Why might a leading diabetes charity offer dietary advice that is likely to increase the need for medication?
Diabetes UK is the UK’s largest and most prominent diabetes charity. Have a look here and you will se the charity proudly proclaiming that: “We stand up for the interests of people with diabetes by campaigning for better standards of care.” However, I’m doubtful that Diabetes UK is fulfilling its brief in this respect, seeing as it continues to suggest that diabetics should include starchy carbohydrates which every meal (see herefor more on this). You’ll see that Diabetes UK’s advice on this matter starts like this: “At each meal include starchy carbohydrate foods such as bread, pasta, chapattis, potatoes, yam, noodles, rice and cereals.”
Yet, these starchy staples break down into sugar, and some of them can release their sugar quite quickly into the bloodstream too. And if we eat them in quantity, like we often do, that only adds to their disruptive effects. Now, what rationale is there for diabetics to include “at each meal” foods that are disruptive to blood sugar? Here’s at least some of Diabetes UK’s ‘logic’ on this: “The amount of carbohydrate you eat is important to control your blood glucose levels.”
This is perhaps the vaguest and woolliest sentences I have ever read. What does it mean? I suppose what Diabetes UK would like people to take it to mean is “Diabetics need to eat starchy carbohydrates with every meal.”
However, I reckon there’s another, far more relevant way of interpreting this sentence which goes something like: “The more starchy carbohydrate you eat, the more out-of-control your blood sugar level will be, the more ‘diabetic’ you will be, and the more likely you are to start to take medication for this or to need to increase your medication regime.” Remember the advice to eat generally sugar-disruptive starchy carbs with each meal comes from the UK’s largest diabetes charity which, it says, campaigns for “better standards of care for diabetics”.
What sort of care is it referring to, do you think? Because on the face of it, it doesn’t look like nutritional care is part of its remit. And if that’s the case, maybe what’s being referred to here is medical care including medication.
Now, that would help to explain why Diabetes UK recently had a bit of a PR push on the idea that many diabetics are not taking their medication as prescribed. See this story from the Guardian in the UK for a typical instance of how this story was reported. The story, details the hundreds of thousands that are not taking their prescribed diabetes medication, and warns of the ills that may befall them as a result.
If Diabetes UK were so very concerned with the health of diabetics perhaps they could start by giving some decent nutritional advice for a change. How about starting by telling diabetics that the more starchy carbohydrate they eat, the more likely they are to require medication, and the more of the medication they are likely to need over time.
Elsewhere, I read that Douglas Smallwood, chief executive of Diabetes UK, has said it is a “tragedy” that many diabetics do not take their prescribed medication. My opinion is that the real tragedy here is the fact that Diabetes UK gives advice which makes it more likely to need that medication in the first place.
Those of you who clicked on the link to the Guardian newspaper and read it may have noticed that the Diabetes UK research was, in fact, partnered by the Association of the British Pharmaceutical Industry. Now, looking on the Diabetes UK website I can find no mention of where the charity derives its funding. Under ‘Corporate Partners’ Diabetes UK states this (and only this):
UK funds research for a future without diabetes while teaching children and adults to live with diabetes today. Our corporate partners provide vital and valued support to our work.
In the UK, 2.3 million people have been diagnosed with diabetes and more than half a million people have the condition but don’t know it yet. These figures are set to double by 2010.
Diabetes can develop at any age and those with friends or relatives with diabetes will understand how difficult it can be to learn to live with the condition.
People are being diagnosed with diabetes at an alarming rate; each year 100,000 people are diagnosed with Type 2. One in 20 of your employees, colleagues, friends and family will develop diabetes in their lifetime.
Lots of scary stuff about diabetes there, but no detail at all about who the corporate sponsors are and to what extent they fund Diabetes UK.
I was, however, able to find a letter in BMJ from 2003 that draws our attention to the need for charities and patient advocacy groups to declare their funding [1]. In this letter, the author states: “Diabetes UK received around £1m from 11 pharmaceutical companies manufacturing diabetes drugs but this is not mentioned in the annual report.”
I don’t want to come across unduly cynical, but is it right that a diabetes charity should have a less-than-transparent financial relationship with the drug industry. And is it right that this charity should be giving nutritional advice that, at the end of the day, looks likely to benefit the pharmaceutical industry. And after all of this, should it then go on to partner with that pharmaceutical industry in ‘research’ highlighting the need for people to take their diabetes medication. Or did I miss something?
References:
1. Hirst J. Charities and patient groups should declare interests. Letter BMJ 2003;326:1211
Published June 25, 2008 . Filed under: Diabetes/Metabolic Syndrome, Food and Medical Politics, Healthy Eating, Low-Carbohydrate/Carbohydrate Restriction, Unhealthy Eating!
John Briffa said,
“I don’t want to come across unduly cynical, but is it right that a diabetes charity should have a less-than-transparent financial relationship with the drug industry. And is it right that this charity should be giving nutritional advice that, at the end of the day, looks likely to benefit the pharmaceutical industry.”
I think this is one for Ben Goldacre, bad scientist and the tragi-cynical Witchfinder General for all England … and beyond.
http://www.badscience.net/
June 25, 2008 @ 11:25 am
John
An interesting point. Acording the ABPI/PMCPA code pharmaceutical companies must disclose funding of patients’ groups:
http://www.bmj.com/cgi/content/full/332/7533/69-a
though I have not located the precise place in the document where it states this.
http://www.abpi.org.uk/links/assoc/PMCPA/pmpca_code2006.pdf
It is evident that the only meaningful way that this could be achieved is if said groups advertise this information in their literature or on their websites.
http://www.bmj.com/cgi/eletters/332/7533/69-a#126085
One possibility is that you might try applying to Heather Simmonds, Director of the PMCPA for her views on the matter, although you may have to wait till doomsday or beyond for an answer.
http://www.bmj.com/cgi/eletters/336/7634/0#187763
http://www.bmj.com/cgi/eletters/335/7618/480#188132
June 25, 2008 @ 12:52 pm
“Or did I miss something?”
By my count, 3 question marks in the paragraph.
June 25, 2008 @ 6:30 pm
Reading this article made me recall an old joke.
Q: What do you call a med student that graduates last in his class?
A: Dr.
June 25, 2008 @ 7:11 pm
It’s definitely not right. I think all the Diabetes associations are the same - giving out the wrong advice that benefits the pharmaceutical companies not the patient.
June 25, 2008 @ 11:23 pm
Ross. Do you go around blog sites correcting grammar all day?
June 26, 2008 @ 7:39 am
@Barry Sharp
I think you’ll find that ‘ross’ is a tiresomely underemployed pharmaceuticals operative whose own blogsite scores precious few meaningful hits.
June 26, 2008 @ 1:15 pm
Food is divided into five main food groups and we need to eat from these groups, in the right proportions every day in order to enjoy a healthy balanced diet. The five food groups are below. Each of these food groups contains different nutrients that our bodies need to function and be healthy.
• fruit and vegetables
• starchy carbohydrates such as bread, cereals, pasta, rice and potatoes
• milk and dairy foods
• meat, fish and alternatives
• fatty and sugary foods
The comment that Dr Briffa refers to is that Diabetes UK suggests having something from the starchy carbohydrate food group at each meal. Diabetes UK recommends this to help aim towards stable blood glucose levels. If people choose varieties from the starchy carbohydrate group that are low GI , these do not affect blood glucose levels as much as they are more slowly absorbed helping to avoid peaks and troughs in blood glucose levels.
All carbohydrates break down to glucose during digestion which enters the blood and converted into a universal unit of energy in the cells.
Carbohydrates are needed in the diet because:
• The brain uses glucose to function (it does not need insulin to cross the blood brain barrier)
• Starchy carbohydrate foods, pulses and fruits contain fibre (both soluble and insoluble). Soluble fibre is important for heart health and insoluble is important for bowel health, preventing constipation.
• Fruit and pulses contain numerous essential vitamins and minerals.
• By removing whole food groups, for example carbohydrates, are likely to increase the consumption of other food groups resulting in an inbalance of the whole diet. Research has shown that by reducing carbohydrate consumption, the amount of fat they eat tends to increase drastically, particularly saturated fat. People with Type 2 diabetes are at an increased risk of heart disease compared to the general population, therefore they should be even more vigilant about their fat intake.
• Fat has nearly twice as many calories per gram as both carbohydrate and protein. Even if someone was not increasing saturated fat levels and concentrating on consuming better types of fat (mono and poly), the risk for gaining weight are real. As we know increased weight can result in increased insulin resistance and therefore could translate into increased medications or insulin requirements.
The diet recommended for people for diabetes is the same diet as recommended for everybody else a healthy well balanced diet including all of the food groups above in the correct quantities.
With regard to Diabetes UK and the pharmaceutical industry, we do indeed work in partnership with pharmaceutical companies to achieve our mission and vision.
Our relationship with pharmaceutical companies is governed by very strict guidelines and total monies from pharmaceutical companies accounted for less than 4.5 per cent of our total income in 2007.
Diabetes UK abides to the stringent policies of the Charity Commission regarding our duty to be transparent and accountable and our legal and financial information can be found on our website (www.diabetes.org.uk)
Interestingly, the ‘The Influence of the Pharmaceutical Industry’ report published by the House of Commons Health Committee in 2005, cites Diabetes UK (point 268 on page 76) as only one of two charities who “explained their funding policy.”
June 26, 2008 @ 2:45 pm
Amen. Looks very much like Diabetes UK uses the same play book as the American Diabetes Association.
If I followed ADA/Diabetes UK guidelines, I would be well on my way to frank T2 diabetes with chronically very high post-prandial BG levels after eating the recommended high starch meals, as well as very overweight. I have no doubt about this. My glucose meter doesn’t lie.
Instead, I ignore just about everything both groups advise and follow a very carb restricted diet of whole, minimally processed foods prepared at home (much of my food comes direct from the farms), take no diabetic medications, and achieve normal or nearly normal blood glucose readings throughout the day. Any food that gives me a high post meal reading is off my diet. It’s very simple. There is also something else that can provide the same nutrients without raising blood sugar levels. Additionally, I lost the weight gained from my former bread and pizza baking efforts and now maintain a normal BMI of about 21-22 or so.
The only interest these “charity” groups have in “helping” people with diabetes is “helping” them stay diabetic, on medications, and in need of diabetic support products and services. Diabetes has grown into a huge cash cow for all sorts of ancillary businesses. Follow the money … the ADA/DUK won’t kill the cow, not while they can milk it so profitably.
I guess I sound cynical … well, let’s just say I had a rude awakening about health “care” a few years ago and cynicism seems like an essential life skill now.
June 26, 2008 @ 5:09 pm
Sara Spiers, Care Manager, Diabetes UK
“Food is divided into five main food groups and we need to eat from these groups, in the right proportions every day in order to enjoy a healthy balanced diet.
…• starchy carbohydrates such as bread, cereals, pasta, rice and potatoes…”
Tell me what it is in these foods that we can’t get elsewhere and in a form that is not generally disruptive to blood sugar levels?
“The comment that Dr Briffa refers to is that Diabetes UK suggests having something from the starchy carbohydrate food group at each meal.”
How does eating foods that are generally destabilising for blood sugar help individuals to stabilise blood sugar levels? Can you explain the logic in this (I’m not seeing it).
“If people choose varieties from the starchy carbohydrate group that are low GI, these do not affect blood glucose levels as much as they are more slowly absorbed helping to avoid peaks and troughs in blood glucose levels.”
Even low GI foods when eaten in quantity can be very disruptive to blood sugar levels. Why are you not advising diabetics of this fact, and why in the light of this are you not advising diabetics to be wary regarding these foods and their effect on blood sugar balance?
“By removing whole food groups, for example carbohydrates, are likely to increase the consumption of other food groups resulting in an inbalance [sic] of the whole diet.”
Who said anything about removing carbohydrates from the diet?
“Research has shown that by reducing carbohydrate consumption, the amount of fat they eat tends to increase drastically, particularly saturated fat. People with Type 2 diabetes are at an increased risk of heart disease compared to the general population, therefore they should be even more vigilant about their fat intake.”
Can you cite the evidence which shows that saturated fat causes heart disease? Can you cite the evidence which shows that eating less saturated fat reduces the risk of heart disease? (it’s actual studies I want, not ‘official’ recommendations).
“Fat has nearly twice as many calories per gram as both carbohydrate and protein. Even if someone was not increasing saturated fat levels and concentrating on consuming better types of fat (mono and poly), the risk for gaining weight are real. As we know increased weight can result in increased insulin resistance and therefore could translate into increased medications or insulin requirements.”
Please answer the following question: is the fundamental problem diabetics have one of controlling:
a. carbohydrate (sugar)?
b. fat?
Also, do you believe that eating carbohydrate could contribute to insulin resistance?
“Diabetes UK abides to the stringent policies of the Charity Commission regarding our duty to be transparent and accountable and our legal and financial information can be found on our website (www.diabetes.org.uk)”
Can you please direct us to the page on the site where you list your corporate sponsors (the names of the companies, please) and the level of funding received by them?
June 26, 2008 @ 8:22 pm
Would Dr. Briffa like to suggest foods containing carbohydrates that are not disruptive to blood sugar levels?
June 26, 2008 @ 8:55 pm
Adam
Would you like to have a go at answering your own question before I do?
June 26, 2008 @ 9:19 pm
Starchy carbohydrates are not required in the diet. Have low carbohydrate vegies instead:
leafy green salad veg, celery, cucumber, zucchini, cabbage, mushrooms, broccolli, asparagus, aubergine, cauliflower, gren beans, peppers, tomatoes, spinach etc.
Diabetics have a problem with controlling blood sugar - those foods that contribute to this should be removed.
June 26, 2008 @ 10:44 pm
what question? that was the first time i typed something!
June 26, 2008 @ 11:34 pm
Hi, Doctor Briffa, once again, you are spot on. I am so, so, disappointed, fed up, even angry, with people like Sara Spiers and medical docs who never spend a minute doing their own research and actually reading all the true evidence, but instead follow the party line. This whole type 2 diabetes information structure nearly destroyed me completely, over 10 years of total compliance with “THEIR so called balanced diet recommendations and medications, I nevertheless came within a hairs breath of kidney disease and dialysis until I decided to do some research, discovered the real facts about the notorious “Balanced Diet” (and the utterly false positive messages about fibre, invented because they couldn’t seem to make the false cholesterol hypothesis work the way they wanted it to work) and its effects on diabetics, and reversed my own kidney disease within 18 months. It is absolutely criminal the way the establishment is literally killing diabetics (slowly and painfully) by giving them incorrect information and then blaming them for non-compliance when things go wrong. People go to your local hospital’s Renal department and see 50 and 60 year olds already on dialysis because of their type 2 and become as enraged with the system and the current guidelines as I am.
Sorry about the rant Dr Briffa, but as you can guess I am somewhat angry with the likes of Spiers and all the diabetes associations around the world who blindly follow what the American diabetes Association does, easy isn’t it, to follow blindly and never do your own research!
Glenice
June 27, 2008 @ 9:34 am
Adam
If you can’t or won’t answer the question, just say. Which is it?
June 27, 2008 @ 10:31 am
i can’t answer my question - that i why i asked you.
June 27, 2008 @ 10:57 am
I’m glad someone from Diabetes UK is reading your website Dr Briffa. I am astounded at their dietary recommendations. If I followed what they said my diabetes (type 2) would be out of control….I know because I’ve tested my blood glucose after eating starchy vegetables, fruits, rice and wholemeal bread, and even in small quantities of those my blood glucose levels rise too high and stay that way 2 hours post prandial.
As for carbohydrate, nowhere did you say to cut out carbohydrate as Sara Speirs suggests you have ! I eat lots of low carbohydrate vegetables, lots of kale, cabbage, chicory, asparagus, salads, broccoli, okra, cauliflower, and more. For fruit I can eat avocados and a small quantity of berries sometimes. I check my blood glucose levels often so I know what effects various foods have on it. The rest of my diet consists of fresh fish, meat, nuts, seeds and eggs…..my diet is well balanced and my diabetes is well controlled. I am slim too
Anne
June 27, 2008 @ 7:37 pm
“SANOFI-AVENTIS continues to support the NHS to develop tailor-made solutions to help meet local circumstance and priorities, such as an initiative among the south Asian population in Warwickshire to improve awareness of diabetes and heart disease. In 2006, sanofiaventis supported more than 70 patient groups and charities, including Diabetes UK, the Stroke Association, the British Heart Foundation, Cancerbackup, the Prostate Cancer Charity and Bowel Cancer UK. The company supported Diabetes UK’s Measure Up awareness campaign, which helps the charity achieve its objective of reducing the number of people with undiagnosed diabetes.”
http://www.abpi.org.uk/publications/publication_details/annualReview2006/ar2006_community.asp
“Lilly funding to Diabetes UK in 2007 was £65,000 which represents 0.25% of the organisation’s income in 2006.”
http://www.lilly.co.uk/Nitro/newTemplates/general/Content_IT_LBCT.jsp?page=1471
Bristol Myers Squibb
http://www.b-ms.co.uk/info-for-patients2.htm
June 27, 2008 @ 10:00 pm
I hope more and more people begin to listen to you Dr Briffa. I have previously written to you directly regarding the diabetic diet and I am the proof in the pudding. I have stopped following dietician’s advice for a few years now and follow a very low carbohydrate diet, avoiding starchy carbohydrate. My HBAc1 results are fantastic, on average 5.5%, I feel great and I have more enery. On the odd occasion I do eat starchy carbohydrate I regret it. I eat lots of fruit (carbohydrate) vegetables fish eggs and meat. Together with small portions of pulses. I now have a very low dose of insulin. I have been insulin dependant for 30 years, since the age of ten, and I have always been in control of my diabetes and not scared of it. Unfortunately too many people are afraid to cut out starchy carbohydrate as they believe and trust what their doctor says as being gospel…It disgusts me that diabetes is a big money making business…Good Luck Doctor Briffa, don’t give up
June 27, 2008 @ 11:46 pm
To Sara , Dietician, You have 5 food groups. Two of these are carbohydrates and fruit and vegetables, but fruit and veg are also carbohydrates. Your food pie chart (not a pun) includes a large section for breads etc and another section for fruit and veg so the daily diet is supposed to be mainly carbs according to that. No wonder there is so much diabetes. Also where is the evidence that ‘we need to eat from these 5 groups every day’? You and your colleagues seem to have learned this parrot fashion. I do not mean to be insulting but do you sometimes wonder why there is so much against this. This is just an arbitrary classification and out-of-date. Where did the Stone Age people get these ‘carbs’ from?
Grains and carbs in that form were grown in order to feed a population who had nearly run out of meat but that does not mean that they are a necessary food.
June 27, 2008 @ 11:56 pm
Anne, I wrote mine without seeing your contribution. I’m glad we agree and that the diet is working for you.
June 28, 2008 @ 12:15 am
When I was told I had Type II, an appointment was arranged with a dietician. She just trotted out the high-carb line - bread, pasta, potatoes, etc., etc.,
When I told her what I eat (bacon & egg for breakfast, etc) her response was “are you on the Atkins diet?”. An interesting response.
Doctors don’t heal, they manage symptoms and prescibe drugs.
June 28, 2008 @ 12:22 am
“Doctors don’t heal, they manage symptoms and prescribe drugs.” Thank you, Robin, I’ll have to remember that. Sadly it is so true for almost all of them.
June 28, 2008 @ 4:44 am
The main problem with the dietary advice issued by Diabetes UK is that it doesn’t work. Eat the high carb low fat diet advocated and your diabetes will progressively worsen and your need for medication will increase. Even with increased medication Blood Glucose levels will fluctuate, increasing the risk of both hypreglycemia and hypoglycemia.
Diabetics have trouble utilising glucose as a fuel. In type 2 diabetes this is appears to be caused by a combination of insulin resistance and an absolute or relative insulin deficiency. Why on earth would you choose to use the very fuel that your body has trouble utilising as your preferred source of energy? This will inevitably result in dangerously high blood glucose levels, chronically high insulin levels, weight gain, difficulty utilising fat as a fuel and a host of long term complications.
Better to follow a low carb, higher fat diet which humans have been happily consuming in many parts of the world for thousands of years. Base your diet around natural foods: eggs, cheese, meat, fish, nuts and seeds (in moderation), and non starchy vegetables. These foods are satiating, nutrient dense and a good source of complete amino acids.
In my opinion, by advocating the othodox low fat high carb diet Diabetes UK have damaged the health of the very people they claim to be seeking to help. I have seen very little evidence that saturated fat is unhealthy and leads to weight gain. Indeed, as fat consumption has decreased the population of the UK has gained weight. The chief culprit seems to be the very food advocated for weight loss: starchy carbohydrates (complex carbs). How can the very same food that farmers feed cattle to promote rapid weight gain, ie corn, lead to weight loss in humans? The answer, of course, is that they don’t.
These foods are nutrient poor and often need to have nutrients adding to them as part of the maufacturing process.
Diabetes UK should uregently readdress the dietary advice it gives. I am not aware of any long term studies that show the current dietary advice works - specifically for diabetics, but just as importantly for the wider population as a whole. The resistance to advocating a low carb diet would have more credability if there was was scientific evidence to support the current approach. In fact the low fat high crab dodietary approach ahs been a hopeless failure, as evidenced by the increasing lelves of obesity, metabolic syndrome and diabetes.
Sara Spiers has trotted out the same old nonsense:
The brain does not run exclusively on sugar - it can also run perfectly well on ketones. Additionally carbs are not the sole source of blood glucose - the liver can manufacture glucose from amino acids if need be.
Type 2 diabetics don’t normally have a problem with low blood glucose. This only tends to occur if they are following the dietary advice advocated by Diabtes UK when over medication in conjunction with a high carb diet leads to roller coster blood glucose levels.
The 5 categories of foods are somewhat arbitary. Why on earth link fatty and sugary foods. It shows a bias against fats. In nature these foods are hardly ever combined, as they might be in processed and manufactured foods: cakes, biscuits, etc.
Diabetes UK is doing a great disservice by recommending the same “healthy well balanced” diet for diabetics as for everybody else. Show me the research that proves that following this advice leads to a reduction in medication and normal bllod glucose levels for diabetics. I very much doubt it eexists. Whereas there have been a large number of recent studies that show the superiority of the low carb, higher fat approach.
Paul Anderson
June 28, 2008 @ 6:38 am
Well said, Glenice, and sorry to hear you’ve had to suffer at the hands of these people.
What the ‘mainstream’ medical establishment is too stupid/self-complacent/insert your own adjective to realise is that they no longer control the medical information that their patients get, now that the internet makes it so much easier for ‘alternative’ theories and treatments to be publicised, and for patients to access them.
More and more people are accessing their own (very likely more up to date) information, make up their own minds about how their condition should be treated, and where they can’t get what they want from mainstream medicine, they’re going to ‘alternative’ practitioners or simply self-treating with medications or nutritional supplements bought online. (If anyone thinks self-treatment isn’t already happening, just look at some of the thyroid and adrenal forums).
Jackie
June 28, 2008 @ 6:54 am
It’s quite staggering isn’t it how the Diabetes organisations toe the party line? Ms Spears is unlikely to have a medical background (or surely she would have said so) but has merely repeated the mantra “low fat, high carb good”, “high fat, low carb baaahd” like the good little sheep that she is.
I guess they don’t want to risk their funding being cut off by an irate industry – in which case they should be asking themselves what, exactly, is their raison d’etre? Are they there to serve the patients, or to pander to the whims of industry – “there’s this new PPAR-gamma agonist… there’s this new HDL-raising drug… there’s this new angiotensin II antagonist…” and so on, ad nauseam. As far as I can see, they are merely self-serving “do-gooders” that actually do more harm than good, and yet get to go home at night in the delusion that somehow, they made someone’s existence more meaningful. If it wasn’t so damaging for so many people it would be pathetic. As it stands it is a hugely harmful endeavour – Ms Spears I would suggest you have blood on your hands, and until you do the prerequisite research on the vomitus you posted here I suggest applying Superglue to your fingers while typing – your scribblings would undoubtedly be all the more coherent for it.
June 28, 2008 @ 9:44 am
I found this comprehensive review article a big help in understanding the science behind low-carb diets.
JOEL M. KAUFFMAN ‘Low-Carbohydrate Diets’. Journal of Scientific Exploration, Vol. 18, No. 1, pp. 83–134, 2004
http://www.scientificexploration.org/jse/articles/pdf/18.1_kauffman.pdf
June 28, 2008 @ 12:17 pm
Sarah Spiers and Adam
Welcome to the ‘Curious World of Dr Briffa and friends’!
Sarah - I hope you weren’t hoping to join some meaningful debate on the relative merits of one dietary approach versus another. If so, I hate to disillusion you - but this really isn’t the website on which to do it.
Dr B doesn’t do meaningful debate. He does mocking comments (based on his own unique interpretation of the medical research) and deliberate misinterpretation of your comments readily supported by his band of merry supporters (you have already met ‘Cathy’, ‘Hilda’ and ‘John’).
All in the hope that by your 4th patient, evidence based reply to his facetious/ insulting/ incorrect comments you will admit defeat, and kindly go away so Dr B and friends can post unpleasant comments about yourself, your organisation, and any collateral bodies.
Adam - i guess you’ve worked out what degree of ‘futile cycling’ goes on here!
So feel free to add another post as I and many dietitians do when we feel like we have a moment to spare for entertainment. But please don’t expect meaningful debate. Your time may be better spent finding out whether Dr Briffa has a case to answer with his comments that debase the excellent job that your organisation does in representing the diabetic population in the UK.
June 28, 2008 @ 11:25 pm
Catherine Collins RD
Once again you focus not on the issue at hand, but on me.
And again you fail to engage with the science and the woefully inadequate dietary advice diabetics are usually given (and then accuse me of shying away from meaningful debate – how ironic).
Do you not see how standard dietetic advice given to diabetics is likely to worsen their condition and increasing their risk of complications and death? And then you say the comments here are a source of entertainment to you and other dietitians.
While you and others are entertained by this issue Catherine, real people are likely to be harmed as a result of standard diabetic dietary advice. Just think about that for a moment: you might imagine that diabetics might feel seriously let down by you and those like you that derive entertainment from this issue.
June 29, 2008 @ 7:19 pm
Ecce homo
June 29, 2008 @ 7:52 pm
Catherine Collins RD - if you have anything meaningful to add then go ahead otherwise scram!
Sara Spiers - look closely at what you are recommending for diabetics - when you do you will realise that its wrong. Do the right thing and get those diet recommendations changed.
June 29, 2008 @ 10:37 pm
Sara Spiers - here is some homework for you:
http://nmsociety.org/index.php?option=com_content&task=view&id=31&Itemid=50
You will learn a lot.
June 29, 2008 @ 10:47 pm
Catherine Collins’ comment epitomises the arrogance of the medical industry and its “business with disease”. Her stance is that the mainstream medical establishment is always “right”, and anyone with the temerity to disagree is by definition a crank.
I am not a “merry supporter” Catherine and your ad hominem BS fools nobody. You just can’t stomach the fact that people have minds of their own and have discovered through their own endeavours that the dietetic emperor is completely naked. Your twisted take is to suggest that the agreement among individuals commenting here is akin to some form of cult (a la Dr Briffa), but the truth is, Catherine Collins, it is you that inhabits the cult in which saturated fat and (eek) vitamins represent the very devil himself.
Read the above comments Catherine; they are from genuine people that have themselves experienced the gross failure of the system – the system you so doggedly defend, and yet you post here with the expectation that your “expertness” will convince those here that the fat emperor’s arse is in fact opulently clothed. You don’t come here to debate, you come here to debase; a fact that is all too obvious to those whose intelligence you insult.
We should probably feel pity for Catherine and her cult – they have seen the writing on the wall. They do not enjoy the unquestioning acceptance of their victims as they did in days of yore. Nutrigenomics will render this dangerous cult even more redundant than it is already. I’d get those P45’s in order Catherine.
June 29, 2008 @ 11:53 pm
To Sara Spiers and Catherine Collins, just in case you visit again to read more comments: if your dietary advice is correct, where are all the diabetics who are getting better, reducing or eliminating their diabetes medications by following your eating advice? The only time I hear diabetics claim their blood glucose is under control and they don’t need as much medication or they can eliminate it altogether is when they reject your advice and follow a low-carbohydrate nutrition plan. Show us all the diabetics who listen to you and get better! And as far as the nutritional advice you give, I don’t care how much you’ve studied, all you do is parrot the same assimilated nutrition commonplaces anyone could rattle off just by repeating what can be gleaned from reading the newspaper and popular women’s magazines.
June 30, 2008 @ 4:52 am
You only have to read the evidence to see that it makes entirely logical sense. It’s not an ‘idea’ or a ‘cult’ - the evidence is there. I think we should do a large study and perhaps the dieticians could lead this and change the working practice! I used to believe the low fat advice, but since reading all the evidence I have had to admit that low carbs is the way to go, to control diabetes and lose weight! Think how we could could change things if the ‘establishment’ would go with us.
June 30, 2008 @ 12:26 pm
I do not wish to be charged with Briffaphilia but have to agree with his stance on both diabetes and weight loss/nutritional dietary advice. I have been following a paleo style diet for nearly two years with excellent results in terms of body composition and general health (I have not had a day off work since going paleo - prior to that colds would really hit me and I would take about two sick-days a year). Before Paleo (BP), I was a classic ‘whole grain, low-fat’ eater. But after looking at the results of traditional dietary advice on my own body, I knew that it was not working as dieticians and nutrionists suggested it should or would. A state of voluntary chronic hunger cannot be sustained by ANYONE.
What I find staggering about the exchange above is that there is good evidence (annecdotally, if not otherwise), that diabetes can be managed and cured with an appropriate change in diet to ‘low-carbing’. If I was involved with ANY organisation “devoted to the care and treatment of people with diabetes in order to improve the quality of life for people with the condition”, I would investigate these claims. A single case of a person curing themselves of diabetes should be worthy of investigation as it might ‘open the door’ for a cure, but there appear to be hundreds of people curing themselves by REJECTING the official dietary advice. To maintain their credibility the diabetes organisations must grasp this nettle and undertake controlled clinical trials - I mean what have they got to lose? Either their current advice will be proven to be good advice (which will ’silence Dr Briffa and his cult’), or it will be proven wrong (in which case they can change their advice and still fulfill their objective of providing care and treatment to people with diabetes and improve the quality of life for people with the condition).
Simple really!
In fact the risk of losing drug company funding is the ONLY reason I can think of that would cause Diabetes UK would not to conduct such an experiment.
June 30, 2008 @ 2:28 pm
Diabetes UK may have been frank with the Commons Health Committee about their funding but they haven’t been here. Any hope that Sara Spiers might return to clear the matter up has been in vain.
June 30, 2008 @ 7:05 pm
Sue
There’s a lot of reading on that website! Are there any articles in particular that you think are most useful?
June 30, 2008 @ 8:14 pm
sokpuppet,
Have a read of the presentation by Ron Raab and Dr Katharine Morrison.
They are short presentations. There is much more info on the site under different sections.
July 1, 2008 @ 12:29 am
Dr B - I don’t think you answered Andy’s question - “Would Dr. Briffa like to suggest foods containing carbohydrates that are not disruptive to blood sugar levels?”
July 1, 2008 @ 10:53 am
Seriously though. what next. Will charities that help people with drug problems be suggesting the go and have lots of the very thing that is making them ill in the first place “drugs”. (oh but it will help you loose weight though)
Drug problem - solution - take more drugs
Peanut allergy - solution - eat more peanuts
Torn Muscle - solution - run more
Alcohol problem - solution - drink more alcohol
sugar problem (diabetes) - UK diabetic solution - eat more high sugar carbohydrate foods
weird…..
July 1, 2008 @ 1:06 pm
Hi Sue
Thanks! Seems like common sense really - low GI foods reduce glucose spikes and will lessen the burden on the pancreas. Have I got that right?
July 1, 2008 @ 1:24 pm
All those who are seriously interested in knowing the facts behind the diabetes & obesity debate, must please read ‘The Diet Delusion’ by Gary Taubes. The answers to everyone’s questions are in there.
It is a long read but certainly anyone who calls themselves a dietician, nutritionist or doctor would be wise to ensure they fully digest this book.
July 1, 2008 @ 2:52 pm
Sally, thanks:
“It is a long read but certainly anyone who calls themselves a dietician, nutritionist or doctor would be wise to ensure they fully digest this book.”
Mind you, uncomfortable.
July 1, 2008 @ 7:47 pm
ross
“my triglyceride levels have plummeted from a pretty scary level to a point where I’ve been able to reduce my medication.”
Thanks for this ross, but can I point out to you that diabetes is a problem characterised by raised blood sugar levels (not raised triglyceride levels).
July 1, 2008 @ 8:17 pm
Another thought crossed my mind - we have had several people on this site who have posted to the effect that once they eschewed the regular/traditional/diabetes UK advice and went paleo/low carb, their condition improved markedly.
What I would like to know from the defenders of the regular/traditional/diabetes UK advice is, can anyone of them encourage a post from a diabetic for whom they have improved the quality of life?
What would be particularly interesting is if the diabetic concerned had actually tried a ‘paleo’ approach, but found that the nutritional guidelines of Diabetes UK produced better results.
You’d think that a big (and growing), organisation like Diabetes UK would have numerous success stories. Statistically, several of their diabetics must surely have tried the paleo route - so, IF DUKs GUIDELINES ARE EFFECTIVE, some of them must have tried paleo/low-carbing and found it inferior to complex/starchy carbing.
Just a thought!
Come out! Come out! Wherever you are!
July 1, 2008 @ 10:21 pm
Dr Briffa
Thanks for eventually answering the question Dr Briffa, and I hope you gain a modicum of satisfaction in the way you address your commentators.
But I have some concerns, Dr B, about your - dare I suggest - rather passé clinical references? The research world has moved on for diabetics and non-diabetics alike since these citations were published (Heavens! Using bona fide medical references to justify your alternative/ complementary/whatever stance! How very daring!).
Indeed, at risk of alienating your key audience, the ‘UCP-2’ model/ oxidative stress/ manganese etc popularly assumed to contribute to the pathogenesis of diabetes (especially Type 2) has - unfortunately – been disproven. A couple of years ago. Sorry. http://lib.bioinfo.pl/pmid:17916951.
Never mind. I agree that manganese-deficient rats should eat manganese-rich cake. But ‘Dr Briffa’s Sucroguard’ ™ is, well, superfluous to manganese requirements - especially as the above reference again quotes the common finding that human diabetics have twice the blood manganese levels of non-diabetics.
Pay Biocare-Not-Dr-Briffa £6.30 pcm for a futile pill-for-diabetic-ills? No thank you, Cathy. I’d rather boost my blood levels with a nice cup of tea.
http://hera.ugr.es/doi/1507920x.pdf
http://lib.bioinfo.pl/pmid:16118651
July 1, 2008 @ 10:25 pm
SkepTicTacToe, there’s a link here:
http://www.badscience.net/forum/viewtopic.php?f=3&t=5487
Curiously enough, since moving to a more low GI oriented diet and starting going to the gym earlier this year my triglyceride levels have plummeted from a pretty scary level to a point where I’ve been able to reduce my medication. And you know what? A low GI diet and exercise are recommended by Diabetes UK. Their paymasters must be sorely displeased.
Just to repeat for the benefit of any Briffas reading who may be hard of thinking …. by following Diabetes UK’s advice I have been able to reduce my medication. And that’s even without taking Briffa’s patented snake-oil, amazing. OK,so that’s just me but I don’t imagine that I’m unique here.
Disclaimer: I have never received a penny from Big Pharma… although I admit I have played a small part as a conduit for taxpayers money to flow their way in recent years. I refer to this relationship as “keeping myself alive.”
July 1, 2008 @ 10:48 pm
Ross,
Just a few observations. THe GI of several of the foods you refer to are: Instant Rice (91), brown rice (55), Mashed Potatoes (73), New Potatoes 56, Wholemeal Bread (69), All Bran (42) Porridge Oats (49).
By way of comparison the GI of table sugar is 65 and a mars bar 68 and chocolate 49. I am sure diabetes woudn’t advocate eating these foods. Or do they?…… And they don’t receive funding from Cadbury’s …… or do they?
And then of course there’s the glycemic loads of these starchy carbohydrates which, unless you eat ridiculously small and unsatisfying portions tends to be very high.
A low GI is something in the teens, or lower eg brocolli (15), cauliflower (15), cucumber (15).
even better still eat fats and protein. You will find that this lowers both your tryglicerides and blood sugar, is more statiating, and quite possibly imporves you quality of life.
If you are managing your diabetes without drugs and achieveing a hba1c below 5 I would be pleasantly surprised - good luck to you.
One further point - the more inuslina diabetic uses, the more difficult or not impossible it is to avoid both highs and lows. A type 1 diabetic needs to use as little insulin as possible whilst maintaining tight control. This can only be done by eating a low carb diet. The greater the insulin use, the greater the margin of error.
Starchy carbohydrates are of no help to a diabetic, if indeed they are good for anyone at all, in my opinion.
Paul.
July 1, 2008 @ 11:15 pm
John Stone said,
“Mind you, uncomfortable.”
Yes, and I can feel my ‘irritable bowel’ coming on at the thought …
July 1, 2008 @ 11:44 pm
Frank: “sugar problem (diabetes) - UK diabetic solution - eat more high sugar carbohydrate foods”
That’s misrepresenting the advice. As Diabetes UK’s advice is only partially quoted in this blog post you might find the following gives a better context:
http://jkn.com/View?j=912225.421546931238
July 1, 2008 @ 11:52 pm
Insulin is a multi-billion dollar industry worldwide. What business would put this at jeopardy with usage reduction strategies? (or heaven forbid ….. a cure.)
You’ll note the bulk of the research dollars are devoted to delivery systems (nasal, tablet) so as to move away from needles. This will allow them to keep selling insulin in some form or another.
Message to the pharma cartels - we do not want new delivery systems - we want a cure. (for type 1 that is: type 2 people should be changing their lifestyles and curing themselves.)
July 2, 2008 @ 6:19 am
Catherine Collins RD
My, you do seem so very pleased with yourself! Why is that?
Could it be because you believe you have managed to deflect the issue from the woefully inadequate dietically-driven dietary advice many diabetics are given?
Or could it be that you think you have got away without having to really engage with the science (never mind the common sense) which shows how flawed such advice is?
Notice, Catherine, how Sara Spiers (Care Advisor at Diabetes UK) has stayed away from here after posting her, I think, ridiculous assertions. Seems she is unable or unwilling to answer the simplest of questions I posed to her above. Maybe you’d like to have a go at answering these questions for her?
Oh, and do please to remember to focus on the issue and not on me. Remember, Catherine, people’s lives are at stake here…
July 2, 2008 @ 6:48 am
except, of course, dr briffa the title you give the blog post , the reference you give, and the content of the actual blog post is largely to do with the vague notion that Diabetes UK’s advice is flawed due to their relationship with drug companies. Yet, you have a cosy relationship with a pill company.
The reference you give suggest that patient groups should declare interests - yet you have studiously failed to declare your interest in SucroGuard!
Anyway, thinking about the science. Would you like to describe the diet you would like to see diabetics following, and back it up with some evidence, then point out the substantial differences between your ideas, and diabetes UK’s advice?
July 2, 2008 @ 9:46 am
Dr B - I don’t think you answered Andy’s question - “Would Dr. Briffa like to suggest foods containing carbohydrates that are not disruptive to blood sugar levels?”
July 2, 2008 @ 10:16 am
“Or could it be that you think you have got away without having to really engage with the science (never mind the common sense) which shows how flawed such advice is?”
Dr B, I think Catherine Collins did engage with the science. You stated that:
“Justification for the inclusion of manganese in Sucroguard comes from studies which show that manganese levels are generally low in diabetics (Biol Trace Elem Res. 2001;79(3):205-19) and that manganese deficiency appears to contribute to glucose intolerance in animals and may be reversed by supplementation (J Nutr 1990;120:1075–9).”
Catherine Collins said:
“Indeed, at risk of alienating your key audience, the ‘UCP-2’ model/ oxidative stress/ manganese etc popularly assumed to contribute to the pathogenesis of diabetes (especially Type 2) has - unfortunately – been disproven. A couple of years ago. Sorry. http://lib.bioinfo.pl/pmid:17916951. Never mind. I agree that manganese-deficient rats should eat manganese-rich cake. But ‘Dr Briffa’s Sucroguard’ ™ is, well, superfluous to manganese requirements - especially as the above reference again quotes the common finding that human diabetics have twice the blood manganese levels of non-diabetics.”
Aer you going to engage with the science?
July 2, 2008 @ 10:38 am
Hi Ross, thanks for the link. You would hope that at least someone would achieve the results that this guy did, by following Diabetes UK advice. It would be interesting to know if the guy involved would see even greater benefits if he went ‘paleo’.
I must point out that by going ‘paleo’, Anna (#9) seems to have removed her need for medication completely, Glenice (#15) has reduced her medication significantly - and has achieved results she was otherwise unable to, following the advice of Diabetes UK. The same goes for Anne (#18), who found that following the dietary recommendation of Diabetes UK her ” blood glucose levels rise too high and stay that way 2 hours post prandial.” Christine’s position (#20) on Diabetes UK dietary advice is similar also. None of them seem to have taken “Briffa’s patented snake-oil”
Short of sock-puppetry, I find these posts rather convincing (albeit anecdotal). So, while it seems that there are cases of diabetics achieving good results by following Diabetes UK advice, this advice does not appear to work across the board. Paleo eating DOES seem to have greater success - and unlike the Diabetes UK nutritional advice, we have yet to hear from a diabetic who says that paleo eating did NOT work for them.
Given their objective and the anecdotal evidence, I still think that Diabetes UK should conduct trials based upon the paleo diet. That way we could sort this issue out once and for all, and avoid some of the more unpleasant exchanges we have seen here!
July 2, 2008 @ 12:47 pm
Dr B, I cant see my original post re. this so I wondered what your thoughts are in relation to NHS Blog Doctor’s article stating that you think Diabetes UK is “deliberately and maliciously encouraging diabetics to eat an inappropriate diet, knowing that such a diet will make their diabetes deteriorate, thus increasing their need for medication.”
http://nhsblogdoc.blogspot.com/search/label/Dr%20John%20Briffa
July 2, 2008 @ 3:42 pm
Admittedly they will find it hard to swallow (!) but Catherine Collins RD and Sara Spiers really do need to digest ‘The Diet Delusion’ by Gary Taubes!
In my personal experience, once people receive a diagnosis of diabetes (both types) and start following the advice of their GPs, endocrinologists, diabetes nurses, and dieticians, their condition always worsens. They are locked into a downward spiral of ill-health, driven by high blood glucose & high insulin levels (endogenous or not) and compounded by pharmaceuticals.
As far as their impact on blood glucose is concerned, there is no difference between the so-called good, complex carbs and simple sugars. As Paul Anderson demonstrates by quoting the GI of some examples, we might as well be eating chocolate, jelly babies and spoonfuls of table sugar, as bread, potatoes, rice and breakfast cereals. In simple terms, the more processed (including by cooking) a carbohydrate-based food is, the worse it is for us.
For anyone battling with diabetes or weight issues the only way out is to ignore the ‘experts’ and drastically cut the carbs. Find a doctor and / or a nutritionist that doesn’t spout dogma (much easier said than done…) and does understand the science of metabolism.
Clearly, the received wisdom on the subject of diet is not right. If it was correct the incidence of obesity & diabetes (not to mention all our other epidemic ills) would be decreasing, as patients followed doctors’ orders. There is a wealth of evidence (from research, clinical experience & anecdotal) that indicts processed carbohydrates as the scourge of the 21st century. Whilst we argue the toss on this site there are millions of people suffering, in this country alone, because the truth is not reaching the masses. Much more could be achieved if our dissenting voices were united. If there are any clinicians and biochemists out there who feel the time is right to move this forward, please contact me.
I don’t know if I’m allowed to post my e-mail address here but I guess it’ll soon be removed if not! sally@diet-therapy.co.uk.
July 2, 2008 @ 3:54 pm
SkepTicTacToe,
I’m not defending DUK’s advice, so please don’t jump down my throat, but I can give you one – admittedly very small and totally unrepresentative – example of people who can’t go totally low-carb: elite athletes with Type I.
They will typically eat a carb-laden breakfast to give them slow release energy throughout morning training, and again at lunch if they have more training or a match in the afternoon.
However, most of them don’t eat carbs in the evening (after about 7pm) because the body doesn’t metabolise carbs well when asleep and carbs suppress the action of cortisol, which is the hormone that helps us wake up in the morning.
John – hope I’ve got the science right here. I work with elite athletes but not from a nutritional point of view.
July 2, 2008 @ 4:21 pm
Hi Rob - interesting point.
I was reading Lauren Cordain’s Paleo Diet for Athletes the other day and he actually recommends athletes broadly follow the paleo diet but ingest refined carbs at key points through the day to restore glycogen levels
This approach was only proposed for athletes following a program of heavy training and on consecutive days (regardless of whether they had diabetes).
Cheers,
July 2, 2008 @ 6:44 pm
I wondered what John Briffa thought of ‘The Diet Delusion’ by Gary Taubes that Sally Taylor recommended. Do you think it a book worth buying?
July 2, 2008 @ 7:01 pm
Catherine Collins you are doing it again; ascribing something to me that I didn’t in fact do. I didn’t advise you to take Sucroguard or any other vitamins, why on earth would I do that?
Nice try BUT…Catherine said “especially as the above reference again quotes the common finding that human diabetics have twice the blood manganese levels of non-diabetics.” – you have quoted from one Nigerian study that is not exactly representative of type 2 diabetes patients in the UK or US eating a SAD-type diet. Could it be that Nigeria has higher levels of manganese in their water? Could it be that diabetics in Nigeria are less well controlled and have a higher water intake (and therefore higher manganese intake) due to hyperglycaemia-driven thirst?
“The median manganese concentrations were similar in Sweden, Hungary, and Guatemala at 3–4 μg/L. In Zaire and Nigeria, the median manganese concentrations were slightly higher—11 and 16 μg/L”.
Rather an elephant-like confounding factor in your “evidence” that the UCP-2/oxidative stress model is “disproven”. Oxidative stress as a factor in type 2 diabetes has demonstrated so frequently I am amazed someone that claims to read the literature can possibly dismiss it.
Here’s a more recent study from Pakistan (1): “The results of this study showed that the mean values of Zn, Mn, and Cr were significantly reduced in blood and scalp-hair samples of diabetic patients as compared to control subjects of both genders (p < 0.001).” But I guess you missed that one huh Catherine? But that is not really representative either. All this demonstrates is that geographical differences may play a role and that you can’t cherry pick one study and generalise the findings (shame on you). Turkey – higher manganese in diabetics, Austria – lower, so really …
(1) http://tinyurl.com/6ct2yg
July 2, 2008 @ 8:36 pm
SkepTicTacToe wrote (message 58):
“I must point out that by going ‘paleo’, Anna (#9) seems to have removed her need for medication completely, Glenice (#15) has reduced her medication significantly - and has achieved results she was otherwise unable to, following the advice of Diabetes UK. The same goes for Anne (#18), who found that following the dietary recommendation of Diabetes UK her ” blood glucose levels rise too high and stay that way 2 hours post prandial.” Christine’s position (#20) on Diabetes UK dietary advice is similar also. None of them seem to have taken “Briffa’s patented snake-oil” ”
I’m Anne from message number 18, and that’s correct that following the dietary recommendations of Diabetes UK did make my blood glucose levels rise too high. I discovered Dr Briffa’s website well after my diagnosis of diabetes and well after I discovered what foods helped my diabetes and what didn’t. I enjoy a Paleo diet but without much fruit as fruit raises my blood glucose.
Shortly after my diagnosis of diabetes (type 2) I had a consultation with the dietician attached to my GP’s practice and the advice she gave was to show me Diabetes UK’s little booklet and recommended that I follow it, plus she recommended that I eat dried apricots to give me extra calcium…dried fruit for a diabetic ! The mind boggles. In my naivety I wrote a letter of complaint to my GP about the dietician and her dreadful advice, the first and only time I have ever written a letter of complaint about a medical professional. Later, my endocrinologist revealed to me the current thinking - he said I should eat more carbohydrates, and, to cover the blood sugar rises I would get from those carbohydrates, he prescribed me a diabetes medication. I really don’t get this kind of logic at all.
I am not overweight, I have never been. I do exercise, in particular weight lifting exercise, and I have no problems getting energy when I go to the gym. I eat some high protein food which is just what my muscles need, both before and afterwards. One’s body makes any glucose it needs from proteins (gluconeogenesis) and from the store that is in the liver which is replenished from what little carbohydrates I do eat (veggies) plus protein metabolism…that’s my understanding of the chemistry of it, but I always have tons of energy and my blood glucose levels are stable with this way of eating.
The doctor who has most influenced me is Dr Richard Bernstein of http://www.diabetes-book.com/ BUT I must stress that I had discovered which foods did and which foods didn’t affect my blood glucose adversely before I discovered Dr Bernstein’s book and website, I discovered this all by taking my blood glucose measurements after eating various foods with my little meter. Anyone can do that and see what’s going on. If only more diabetics would do this I’m sure they would learn lots and help themselves….I’ve met diabetics who just parrot what Diabetes UK says about a ‘healthy diet’, yet their HbA1c’s are high and they never test their blood. Btw, my HbA1c is 5.3.
Anne
July 2, 2008 @ 8:54 pm
sally (and dr briffa)
would you like to suggest an approximate diet for diabetics and explain the substantial difference between your proposal, and ’standard’ advice to diabetics?
July 2, 2008 @ 11:58 pm
superburger,
Dr Bernstein recommends the following amount of carbs - 6g for Breakfast and 12g for lunch and dinner = total 30g for the day.
You can read some of the chapters of his book online here:
http://www.diabetes-book.com/readit.shtml
Also, an article from Bernstein re the ACCORD Study and ADA:
http://www.diabeteshealth.com/read/2008/03/26/5701.html
July 3, 2008 @ 1:46 am
dr bernstein is free to advise what he likes.
It would be nice if you could provide some sort of peer reviewed reference for some diet that you would advise diabetics. Then highlight the differences between this advice and D-UK adivce.
July 3, 2008 @ 3:15 pm
To address the question posed by Superburger, I believe a ‘paleo’ diet, as has been suggested already by various posts (see http://paleodiet.com/ for info), or the best approximation we can get to it in this day & age, is what’s required to maintain or re-establish good health in anyone.
Man is not designed to eat any other way. It is common sense that the more we deviate from that path, the more our health will suffer. And the evidence is all around us. If conventional beliefs regarding diet were correct, the incidence of chronic disease in Westernised societies would be falling, not increasing.
The clear difference between this view and the standard advice to diabetics is both the quantity and the quality of carbohydrate, fat and protein that is recommended - and the precise ratios of these macronutrients should be tailored to an individual’s needs.
There is an awful lot uttered about diet but I believe the subject is overcomplicated by the ‘experts’. And therein lies the problem. People are confused by conflicting advice from doctors, dieticians, nutritionists, diet gurus, et al. Surely the right basic diet for mankind can be distilled into simple principles - we need to eat REAL food, not manufactured substitutes, and preferably that which is not inherently toxic if it were to be consumed raw. Perhaps a useful rule of thumb might be the closer a food resembles its natural state, the better it is for us, and the longer it can remain in a cupboard without spoiling, the worse it is for us.
Now, I’m sure there are those who will come up with exceptions to these rules, and some may even be valid, but the point I’m making is that we have to simplify it so every man, woman & child can grasp the facts of what constitutes a healthy diet.
Our lifestyles are so far removed from nature that we’ve lost sight of these basic truisms. Our obsession with convenience foods has been compounded by experts’ advice to increase our intake of processed carbs. But how can anyone who claims an understanding of nutrition seriously believe that a diet of bread, pasta, breakfast cereals, etc, provides the quality of fuel our bodies need to operate, repair and regenerate efficiently & effectively - let alone stabilise blood sugar?!
As far as diabetics are concerned they must be encouraged to take control of their health, just as others on here have successfully done, rather than trusting to experts. Use those BS monitors throughout the day and see what happens when standard dietary advice is followed. And should anyone want to try an alternative approach these two books contain all the supporting information needed: ‘Dr Bernstein’s Diabetes Solution: Complete Guide to Achieving Normal Blood Sugars’, and ‘Atkins Diabetes Revolution: Control Your Carbs to Prevent and Manage Type 2 Diabetes’.
Sally
July 3, 2008 @ 6:32 pm
Superberger,
Show me a peer reviewed diet for the Standard Diabetic Diet as advocated by Diabetes UK that produces stable blood sugars and good health. You will not find such evidence for a type 2 diabetic who manages their condition by diet and exericse alone - or if you do it will be very much the exception to the rule.
The same is almost certainly true for a type 1. Just for clarity, I would regard stable control as a hba1c around or below 5, with no, or very few episodes of hypoglycemia. The diabetes target of 7 is far too high and all but guarantees the developmnet of diabetes related complications.
Very few people argue that Dr Bernsteins regime doesn’t work. The main criticism levelled against it is that is austere, too restrictive and that many patients won’t comply with it. I would suggest that patients should be made aware that this is an approach that they might wish to consider and adopt: better to have a good quality of life on a restricetd diet than eat a high carb diet and suffer from a host of long term complications.
Paul.
July 4, 2008 @ 12:19 am
that’s not an answer to my question sally.
July 4, 2008 @ 8:21 am
interesting review
Diabetes Care 25:148-198, 2002
from the summary
“With regard to the glycemic effects of carbohydrates, the total amount of carbohydrate in meals or snacks is more important than the source or type.”
“Although the use of low–glycemic index foods may reduce postprandial hyperglycemic, there is not sufficient evidence of long-term benefit to recommend use of low-glycemic index diets as a primary strategy in food/meal planning.”
“Carbohydrate and monounsaturated fat should together provide 60–70% of energy intake. However, the individual’s metabolic profile and need for weight loss should be considered when determining the monounsaturated fat content of the diet.”
“The long-term effects of diets high in protein and low in carbohydrate are unknown. Although such diets may produce short-term weight loss and improved glycemia, it has not been established that weight loss is maintained long-term. The long-term effect of such diets on LDL cholesterol is also a concern.”
“Standard weight-reduction diets, when used alone, are unlikely to produce long-term weight loss. Structured, intensive lifestyle programs are necessary.”
“There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes who do not have underlying deficiencies. Exceptions include folate for prevention of birth defects and calcium for prevention of bone disease.”
“Routine supplementation of the diet with antioxidants is not advised because of uncertainties related to long-term efficacy and safety.”
so, that’s a fairly long review which seems to bear out many of the key points of the D-UK diet. It also casts doubt on some of the low-carb high protein diets and “GI” based diets (although, of course, the evidence may change) and it certainly rules out vitamin supplements (including dr briffa’s formullation?)
I would stress that this is a review of other peer reviewed work, and has itself been peer reviewd. Some recommendations carry less weight than others (particulary the 60-70% carb advice, which i think is where some people’s confusion arises from) - although fwiw suspect the caveat that all dietry choices should be supervised by dieticians/physicians and that individual metabolism and (any) need for weight loss are most important.
So it remains to be seen if sally, dr briffa, paul anderson et al can offer a good evidence based alternative to the standard diabetic diet and in particular if dr briffa would like to justify his formulation of SucroGuard in the light of this work.
July 4, 2008 @ 3:13 pm
can i just ask what qualifications sally taylor has as regards nutrition? not an aggressive question, but i was wondering if you just take the paleo diet as read or have some grounding in biochemistry, nutrition, etc
Thanks.
July 4, 2008 @ 4:20 pm
superburger - here is an answer for you: http://www.sciencedaily.com/releases/2007/06/070627225459.htm
But I’ve copied and pasted it below in case you don’t want to go to the link. The “Mediterranean-like prudent diet” that was compared to the Paleolithic ‘Stone Age’ diet (Paleo) is the type of diet Diabetes UK recommends.
Original Human ‘Stone Age’ Diet Is Good For People With Diabetes, Study Finds
ScienceDaily (June 28, 2007) — Foods of the kind that were consumed during human evolution may be the best choice to control diabetes type 2. A study from Lund University, Sweden, found markedly improved capacity to handle carbohydrate after eating such foods for three months.
During 2.5 million years of human evolution, before the advent of agriculture, our ancestors were consuming fruit, vegetables, nuts, lean meat and fish. In contrast, cereals, dairy products, refined fat and sugar, which now provide most of the calories for modern humans, have been staple foods for a relatively short time.
Staffan Lindeberg at the Department of Medicine, Lund University, has been studying health effects of the original human diet for many years. In earlier studies his research team have noted a remarkable absence of cardiovascular disease and diabetes among the traditional population of Kitava, Trobriand Islands, Papua New Guinea, where modern agrarian-based food is unavailable.
In a clinical study in Sweden, the research group has now compared 14 patients who were advised to consume an ‘ancient’ (Paleolithic, ‘Old stone Age’) diet for three months with 15 patients who were recommended to follow a Mediterranean-like prudent diet with whole-grain cereals, low-fat dairy products, fruit, vegetables and refined fats generally considered healthy. All patients had increased blood sugar after carbohydrate intake (glucose intolerance), and most of them had overt diabetes type 2. In addition, all had been diagnosed with coronary heart disease. Patients in the Paleolithic group were recommended to eat lean meat, fish, fruit, vegetables, root vegetables and nuts, and to avoid grains, dairy foods and salt.
The main result was that the blood sugar rise in response to carbohydrate intake was markedly lower after 12 weeks in the Paleolithic group (–26%), while it barely changed in the Mediterranean group (–7%). At the end of the study, all patients in the Paleolithic group had normal blood glucose.
The improved glucose tolerance in the Paleolithic group was unrelated to changes in weight or waist circumference, although waist decreased slightly more in that group. Hence, the research group concludes that something more than caloric intake and weight loss was responsible for the improved handling of dietary carbohydrate. The main difference between the groups was a much lower intake of grains and dairy products and a higher fruit intake in the Paleolithic group. Substances in grains and dairy products have been shown to interfere with the metabolism of carbohydrates and fat in various studies.
“If you want to prevent or treat diabetes type 2, it may be more efficient to avoid some of our modern foods than to count calories or carbohydrate,” says Staffan Lindeberg.
This is the first controlled study of a Paleolithic diet in humans.
Adapted from materials provided by Lund University.
July 4, 2008 @ 4:41 pm
Why do people who would not conceivably endorse creationism, still seem to think that carb diets are God-given?
July 4, 2008 @ 6:55 pm
Superburger (#72), I am interested in a quote from the your extract above:
“The long-term effects of diets high in protein and low in carbohydrate are unknown.”
Notwithstanding that the paleo approach is specifically low in refined carbohydrate rather than simply being low in carbohydrate, I think a little look at history will tell us all we need to know about the benefits of such a diet - it is a template for our ancestral nutrition. Also, a look at the health of hunter-gatherer tribes around the world will also add to anecdotal evidence. However, I will agree that yes, there does need to be some formal long-term research.
“Although such diets may produce short-term weight loss and improved glycemia, it has not been established that weight loss is maintained long-term.”
I have yet to see evidence of obesity in hunter gatherer populations who follow their traditional ‘paleo’ eating patterns. (Conversely I have seen a lot of morbid obesity in populations who have moved to a conventional western diet in the last century. I have also seen the same people fail to lose weight following conventional low fat high and high complex-carb nutritional advice). I lost body fat (I am down to well under 10% BF) by eating ‘paleo’. This has been a two-year state of affairs - anecdotal evidence, but I am one of MANY people who expericen such dramatic, sustainable and effective drops in BF (note I say bodyfat NOT weight).
“The long-term effect of such diets on LDL cholesterol is also a concern.”
This line concerns me as I suspect this statement is NOT based on medical science and I have yet to see ANY evidence that a paleo diet has a negative effect on LDL. In the last two years I have had two cholesterol tests (once of which was compared against the Framingham template). They both came back with ‘No Further Action’ - ie, my cholesterol was fine - even after over a year eating paleo. In fact Cordain contends that paleo diets improve LDL profiles (also evident in the Masai):
http://www.thepaleodiet.com/articles/Am%20J%20Cardiol%202006.pdf
I still wouldn’t eat SucroGuard though!
July 4, 2008 @ 7:46 pm
couple of comments, anne.
Firstly sciendaily is not a source of peer reviewed leiterature. it’s an online newspaper.
I think i’ve tracked down the work that you refer to (doi: 10.1007/s00125-007-0716-y) I’m sure you’ve read it too…..
Interesting - but bear in mind the following - it was a minute study (total sample size of 29) and all the participants were suffering heart disease (and not all of the sample actually had type II diabetes either) and the study only lasted 12 weeks.
I’m not sure that the conclusions of this work contrast strongly with the conclusion of the review I pointed out, which included
“The long-term effects of diets high in protein and low in carbohydrate are unknown. Although such diets may produce short-term weight loss and improved glycemia, it has not been established that weight loss is maintained long-term. The long-term effect of such diets on LDL cholesterol is also a concern.”
Who knows? Maybe this is the start of a new approach to management of diabetes. Maybe it’s not. The point is that Dr Briffa’s blog post tries to imply some motive for D-UK’s actions when really they seem to be grounded in generally good evidence.
July 4, 2008 @ 8:18 pm
skeptictactoe said
““The long-term effect of such diets on LDL cholesterol is also a concern.”
This line concerns me as I suspect this statement is NOT based on medical science and I have yet to see ANY evidence that a paleo diet has a negative effect on LDL.”
Ref. 204 in the review
J Am Diet Assoc. 1980 Sep;77(3):264-70
July 4, 2008 @ 8:31 pm
What is more relevant, I think, is that there is no evidence whatsoever that the much touted low fat, high carbohyrdate diet results in sustained weight loss. Indeed, as fat consumption has reduced and carbohydrate consumption has increased there has been a steep rise in obesity, and the majority of the UK population is now oveweight. This is in marked contrast with previous generations who ate more fat, red meat, butter, eggs, lard and cheese.
I am not aware of any society where a low carbohydrate diet is consumed where there the population suffers from obesity and other western lifestyle dieseses.
Voluntary starvation, as followed by many people following a reduced calorie low fat dietary regime is almost guaranteed to fail in the long term.
Where are the peer reviewed studies that show a low fat high carb diet results in long term sustained loss - they don’t exist, despite their widespread adoption of this approach by health authorities throughout the world. This doesn’t stop them being recommended for weight loss. It seems to me that double standards are applied when dietitions, etc discuss the effects of low carb diets, and caution about possible long term negative effects of these diets.
Paul.
July 4, 2008 @ 9:16 pm
Hello Adam…
I’ve studied nutritional therapy and nutritional biochemistry both formally and through autonomous learning, but don’t hold a degree in any subject. I’ve practised as a diet therapist, advising clients (as well as other natural health practitioners and some private doctors) on dietary matters relating to health, well-being and nutrition. Why diet therapy? Because, unlike many nutritionists, my approach concentrates on dietary modification to correct underlying imbalances that lead to poor health, rather than on supplements to address specific symptoms.
My original interest stemmed from a personal battle with weight, which was solved when I discovered the Atkins’ Diet seven years ago. Up to that point I ate pretty much the orthodox ‘healthy’ diet, and ended up 3.5-stone overweight. I’ve eaten low-carb ever since, as paleo as is practical for me, and maintained my weight loss. Being the sort who has to know how and why things work, I was driven to study the subject in depth, and study I did, and do.
Both my parents are Type 2 diabetics (hence my particular interest in this area), and both have CVD & arthritis. At 49 years old I have no health problems and more energy than most people half my age. Given my genetic inheritance, I believe I am a good example for others to follow.
Please don’t get me wrong - I’m far from perfect and certainly no earth-mother type. I live in the real world. I lead a busy, stress-filled life and have four school-aged children who, left to their own devices, would subsist on a diet of processed carbs and spend all day glued to a TV / PC. I was moved to post here because I feel passionately that we need to spread the message that our high-carb, convenience food lifestyle is killing us. I’m fed-up with my kids being told at school that a healthy breakfast comprises corn flakes, skimmed milk, orange juice, and toast spread with butter-substitute, jam, marmalade or lemon curd.
So, those are my ‘qualifications’ for daring to voice an opinion that contradicts the establishment line.
And Superburger…
All the references you require are cited in ‘The Diet Delusion’ by Gary Taubes. In my opinion, blinding people with science is what got us into this predicament in the first place. We need to cut the crap and explain the issues in terms that every man, woman and child in the street can understand. However, if you really are interested in the science, rather than in appearing clever, invest £12 and read it. And if you’ve any qualms about accepting my recommendation, look at the reviews on Amazon.
Sally
July 4, 2008 @ 11:14 pm
“I have yet to see evidence of obesity in hunter gatherer populations who follow their traditional ‘paleo’ eating patterns. (Conversely I have seen a lot of morbid obesity in populations who have moved to a conventional western diet in the last century”
First up, how would you propose we could have measured rates of obesity in paleo populations with any degree of accuracy?
Second, would you agree that the abundance of food in the western idiet is probably far higher than our paleo ancestors - couldn’t your supposed rates of obesity in either population be explained simply by higher calorific intake?
July 5, 2008 @ 9:31 am
Groovey,
I think the anwer to you question is no, its not simply a question of higher calorific intake. Some foods are easier to consume over consume than others - you could say, almost addictive, eg sugar, wheat. You are very unlikely, the the other hand to binge on meat, or fish for example, or brocolli or lettuce.
The calorie issue is just too simplistic, in my opinion. You cannot really expect to regulate calories by counting everything you eat. If you think about it a 40 year old who is 1 stone overweight, has accumulated 49,000 surplus calories (stored as fat) during their life to date. That means that, on average they have consumed just over 3 suprlus calories per day on average over their lire to date. If you accept the calories argument, that person would not have gained their weight if they had eating 1997 calories a day, rather than 2000. In theory, if they had eaten 20 calories a day less they would weigh approximately 6 stone less. Do you know anyone who is capable of calculating their calorie intake (and level of activity) with that level of precision.
My suggestion would be that if you eat the correct foods - natural, unprocessed and low GI your body can evolved to regulate weight effectively. On the other hand if you eat processed and high GI foods you body’s weight regulation mechanism will, eventually, go haywire, resulting in weight gain and metabolic disturbances.
If you are in perfect health and at a perfect weight I guess you have found a diet that works for you. If not, why not give it a go for a week or to and see for yourself jow you feel. Even the mainstream medical establishment concede that a low carb approach is effective for short term weight loss and that it is safe to follow in the short term. They have, more or less, had to given to accumulating number of studies indicating its effectiveness.
Paul Anderson.
July 5, 2008 @ 2:12 pm
Also Groovey, the active lifestyle of hunter gatherers (all that hunting and gathering for instance) contrasts markedly with the modern sedentary lifestyle. It would be interesting to know if this confounding factor been taking into account in the research.
(I’d like to see some research on the paelo diet - is there any good quality peer reviewed literature in the public domain?)
July 5, 2008 @ 2:40 pm
sally,
I don’t think i would say I’m blinding you, or anyone else, with science.
You might not like the arguments I present, nor the scientific papers which have been peer reviewed, but i note that you choose not to engage with them, instead claming you are being blinded with science and say that i am trying to ‘appear clever’ by pointing out things which you seem not to agree with.
I would argue a compehensive literature review, peer reviewed, and offering a bullet pointed summary section, written in accesible language, is an excellent way of communicating a complex subject.
It says a lot about the level of debate you are capable of engaging in when, once questioned about the actualy hard evidence for your claims, you can only point to online newspapers, books with positive reviews on amazon! and your own conjecture and anecdote.
You try to point to a piece of work (the Lund Univ study) - when i tracked down the reference and offered some honest criticism you fail to engage with it.
So again, I would ask you to point towards some peer-reviewed evidence that a paleo diet offers a safe, long term solution towards the management of diabetes and why it is better advised than the current recommendations.
July 5, 2008 @ 6:09 pm
“Also Groovey, the active lifestyle of hunter gatherers (all that hunting and gathering for instance) contrasts markedly with the modern sedentary lifestyle. It would be interesting to know if this confounding factor been taking into account in the research. ”
Absolutely Ross.
“My suggestion would be that if you eat the correct foods - natural, unprocessed and low GI your body can evolved to regulate weight effectively. On the other hand if you eat processed and high GI foods you body’s weight regulation mechanism will, eventually, go haywire, resulting in weight gain and metabolic disturbances.”
Fair.
July 5, 2008 @ 8:06 pm
superburger,
Read The Diet Delusion and you’ll see how the current thinking on diet is so infuriatingly wrong.
July 6, 2008 @ 1:24 am
Superburger
The Medical Journal of Australia is a peer-reviewed journal and while this doesn’t substitute for a prospective trial there have been many instances around the world that indigenous peoples derive myriad health benefits from returning to their traditional hunter-gatherer diet.
There is also conflicting evidence as to whether Aboriginal HG diet was/is actually low in fat[1], but that dispute aside:
“OBJECTIVE: To examine the published data on the impact of westernisation on obesity, non-insulin dependent diabetes mellitus (NIDDM), and coronary heart disease (CHD) in Australian Aborigines. DATA SOURCES: Fifty-five articles from Australian and international sources (primarily peer-reviewed journals) are cited. STUDY SELECTION: Twenty-eight reports providing data on the diet, lifestyle, health and “lifestyle diseases” of Australian Aborigines before and after westernisation are included in this review. A further 27 articles on obesity, NIDDM, CHD, insulin resistance, and the impact of diet and exercise were used to help interpret the Aboriginal data. DATA EXTRACTION: Information on dietary composition, anthropometry, disease and risk factor prevalence, and relevant biochemical measurements were used for comparative and interpretive purposes. DATA SYNTHESIS: The traditional hunter-gatherer lifestyle of Australian Aborigines, characterised by high physical activity and a diet of low energy density (low fat, high fibre), promoted the maintenance of a very lean body weight and minimised insulin resistance. In contrast, for most Aborigines a Western lifestyle is characterised by reduced physical activity and an energy-dense diet (high in refined carbohydrate and fat) which promotes obesity and maximises insulin resistance. When they make the transition from their traditional hunter-gatherer lifestyle to a westernised lifestyle, Aborigines develop high prevalence rates for obesity (with an android pattern of fat distribution), non-insulin dependent diabetes, impaired glucose tolerance, hypertriglyceridaemia, hypertension and hyperinsulinaemia. The striking improvements in carbohydrate and lipid metabolism in diabetic and non-diabetic Aborigines after a temporary reversion to a traditional hunter-gatherer lifestyle highlight the potentially reversible nature of the detrimental effects of lifestyle change, particularly in young people who have not yet developed diabetes. CONCLUSION: It is suggested that insulin resistance was important to the survival of Aborigines as hunter-gatherers, but is also the underlying metabolic characteristic predisposing them to obesity, NIDDM and CHD after westernisation. Intervention strategies to prevent chronic diseases related to insulin resistance should be directed at lifestyle modification. To be effective such programmes will have to be developed and implemented at the community level.”[2]
Furthermore, intervention studies in these populations that promoted low fat, high carbohydrate diet were successful in reducing “risk factors” like hypercholesterolaemia, hypertension etc. but did not reduce diabetes prevalence.[3]
1. Brand-Miller, J., Holt, S, Australian Aboriginal plant foods:a consideration of their nutritional composition and health implications. Nutr Res Rev, 1998. 11: p. 5-23.
2. O’Dea, K., Westernisation, insulin resistance and diabetes in Australian aborigines. Med J Aust, 1991. 155(4): p. 258-64.
3. Rowley, K.G., et al., Improvements in circulating cholesterol, antioxidants, and homocysteine after dietary intervention in an Australian Aboriginal community. Am J Clin Nutr, 2001. 74(4): p. 442-8.
July 6, 2008 @ 3:40 am
Hi Superburger,
You wrote:
“Firstly sciendaily is not a source of peer reviewed leiterature. it’s an online newspaper.”
I was looking for the original study, I read it when it first came out, but since I couldn’t find it the other day for you, that’s why I used Scienedaily.
And you wrote:
“Although such diets may produce short-term weight loss and improved glycemia, it has not been established that weight loss is maintained long-term.”
I don’t believe weight loss should be brought into this discussion. We’re talking about glycaemic control. Yes I know lots of type 2 diabetics are overweight, but there are type 2’s who are thin. I am a type 2 diabetic who is thin and I’ve always been thin. Weight is not an issue for me or other thin type 2’s, it is glycaemic control that is the only issue. A low carb Paleo diet keeps my blood glucose very well controlled, the Diabetes UK type diet raises my blood glucose…I know I’ve checked my blood sugar after eating the complex carbohydrates so highly recommended by Diabetes UK.
I don’t know why I developed diabetes but I would guess that it could well be the Diabetes UK type diet that did it. For years and years before my diagnosis I followed the high complex carbohydrate diet that is recommended as being so healthy. I not only ate wholemeal bread I made it. I made all my own bread, and yoghurt,….I was a real fan of that kind of diet. I’d eat brown rice, wholewheat pasta, wholewheat bread, other whole grains, lots of fruit and vegetables, not much meat and only low fat things and in exactly the proportions recommended by Diabetes UK ! In theory I should never have developed diabetes following that kind of diet !
Anne
July 6, 2008 @ 11:41 am
cathy - interesting work you point to - although I would say that the change of lifestyle (high to low physical activity) could be as, or more important than dietary factors. There is nothing in their description of “low fat, high fibre” coupled with high physical activity that contradicts the recommendations made by D-UK. Plus there is the obvious possibilty of genetic differences between australin aborignes and UK population.
Anne - not sure the relevance of your personal anecdote here - you still haven’t engages with any substantial point i have made. Glad your diabetes is well managed though.
July 6, 2008 @ 7:41 pm
>>Dr B - I don’t think you answered Andy’s question - “Would Dr. Briffa like to suggest foods containing carbohydrates that are not disruptive to blood sugar levels?”
Non-starchy vegetables
July 6, 2008 @ 9:59 pm
Thank you Michael
“Would Dr. Briffa like to suggest foods containing carbohydrates that are not disruptive to blood sugar levels?”
Do you think that a fundamental ignorance of nutritional matters (as demonstrated by a failure to be able to answer this question) is behind why some seem not to be able to accept that Diabetes UK’s dietary advice is woefully inadequate and potentially detrimental to health?
July 6, 2008 @ 10:14 pm
it is you that failed to answer, dr briffa!
would you, personally, care to name a “non-starchy” vegetable that is also a significant source of carbohydrate - and will not affect blood sugar?
you’ve also not been able to describe an alternative diet, differing from the broad advice of D-UK, which would suit diabetics better. In particular, it would be interesting if you were able to offer the reasons why the recommendation in this review are incorrect.
Diabetes Care 25:148-198, 2002
the recommendations in which are generally the same as offered by D-UK.
July 6, 2008 @ 10:42 pm
>>Research has shown that by reducing carbohydrate consumption, the amount of fat they eat tends to increase drastically, particularly saturated fat.
um.. Two Points!
1. Please provide links to this research.
2. Please show that fat and/or saturated fat in a low carbo diet is a problem.
Seriously, it does appear that saturated fat and a high carbo diet is an evil combination.
I have seen NO EVIDENCE that saturated fat is a problem in a low carbo diet. None.
If any of the dieticians lurking here can point to any studies showing problems with saturated fat in very low carbo diets, I would like to see the studies.
The common pattern in low carbo diets is a drastic fall in Triglycerides, a significant rise in HDL and improvement in LDL particle size.
See:
http://jn.nutrition.org/cgi/content/full/135/6/1339
To all the dietitians lurking here - Yes, we all know what you were taught in school.
The point is that we don’t believe it.
Low-carb has certainly improved my BG control.
Nobody can produce evidence that increasing carb intake would reduce blood sugar levels.
Low-carb has also drastically improved my lipid profile.
Triglycerides dropped from 300 to 88
HDL improved from 38 to 61
LDL has dropped and more significantly LDL particle size has increased.
If saturated fat is still a demon, I don’t understand how.
I am very open to a science based, evidence backed discussion supporting what you dietitians were taught in school.
Links to current studies would help illuminate the discussion a lot more than just repeating the standard low-fat dogma.
Thanks,
Michael
July 6, 2008 @ 11:13 pm
“It is telling that all the “refutations” of Dr. B’s post are ad hominem - they attack the man by pointing out that he is not specially trained in appreciating the emperor’s clothes.”
AC - care to give an example?
July 6, 2008 @ 11:16 pm
>>Do you think that a fundamental ignorance of nutritional matters (as demonstrated by a failure to be able to answer this question) is behind why some seem not to be able to accept that Diabetes UK’s dietary advice is woefully inadequate and potentially detrimental to health?
What gets these folks upset is your acceptance of evidence rather than current low-fat dogma.
So, to answer your question, it seems more like willful ignorance than fundamental ignorance.
Dr. B, does it ever get lonely to be the one pointing out that the emperor has no clothes?
July 6, 2008 @ 11:29 pm
Superburger I am sure physical activity plays a role but why avoid the issue of glycaemic load?
The same authors I quoted above took issue with that review’s conclusions being incorporated into the ADA’s position statement:
“Recently, the American Diabetes Association published the following statement: “”with regard to the glycemic effects of carbohydrates, the total amount of carbohydrate in meals and snacks is more important than the source or type” (1). However, the revised glycemic index (GI) table published in the July 2002 issue of the Journal (2) indicates that even when foods contain the same amount of carbohydrate (ie, carbohydrate exchanges), there are up to 10-fold differences in the glycemic effect among them. Moreover, prospective observational studies found that the risk of developing diseases of affluence (eg, type 2 diabetes, cardiovascular disease, and some cancers) is independently related to the overall dietary GI and glycemic load (GL), but not to the total carbohydrate content (3).”
http://tinyurl.com/5bqzv7
The review dismisses post-prandial glucose excursions as unimportant; I find this incredible in light of the fact that post-prandial glucose excursion is a stronger predictor of macrovascular complications and mortality than fasting plasma glucose. http://tip.org.pl/pamw/issue/article/56.html
Given that so