ends with the following indictment:

The complicity of doctors and lack of dissent against the drug model of diabetes care is bad medicine.

It’s rare to read such candour in a medical journal, and I think Dr Spence is to be commended for, I think, saying it like it is. Personally, I think diabetics have been seriously let down by the medical profession. There is some light at the end of the tunnel, though: increasing numbers of diabetics are discovering for themselves just how effective low-carbohydrate eating usually is for controlling blood sugar and improving health markers.

Back in October, I wrote about a diabetic who had transformed his health through diet, but was admonished by his doctor when it was revealed that a ‘low-carb’ diet is what appeared to make the difference. This did not deter the diabetic though. And this is what I’m finding increasingly: individuals are less and less deferring to their doctor and more and more inclined to turn their back on what they see as out-of-date, unscientific and non-evidence-based advice.

I think we need more doctors like Dr Spence. Some may see him as a pesky whistleblower. I think the reality is that without doctors like him, the medical profession is just going to see a continuing erosion of its credibility.

References:

1. Spence D. Bad medicine: the way we manage diabetes. BMJ 2013;346:f2695

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56 Responses to British doctor laments the pharmaceuticalised management of diabetes

  1. Michael Allen 2 May 2013 at 6:45 pm #

    Bloody hell Nora, this guy Spence has balls in abundance. I am absolutely astonished, frankly, that the BMJ should allow such brutal frankness — and every word of it, in my view, fully justified.

    Judging by the treatment recently handed out to Dr Robert Lustig, Spence can now expect to go on every drug company’s shit list. His name will be the subject of a google alert in all their offices, and whenever he is quoted or his opinions printed, it won’t be long before a comment is added, or the word is put around, that actually, you know, Spence isn’t all that well qualified, doesn’t really understand the science, drinks a bit too much, pinches his nurses’ bottoms, and all like that. Never mind, Dr Spence, some of us are not blinded by the drug companies’ money, and we think you are a hero.

  2. Dave P 2 May 2013 at 7:49 pm #

    Absolutely right on the money, The best response I ever got from my Spec Nurse was OK so it seems to work for you !
    The NHS has the records of many who follow a similar regime but don’t admit it because of the Stigma. That would be evidence based medicine if the numbers could somehow be revealed

  3. Christoph Dollis 3 May 2013 at 6:08 am #

    Hear, hear.

  4. Asclepius 3 May 2013 at 7:37 am #

    @Michael Allen “I am absolutely astonished, frankly, that the BMJ should allow such brutal frankness”

    I agree, but I also think they don’t have any choice. With Facebook and Twitter, knowledge and power are being democratised. Previously murky scientific, political and business activites are becoming increasingly transparent because of channels of communication.

    Witness the impact of AllTrials (http://www.alltrials.net/) and UKUncut (http://www.ukuncut.org.uk/). These are grassroots movements driven by social media that enable us all to participate at our own convenience and through which we can convey important messages and ideas worldwide in seconds.

    Even the BMJ must recognise that if they stand against ethical, moral and robust activities as those championed by a campaign such as AllTrials, at best they will lose credibility and at worst they become irrelevant. The BMJ can no longer be afraid of business or politicians.

    Welcome to the brave new world of social media!

  5. Sally Simpson 3 May 2013 at 9:38 am #

    Although this is about Type 2 diabetes the dietary advice for low carb diet is also good for Type 1.My daughter has had Type 1 since 9 years old ( now 25yrs) and the advice from diabetic nurses and dietitians has been very poor.Consequently my daughter’s weight was increasing at an alarming rate and was 13stone by the time she was 15 years old.The hospital seemed quite happy with this but I was not .She adopted a much lower carb diet and her weight reduced , blood sugar control improved and HBA1c fell.She has very little faith in the diabetic advice that she recieves from the hosital or GP diabetic nurses .However the Dafne course at UCH London was useful .This was about matching carbs and insulin doses exactly but still maybe should teach a much lower carb diet as well.

  6. Sandy Angove 3 May 2013 at 9:52 am #

    I see a response on the BMJ website by Janet Collis (27/04/2013). I am on sitagliptin and of particular concern is her highlighting of significant risk of acute pancreatitis. Having had this in my 20′s I no way would want to risk having it again.

  7. Jennifer 3 May 2013 at 10:04 am #

    OMG!!!
    I spoke to my GP about the risks associated with Sitagliptin and Pioglitazone, as mentioned by Dr Spence. The GP was absolutely dismissive of my concerns, as I posted last week on this site. I have now come off ALL medication over the last 3 months, and will take my chances of ” having a cardiac event, or a stroke” as threatened by my GP if I reduced the medication. I have read many books and articles regarding type 2 management with very low carb diet, and that is how I have achieved my well being.
    Please keep posting these articles, as we need a revolution in the NHS, to get it out of the grips of the pharmaceutical industry.
    We diabetics need up to date, practical advice on the management of this condition, and a reversal of the out of date and damaging garbage still being spouted by the so-called specialists in diabetes management. Where has Continous Professional Development gone regarding our Medical Professionsals? Just another ticky-box ritual, that has failed us, the public. Oh, I am so annoyed with my GP!!!!

  8. Scott 3 May 2013 at 10:13 am #

    It’s astonishing how Diabetes UK are bending over backwards to deny the obvious. This story from the BBC reports that soft drinks are associated with diabetes: Diabetes warning over soft drinks (http://www.bbc.co.uk/news/health-22280297).

    Surely the most direct link between soft drinks and obesity is: sugar>insulin disruption>diabetes (especially given that “link between sugar-sweetened soft drinks and Type-2 diabetes persisted even when body mass index was taken into account”).

    And yet Dr Matthew Hobbs (head of research at Diabetes UK) goes out of his way to suggest the link is actually: sugar>calories>weight gain>diabetes (treating obesity as a cause of diabetes, rather than seeing both as symptoms of an underlying metabolic disorder/syndrome, and hence correlated).

    He says this recent study “is not definitive evidence that sugar-sweetened soft drinks increase the risk of Type 2 diabetes, other than through their effect on body weight” — “sugary foods and drinks . . . are usually high in calories and so can lead to weight gain if you have too many of them. This is important for Type 2 diabetes because we know that maintaining a healthy weight is the single most important thing you can do to prevent it.”

    What, I wonder, is their theory of how obesity causes diabetes? By what mechanism?

  9. Simon Shorrock 3 May 2013 at 10:30 am #

    Having just read the NHS Choice advice on how to treat diabetes I am not surprised diabesity is on the increase. Their nutritional advice is appalling and outdated. Here is some of their advice on their Livewell site:

    Some diets, such as the Atkins diet, are very low in carbohydrates (for example pasta, bread and rice), which are an essential source of energy. While you may lose weight on these types of diets, they’re often high in protein and fat, which can make you ill. Low-carbohydrate diets can also cause side effects such as bad breath, headaches and constipation. “It has been suggested that the high protein content of these diets ‘dampens’ the appetite and feelings of hunger,” says Arens. Many low-carbohydrate diets allow you to eat foods high in saturated fat, such as butter, cheese and meat. Too much saturated fat can raise your cholesterol and increase your risk of heart disease and stroke.

    How long do we have to wait before the general population are told the truth?

  10. Dr John Briffa 3 May 2013 at 10:42 am #

    Simon

    The (I think) appalling and biased advice dished out by the British Government only adds to the increasing cynicism people have about politicians.

    And as for the (I think) misleading comments from Ursula Arens, does anyone actually listen to what dieticians have to say these days, anyway?

  11. JustMEinT 3 May 2013 at 11:17 am #

    After a GTT that put me into the Diabetic category – 6 weeks ago – My GP did NOT even mention lifestyle changes, but started writing a prescription for METFORMIN immediately. I declined his (kind) offer and asked for a three month hiatus and then to be retested. I immediately went on low-carb (around 30g per day) and within a few days my early morning sugars were back into the ‘healthy range’. I have since seen my GP aging who is very pleased with the records I showed him….. he will do a blood test in June to see how my 3 month sugars are truly doing. I am sure he will be impressed. He does not know because he did not ask what I was eating – he simply suspects I am following the ADA food recommendations!!!! Bacon, eggs, fresh vegetables with butter on for breakfast. Protein and cheese for lunch and soups and salads/veggies for dinner…… IF ONLY the ADA recommended this:-)

  12. JustMEinT 3 May 2013 at 11:19 am #

    TYPO I have since seen my GP again – he might well be aging if he knew what I was eating – sorry for the typo

  13. Muni 3 May 2013 at 11:26 am #

    Hurrah! Someone having the courage to say the truth. I was diagnosed as type 2 a couple of years back. I did my own research, joined great forums on-line, read all about how low carb diet as well as intermittent fasting controls the condition. My blood sugar is totally controlled, I do Atkins to eat low carb, don’t worry at all about protein and fats and I am normal weight now having lost 3 stones.

    I never go to the doctors, I am on no medication. I would not dream of taking tablets or injections for diabetes. They are unnecessary as long as you pull yourself together and sort out your diet. My basis is that carbs are not needed at all, fats and proteins are vital – so enjoy!

    Personally I refuse to put my health in the hands of the medical and pharmaceutical professions. I have a meter to measure my own blood glucose and a blood pressure meter too that shows my readings are absolutely normal.

    Low carb should be how we all eat. It is destructive to everyone’s health to be eating sugar and starch any more than absolutely minimal. It is hellish for the health and will affect the whole body badly.

    Anyhow, thank god the message is beginning to come out. Excess eating of all the wrong foods is to blame for the majority of diabetes type 2 certainly. Type 1 is a different matter but insulin can be minimised by eating strictly low carb. Yet most people do not know this and dieticians and doctors are advising the opposite! I take no notice of the lot of them, I know what I have to do to control mine.

  14. Sheulee Roy 3 May 2013 at 11:28 am #

    Sometimes I wonder what would happen if a campaign was run, in huge letters, YOU ARE WRONG, OPEN YOUR EYES think what you are doing doctors, if you purport to care about people, then stop this perpetuation of criminally bad advice that keeps other criminally bad treatments afloat and causes horrendous suffering…would it work? Could an army of doctors join all the punters know what helps by n=1 Internet = community methodology and turn on the sugar/carb pushers that overwhelm our culture with the endorsement of government? I think some doctors would be deeply ashamed and want to help effect change, the tide could turn rapidly. Perhaps this article getting as far as the BMJ is the start of real infiltration a pitifully brainwashed section of society. Haven’t always agreed with Des Spence’s take on things but good on him and good luck. And while it’s not just diabetes but pretty much all of medical advice that could do with a nutritional overhaul before pharmaceutical intervention, it’s a belter of a place to start. I will never contemplate going back to medicine till there are huge U turns in thinking.

  15. doug cook 3 May 2013 at 11:50 am #

    I’m a dietitian who works in the ‘health care’ system in canada, it’s the same here and i’d this article….medicine has failed chronic diseases for decades and everyone is bullied in a sense from doctors…

  16. Morwenna 3 May 2013 at 12:41 pm #

    I practise as a Medical Herbalist and consider myself a physician ie a professional caring for others in a medical context through the use of plant medicine. It is so professionally upsetting to see patients, as I regularly do, come to me with diabetes type 11 which could so easily have been reversed and inhibited if treated properly in the early stages; patients on 12 or more drugs some of which are contradicated or conflic;, patients who have been harmed by the dreadful protocols followed by the conventional socialised system where profits and self interest are put ahead of patient health. Diabetes is reversible and can be totally controlled through diet, inappropriate eating caused the condition in the first place for most patients and plant drugs are effective, helpful and have no negative consequences. I guide my patients to reverse/control their diabetes with no drugs. The so called evidence from Pharma is by and large manipulation of data and misleading marketing and conventional doctors have disgraced their profession by relying on them to justify inappropriate treatments and failing to act independantly/critically. Thank goodness there is still at least one man out there with his patient’s as his priority. Your readers may be interested to know that when I offered to give a speech for free on diabetes, Diabetes Canada Toronto Chapter refused to have me on the grounds that they wanted to ‘manage’ their patients not give them the opportunity to reverse their diabetes. That comment said to my face says it all.

  17. Hilda Glickman 3 May 2013 at 1:25 pm #

    DIiABETIC EATING CAKE WITH 2 DOLLOPS OF ICE CREAM AND CALLING THIS ‘SUGAR IN MODERATION’. EVEN I WOULDN’T EAT THAT.

  18. Janet B 3 May 2013 at 2:17 pm #

    It amazes me that diabetics, type 1 and 2, are told to base their eating habits on the one thing the diabetic body can’t properly cope with – carbohydrate.
    It wasn’t always thus. Back in the 50s when my brother and I, in our teens and both skinny as beanpoles, were diagnosed with type 2, we were issued with very strict diet sheets which required ALL carbs, including a lot of vegetables and all fruits, had to be weighed and eaten in very small quantities. All meat, fish, cheese, butter, cream, etc were unrestricted.

  19. Christoph Dollis 3 May 2013 at 3:49 pm #

    One thing I’ll say for everyone here who is saying they wouldn’t take diabetes medications.

    Don’t throw the baby out with the bath water!

    Metformin, based on an ancient herbal remedy, is not the same as these other drugs that are increasing cancer rates. Metformin seems to do the opposite and lowers cancer rates.

    Metformin can be taken at higher doses for those still attempting to get their blood sugars under control and insulin levels down.

    Even if you could control your diabetes with just diet, adding low-dose metformin therapy (500-1000 mg/day in divided doses) to your regimen may well prove beneficial in yet better blood sugar control (and more important) lower insulin levels (as in serum insulin).

    Metformin can be taken in standard form (which is extremely economical) or, if one has gastrointestinal side effects or just prefers to take it once a day for convenience, in the time release format (which reduces side effects).

    Maintaining an adequate vitamin D levels, and taking Cinnamon (cassia form seems to be the most effective, and it’s the cheapest one, and Ceylon cinnamon has been shown to work too) as supplements or with food also help with blood sugar control, perhaps as much as metformin.

    Just because some drugs are crap, doesn’t mean metformin is! Don’t be dogmatic about it. It could help you or your loved ones.

    Finally, metformin can result in too low vitamin B12 levels over time, which is the only serious complication (can cause neurological problems) from it that I’m aware of. This is in the literature.

    My suspicion, not proven, is those who take metformin but keep eating a grain-and-legume based diet are the ones who develop a B12 deficiency. Those who eliminate grains and base their diet on animal fat and protein (rich in B12) probably don’t, but for safety, those on metformin may want to get annual or biannual vitamin B12 blood tests. If a deficiency is detected, an annual or biannual vitamin B12 shot at the doctor’s office will fix that, and oral supplements are another option.

    So, in summary, don’t lump in metformin with everything else. It still is a good drug.

    Also, consider adding a quality cinnamon supplement to your diet.

  20. Christoph Dollis 3 May 2013 at 3:56 pm #

    JustMEinT,

    Wonderful, wonderful progress.

    Two thoughts.

    Your doctor was right to prescribe metformin — studies show diabetics do best when starting it right after treatment. And even if you can control your blood sugars with diet, you may want to consider low-dose metformin therapy anyway. Studies show this promising even for healthy people. Unlike these other drugs, it lowers cancer rates.

    Second, you certainly don’t have to, but you may want to tell your doctor how you’re achieving your success using diet, in order to give your doctor a data point for him to consider. Eventually he will come to change his mind, most likely, and you can help him reach this point that much quicker. Then he can go on to help patients better, and you will have been a positive influence over your doctor and these patients’ and their loved ones’ lives.

  21. Christoph Dollis 3 May 2013 at 4:02 pm #

    *when starting it [metformin] right after diagnosis

  22. SueG 3 May 2013 at 4:49 pm #

    It doesn’t get any better does it! I visited the GP on Monday, he decided on a blood test to check my cholesterol, I don’t have any heart problems that I know of. I said I wasn’t worried about my cholesterol levels, he said’ “They are the biggest single indicator of possible heart/stroke problems”. I despair, this GP could only be in his mid thirties.

    Actually I am more concerned about familial links, my mother having both a heart problem and my mother and maternal grandfather both dying from a CVA, although in their 80s. I am not that old but it’s still of more concern than my cholesterol levels.

  23. PhilT 3 May 2013 at 4:51 pm #

    I just came from Tesco where there’s a Diabetes UK/Tesco leaflet at the checkouts with emphasis on being overweight as a risk factor. http://www.diabetes.org.uk/tesco/

    I’m sure Tesco would be equally happy selling low carb foods as well as high carb, so they’ll be taking their lead from DBUK. There’s an online risk calculator or they’ll do it in store ww.diabetes.org.uk/Tesco/Know-your-risk/Diabetes-UK-Online-Risk-Score/

    This morning I read that one third of diabetics were missed in health checks because they were either at a healthy weight or underweight according to their BMI. http://bmjopen.bmj.com/content/3/3/e002219.long

  24. Megan 3 May 2013 at 4:55 pm #

    Talking of fat and protein horror stories, has anyone else seen the British Heart Foundation advert? A plate of (Oh Nooooooo!) vile fried eggs and bacon hovers in the background of one scene. Strangely, it isn’t accompanied by 10 slices of toast and a coffee with 2 sugars but perhaps showing the real heart disease culprits would be altogether too frightening.

  25. John Walker 3 May 2013 at 6:35 pm #

    When Dr. ‘Christian’ and his colleagues on ‘Embarrassing Bodies’ realise they are perpetuating misconceived ideas on diet and weight-loss, then maybe we will be getting somewhere. Also, maybe then ‘Celebrity Chefs’ will stop offering low-fat, ‘healthy-eating’ options. They at least should know the truth about fat; that without it, meat and fish have less flavour and taste.

    As for the benefits of eating to a low-carb plan, In November last year I weighed-in at 294lbs. Since ditching the ‘conventional wisdom’ eating plan, I have lost 42lbs. I eat like a King, and I can go all day without feeling ravenous, on a breakfast of protein and fat. It costs more to buy good meat, fish and fresh greens, but the benefits to my health make it worthwhile. Thank you Dr. Briffa.

  26. Jennifer 3 May 2013 at 6:47 pm #

    Janet B. describes exactly what I learned in the early 1960′s, whilst studying anatomy and physiology. Unfortunately, by the time I was diagnosed with type 2, 10 years ago, i.e.a good 40 years after my initial training, diabetes management seemed to have done a complete about turn. So……I followed the modern way…….who was I to question the new thinkers?
    Well…..after 10 years of continuous decline in my health, I decided to put into practice that which I was taught about ‘senile onset diabetes’ as it was termed in the 1960 ‘s, and lo and behold! I am in total control of the condition. And no longer consuming nasty cancer-risk drugs for the last couple of weeks, or even metformin, either. Nor simvastatin, nor amias.
    Just very low carb, fresh food. Plenty of butter and cream, moderate animal and fish proteins, lots of yoga, and a perfectly agile body and mind to enable me to keep clear of the medical profession for as long as I can possibly manage.
    Forgive me for sounding so cynical, but I can see from the recent postings, I am not alone.

  27. Suzy Kelham 3 May 2013 at 6:58 pm #

    We used to have doctors. Now we have administrators for Big Pharma. I have as little to do with the medical profession as possible. :-(

  28. Fiona Benson 3 May 2013 at 9:48 pm #

    Picking up on PhilT’s comments – Just this week my husband and I attended a meeting of our local Diabetes UK support group where we were told about the Tesco charity support. The plan is to spend the money raised to support research into developing a Vaccine to help prevent Diabetes in Children. Am I wrong – I have always thought vaccines are there to prevent serious infectious diseases, not diseases caused as a direct result of diet? How can a health problem caused by poor diet be prevented by yet another vaccine? Putting money to that type of research would be such a waste of resources.

    Tesco devote a section of their web site to all the different diets. Under Low carb – they fail to mention it is a LCHF (low carb high fat) diet.

  29. Hilda Glickman 3 May 2013 at 9:49 pm #

    I am surprised about how high a diabetic’s sugar is allowed to go. A diabetic friend said that his could go to 8 and that is considered OK.

  30. Dr David Unwin 3 May 2013 at 10:30 pm #

    Well here is at least one GP who advocates the low carb low drugs approach!! so far I have been delighted with the results.I am applying for a grant for a two year project to spread the word to as many patients as I can !!

  31. JustMEinT 4 May 2013 at 5:51 am #

    Christopher Dollis (I do hope I am wrong) but you come across as a sales representative for the pharmaceutical interests – Forgiveness please if I am incorrect.

    Metformin may well be one of the oldest and nest tried and true medications, however it is still a drug and as such (to me) has no place in a healthy human body. Having admitted I failed a GTT and that obviously my body has registered as being unhealthy in glucose and insulin metabolism I decided to eliminate from my body the cause of my illness… in this case carbohydrate excess, with the aim of improving my unhealthy situation.

    Surely we can move away from ‘here take this pill’ mentality and at least attempt to right the imbalance ourselves first – before having a life long (in most cases) drug pushed down our throats? I was not even given the opportunity to consider diet and lifestyle changes. I was sent to see the Diabetic Educator who talked me thru all the usual stuff regarding eating carbohydrates regularly to maintain my sugars etc….. She knows I am trying to lower my carbs and did not spit the proverbial dummy when I explained this to her. She does not think I will manage to stick to it!

    My GP was not interested in how I managed to lower my sugar… so long as I attend the Diabetic education people he has done his part. I will tell him eventually.

    I have noticed there is a huge movement away from sugar and carbohydrates which convert into sugar … a move towards more healthier vegetables and protein sources other than legumes etc… except in the dumbed down masses — there are some great teachers out there, and I do my bit to spread the word.

    • Christoph Dollis 11 May 2014 at 7:00 am #

      Metformin is a drug which isn’t under patent protection and there’d be little point in promoting it. It’s derived from an ancient herbal remedy for diabetes and while it isn’t without risk, it saves far more lives than it costs.

      Low-dose metformin therapy is even safer as both lactic acidosis and vitamin B-12 deficiency risk are commensurately reduced.

      The Drug Virtually Everyone Should Ask their Doctor About in Life Extension Magazine

      It isn’t a panacea, but it does seem to reduce all-cause mortality and especially pre-diabetes, diabetes, and cancer. To say that because it’s a drug it has no place in a human body is simplistic. It derives from a herbal remedy, a food if you will, with the more toxic bits stripped out.

      • Morwenna Given 11 May 2014 at 2:43 pm #

        I regret to say that there appears to be some ignorance on this matter.
        Metformin is an analogue of Galega officinalis ( goat’s rule )
        All it does is encourage the uptake of circulating glucose into the tissues thus saturing the tissues. The extra molecule on the compound which is not found in nature inhibits B12. Rather like aspirin derived from Filipendula Ulmaria but with an extra molecule which irreversibly thins the blood. Neither property is found in either plant in its natural state.
        IT DOES INHIBIT THE LEVEL OF ABSORPTION OF B12 – which is why it is partly not a very effective drug. Please see your BNF as it is explicitly stated – or at least in mine.2013. It is essential to maintain a high level of B12 if you have diabetes or indeed Cancer
        It is not an ancient herbal remedy. It is a very modern herb in use to treat several conditions including diabetes. It has been used in ancient times but that does not diminish its efficacy.
        Medical herbalists very rarely give simple doses of anything ( ie 1 plant ) – they compound to provide a unique effective formula for that patient including plants with B12 if prescribing Galega officinalis.
        I both help to manage and reverse diabetes with plant medicine in my patients but that plant medicine like Metformin is not available over the counter as it is a plant based liquid made with sound scientific and pharmaceutical principles and tested under same and properly evidenced.

        IN OTHER WORDS THEY ARE NOT FOODS WITH THE TOXIC BITS THROWN OUT. THEY ARE PLANT DRUGS. OFTEN THE STARTING FORMULATION FROM WHICH BIG PHARMA GO ON TO MAKE MILLIONS BUT WITH PLANTS YOU CANNOT PATENT THEM.
        PLEASE BE DISABUSED OF YOUR MISCONCEPTION THAT PLANT MEDICINE AS PRESCRIBED BY A PROFESSIONAL IS JUST A FOOD
        On another note although there have been several trials some inconclusive regarding the use of metformin cancer patients this will never be of ultimate benefit for the simple reason excess circulating glucose is the prime cause of cancer at the cellular level ( see Warburg 1925 for starters ) that is the preferred substrate for cancer thru the NFKB inflammatory pathway . Its like giving a bonfire fuel and keeping storage tanks nearby of fuel when the original tumour either expands or is removed thus upregulating the CTC’s and the neurological signalling pathways. This is also why so many cancer patients are either diabetics or insulin resistant, initially caused by lifestyle in most cases.

  32. PhilT 4 May 2013 at 9:10 am #

    OMG – take a look at http://www.tescodiets.com/px/diet-plans/diets/Diabetes

    I know it’s DBUK to blame as their site gives the same advice. In a hurry ? then eat :

    Breakfast – wheat biscuits with banana and orange juice (carbs, carbs and carbs)
    Lunch – Tuna mayo sandwich (protein, fat, carbs)
    Dinner – Baked potato with cottage cheese and baked veg (carbs, protein, carbs)
    Snack – Popcorn and milk (carbs and carbs)

    Gallon of lucozade anyone ?

  33. George 4 May 2013 at 1:39 pm #

    Heartfelt thank you Drs Biffra and Spence for opening space for a different kind of evidence-based medicine that takes into account the patients’ experiential knowledge. As a token sign of appreciation, let me contribute a bit of mine.

    I was diagnosed with Type 2 diabetes in 1990. Since then, I used to feel very sluggish and tired most of the time. My body felt more like a burden and I found my various health problems quite oppressive and limiting to my life. It definitely affected my view about my future, which became more limiting in view of my physical health. It felt like there was no end to developing one health problem after another and the unwanted side effects of one drug causing problems in other areas needing other drugs made me feel like a victim. I did not understand how the different health conditions I was diagnosed with related to each other and the small attempts that I had made on my own to improve my health didn’t make much difference. I thus felt discouraged and didn’t feel motivated to make more changes on my own.

    I used to take Metformin 850mg three times a day as well as Repagline 1-2mg three times a day and my blood sugar was still higher and much more unstable than it is now. Thanks to the encouragement and support from a medical herbalist, I have experimented with my diet and worked out a non-carb diet that
    is about 70% based on raw food which seems to work well.
    I havent taken Repagline for 2 months and reduced Metformin by 1/3. I am still hoping to reduce the need for Metformin gradually.

    I feel more energetic throughout the day. I also feel a lot more hopeful and optimistic about my future both in regards to my physical health and my professional possibilities which include a lot of travelling and extended periods of time of focused work that requires high concentration and mental and physcial stamina.

    My fear of having to spend the rest of my life going from one medical appointment to another and needing increased medical interventions for all my various health problems has been replaced with optimism of what is possible with understanding the relationship between different health problems and the relationship between my diet, lifestyle, exercise and my physical symptoms.

  34. Jennifer 5 May 2013 at 9:09 am #

    I am getting so vexed with the escalating influence of DiabetesUK, which is now involving Tesco with the same rubbish that we are all trying to dispel. The dietary “advice” from DBUK, the NHS and incessant TV foodie programmes, is so damaging to the health of the nation. When, oh when, is there going to be a reversal of this rediculous state of affairs?
    My new, vastly improved health status has nothing to thank these big institutions for, but thank goodness for the internet giving access to knowledgeable and sensible contributors. e.g. access to BMJ articles and Dr Briffa, as well as the many American doctors who are so generous with their free internet research papers.
    I wish I had known years ago what I know today, for instance, having asparagus soldiers with my couple of soft boiled eggs for breakfast was every bit as nice as the wholegrain soldiers I was told were so healthy, yet today’s meal was infinitely healthier and safer too for my diabetes.
    I am giving Tesco a miss– they are misguided, it is as simple as that!

  35. Anna Betz 5 May 2013 at 10:22 am #

    As things get worse and worse (ref big pharma and unquestioning doctors in the NHS) we mustnt forget that things are also getting better and better all the time as well (ref global, regional, local networks that are created by people who want to make the world a better place for everyone). After all that is how the evolution to our next level of what is possible tends to emerge from our interactions.

    As we grow in numbers, become stronger, more confident and more capable in documenting and sharing our knowledge and experience, we will have the power to create the kind of healthcare system that we can show/evidence works better.
    In the end the system thats no longer working will need to give way to something that works better. That will hopefully be a more holistic understanding of health and disease.

    The future of healthcare will need to be designed and soem of it also delivered by the users.

    Experts will no longer have power over us but share their knowledge and insights so as to empower patients. They will serve us rather than control us.
    However this wont happen from the top down due to invested interest in the old system. Of course there are a few sympathetic and courageous medical professionals in the system but they are still few.
    We as users of healthcare need to develop networks and collaborate with each other more openly and transparently.that in itself could inspire others to do the same.
    The desire to provide such a platform for collaboration inspired me to start a group called the Commons of Health & Wellbeing.

    If you are interested to participate and help us all grow in capability and strength, please check us out here where I described the functions that such a group could have. http://commonsrising.ning.com/group/commons-of-health-and-well-being/forum/topics/the-functions-of-a-health-commons
    Lets start creating the world want to live in. A world and a healthcare system that makes us proud to be able to pass on to our children.

  36. Dr John Briffa 5 May 2013 at 11:31 am #

    Anna – thanks, I think you raise good points and an inspirational message.

    I kinda touched on this theme here http://www.drbriffa.com/2013/04/23/patients-are-the-new-doctors/

    Like you, I’m hopeful for the future. But, as you say, it’s unlikely that change will come from the top down…

  37. Morwenna 5 May 2013 at 2:23 pm #

    Mr Christopher Dollis,

    I would like to point out to you that Metformin is a synthetic analogue of Galega officinalis.
    ( Goats rue ). While I use this as a whole plant extract in treating diabetes type 2 as I am a Medical Herbalist , when used as a synthetic drug it does not have the same actions. Metformin stores glucose in the tissues and inhibits the absorption of B12. ( Check your BNF ) Thus it gives a false sugar reading ie just minimises the symptoms but the inhibition of B12 is positively harmful as it is essential for human health and most diabetics are deficient. I have never found a doctor who prescribes B12 with the metformin pill. Furthermore by leaving excess sugar in the tissues this becomes a cancer initiator which is partly why there is such a close association between cancer and diabetes. Sugar is the proliferator and stimulus in both diseases and both diseases are inflammatory which is the molecular pathway for cancer development. Both diseases are primarily expressions of inappropriate diet and insufficient exercises.

    • Christoph Dollis 11 May 2014 at 7:11 am #

      Morwenna, what you say about B12 is well taken, which is why I am talking about low-dose metformin vs. high-dose metformin. Also, I have no reason to believe goat’s rue doesn’t have the same problem, even though few studies have been done on it. It is believed to be at least somewhat toxic.

      Your statements about metformin increasing cancers are simply wrong. Metformin has been shown to be a potent cancer-preventative agent. I don’t believe you understand how metformin works either (hint: in a similar way to goat’s rue).

      That said, if a person wished to try goat’s rue, I wouldn’t think that would necessarily be a bad idea, but I’d probably again opt for low dose. I’m not saying goat’s rue isn’t useful—it’s been used for a long time—however, the balance of the evidence is that metformin is useful.

  38. helen maree 5 May 2013 at 7:49 pm #

    The powers that be have spent so long in denial and saying that sugar does not cause diabetes I think it will be many years before we see a reversal in this attitude. The low fat religion can take full blame for the rise in type 2 diabetes and obesity ……..take a bow guys you have ensured that the drug companies have a compliant market and a healthy profit margin ….as people gain knowledge on these health issues we will see a rapid decline in the use of drugs and a return to a healthier population.
    Ever noticed how the rise in disease is in direct correspondence to health spending (we throw money at hospitals etc for very little results) and advice on diet. Low fat and eat less meat advice has seen chronic diseases rise including diabetes and cancer. They will tell you it is better screening for disease but it is really our diets that are to blame too much carbohydrate way too much!!

  39. Anna Betz 6 May 2013 at 12:46 pm #

    Thank you Morwenna for drawing the attention to the link between Metformin use and development of cancer.
    My observation and that of many other practitioners I have been talking to has been that there is an observable pattern in development of cancer some time (1-3 yrs or more) after starting Metformin.

    Of course diet and lack of exercise also play an important role. No disease ever has one cause but certainly Metformin leaves excess sugar in tissues and thus increases the risk of cancer.

    I think at the very least patients should be made aware of that and what they can do to reduce the need for the drug and to reduce potential side efects. Diabetes 2 is not just a problem of insulin resistance but is complex and involves many other hormones i.e cortisol, adrenalin, thyroid hormones and many more.

    I agree that a synthetic chemical doesnt work the same as a whole plant extract. As a medical herbalist I wouldnt rely on just one plant either but use different plants to strengthen and balance the whole system.

  40. Simon Shorrock 6 May 2013 at 12:48 pm #

    To all the people who have made wonderful contributions to John’s post we’re presented with this gem in today’s Daily Telegraph. It appears we’re on a sinking ship with a clueless Captain in command.

    “Ministers are set to demand that food manufacturers, cafes and supermarkets reduce the portion size of items high in saturated fat, such as biscuits, doughnuts, milky coffees and cakes.
    Under the plans, seen by The Telegraph, customers could be encouraged to buy low-fat options by restricting the availability of less healthy food in restaurants and shops.
    When ready meals and snacks are being manufactured, saturated fat would also be replaced with healthier ingredients, where possible, under the deal.
    The government is drafting a new “pledge” on reducing saturated fat in meals, which retailers, food and drink producers, and the hospitality industry will be expected to deliver.

  41. Jennifer 6 May 2013 at 4:54 pm #

    OK, let even us who are well informed, accept that high dietary fat COMBINED with REFINED carbs found in junk food, is certainly not good. But, I have been restricting carbs to 10%, made up of very slow releasing sugars, including cocoa powder, combined with quality proteins from meat, for about 15% of daily calories, , with lots of eggs which as well as protein contain the dreaded ……ÔOOOOOHHHHHHH!!!! Help….. FAT, making up the other 75% calories of my daily 1300 calories , which I get mainly from dairy, coconut products, walnuts, linseeds and almonds.
    I have removed ALL grains, including my ‘essential’ daily bowl of porridge, most fruit, except berries, and anything which does not resemble true food. In 3 months, I have lost 22lbs and reduced my BMI from 26 to 22, taken 6 inches off my waist, reduced B/P and cholesterol to normal, and got blood sugars in normal levels, after 10 years as a diabetic.
    Who on earth is advising the Government? This policy surely can’t be passed! Or am I living in cloud-cookoo land and dreaming about my new heath status after turning my back on NHS guidelines?

  42. Helen Howes 6 May 2013 at 7:55 pm #

    To Fiona Benson
    Type 1 diabetes (sometimes called “Juvenile” diabetes) is caused by an insult to the immune system which attacks the pancreas. A vaccine may well be useful. It has ABSOLUTELY no connection with weight. And it is a commonly-held idea that excess weight causes diabetes, when I think it is diabetes that packs on the weight. I have never met a Type 2 without some sort of family history (certainly in my case) and I am certain that this is a genetic condition.. So, being hungry all the time because one’s metabolism is bust makes it easy to eat too much.. When I controlled my blood sugars, I lost 25 kilos with no problems and have kept my weight stable ever since..

    Don’t assume these are the same disease, just the symptoms are much alike..

    HH

  43. Dawn McVey 8 May 2013 at 10:29 am #

    @ Helen Howes, well you have ‘met’ one now. There is no absolutely no history of Diabetes in my family.
    I became diabetic after a hysterectomy and then the menopause, I was a skinny person before that and then put fat on around my stomach.
    Until ‘proper’ research is done to find out what causes diabetes, maybe then we will have a better idea, rather than just treating it.

  44. Joe Thomas 11 May 2013 at 1:09 am #

    It’s just about the money. Large corporations (including Pharmaceuticals) main goal is to profit. They no longer care about people health. They’re trying to make the diseases chronic. That’s the way they ensure you pay a ‘rent’ for your health making you dependent to drugs. We are a sick society, but as most people in this blog say, we must heal ourselves, the main way to achieve that is changing our food, eating healthy, that solves a lot of problems…

  45. Tracey Greenwood 23 May 2013 at 10:37 pm #

    Scott said “What, I wonder, is their theory of how obesity causes diabetes? By what mechanism?”

    This is what I have been *shouting* about for years.

    It is my (non-learn-ed) opinion that diabetes is most often the effect of some kind of eating disorder and/or lifestyle choices (with a bit of genetics/DNA thrown in, and quite possibly something to do with food companies tinkering with ingredients – but that’s another topic altogether!). Many people with Type 2 diabetes also are obese. All the general medical advice is that if you are overweight, you are at increased risk of T2 diabetes. But what if it was (or is) the opposite? What if it was your DIET and LIFESTYLE that led to increased risk of T2 diabetes? And that obesity was a SYMPTOM, but NOT a CAUSE of insulin-resistance and T2 diabetes?

  46. Tracey Greenwood 23 May 2013 at 11:53 pm #

    Simon Shorrock said: “we’re presented with this gem in today’s Daily Telegraph. It appears we’re on a sinking ship with a clueless Captain in command: ‘Ministers are set to demand that food manufacturers, cafes and supermarkets reduce the portion size of items high in saturated fat, such as biscuits, doughnuts, milky coffees and cakes.’ {see above for full quote}

    The food industry, the pharmaceutical industry, the government…they’re 3 heads of the same beast. All striving for the same cause: consumerism (equals profits).

  47. JustMEinT 26 May 2013 at 12:47 am #

    http://justmeint1health.wordpress.com/2013/05/10/how-did-it-happen/

    http://justmeint1health.wordpress.com/2013/05/25/even-with-the-data-they-still-push-low-fat/

    These two RANTS are dealing with the fat/carbohydrate/obesity/diabetic situation that is being discussed by Tracey and Scott. MAY/perhaps shed some light.

    In my (not so) humble estimation the entire low fat fiasco was politically and NOT scientifically motivated.

  48. Kentu 29 May 2013 at 9:39 pm #

    Dear Dr. Briffa; While I’m sure you’ve had many frustrated moments, about your fellow MDs reticence over “bucking the system”, I’m also sure we believe that [at least] a majority had some kind social/caring drive to go through the ordeal [maybe some super-genius found is non-taxing, but I doubt it!] of getting the skills & knowledge required to be a physician. So what kind of “fly-paper” are these people trapped upon, that they together cannot make some effort to reform the mobius loop of current medicine/politics/”medical authorities”? [We must remember the transformation caused by Gandhi] Have you herd of any idea that could reach/re-motivate this huge class of educated people? After all, even the internet laity is quite vociferous on this point.
    Kentu

  49. Dr John Briffa 30 May 2013 at 6:14 am #

    Hi Kentu

    Your comment really got me thinking.

    Rather than answer your ‘fly paper’ question here, I think I’d like to write about it in the context of a post, where I’ll include your comment as context. Thanks for stimulating me to think about this because, somehow, I think it would help us all to understand what might motivate a ‘good’ doctor to do ‘dumb’ things.

  50. Kentu 30 May 2013 at 7:34 pm #

    I’m happy if I add anything that might help medicine/all of us.
    Thank YOU, for your personal integrity.

  51. Anna Betz 30 May 2013 at 10:03 pm #

    It sounds as if the time has arrived to get organised and form a movement for change. Ghandi said that: ” A movement needs a newspaper” which in our day and age would mean an internet based collective sense and meaning making organ.

    I know of many movements, organisations and individual medical professionals who so far still work separately and are thus less powerful in effecting transformation than they could be if they networked more closely and expressed solidarity for the sake of the whole.

    Just a few examples:
    http://www.heartsinhealthcare.com/welcome
    http://www.collegeofmedicine.org.uk/education-our-philosophy
    http://www.phmovement.org/en/node/7572
    http://sustainablehealthcare.org.uk/
    Rethinking Health: a developmental perspective http://youtu.be/h9jHBikSD5g

    in solidarity
    Anna

  52. Nigel Kinbrum 21 June 2013 at 8:30 am #

    Scott 3 May 2013 at 10:13 am said…
    “What, I wonder, is their theory of how obesity causes diabetes? By what mechanism?”
    The mechanism for Type 2 Diabetes (Type 1 Diabetes is caused by beta-cell destruction, usually auto-immune in origin) is Hepatic and/or Muscular and/or Adipocyte insulin resistance, followed by beta-cell damage due to excessively-high serum NEFAs (non-esterified fatty acids).

    See http://nigeepoo.blogspot.co.uk/search/label/Diabetes

    Cheers, Nige

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