By Dr David Unwin
A few years ago Dr David Unwin stumbled upon the website for patients with diabetes – diabetes.co.uk - fairly easily confused with the official diabetes charity site diabetes.org.uk It was a revelation. “It had over 100,000 members and one of the most popular topics was the low carb high fat diet,” he says. “I was very impressed and moved by the stories of patients who had benefited and with the quality of the discussion. Some of the people posting were really well-informed.”
A search on diabetes.co.uk revealed that the low carb success stories on the site had over 81,000 views. “That reflects a level of popularity that was just being ignored by official sources,” he said. It still is.
It was a world away from what he had been taught was the best diet for type 2 diabetes – one based on carbohydrates that was then and still is promoted by diabetes.org. What he found out there changed the way he treated his diabetic patients. “Before I’d be much more likely to take the fairly conventional approach of warning patients that if they didn’t control their blood sugar with diet they would have to go on drugs. As for losing weight that wasn’t really my field so I’d send them to the dietitian.”
Since then he’s run a small pilot study with 19 type 2 diabetic patients from the practice who were following the low carb diet, which was published last year. He calls the results “hugely promising’ and writes about them below. The process of researching the diet and discussing it with his patients has had a big impact on Dr Unwin’s practice and had his team as finalists in the 2014 BMJ (British Medical Journal) diabetes team of the year.
“People appreciated that we tried very hard to make clear why the diet could help them reach their goals. We found it was more effective to spend time on personal goals than being too prescriptive about the diet itself.”
He’s now is so proactive on the diet front that he is not only on the low carb high fat diet himself, along with several other members of his team, but he attends regular sessions where his dieting patients share their successes and swap tips. ‘The big topic last week was Christmas and how to stop it turning into a high carb sugar fest and a weight gain disaster.
“Now I collaborate with diabetic patients on their problems with weight. I ask them about their goals and what they hope to achieve. If I get involved with what they are doing they often surprise me with what they can achieve. It gets much better results than the other way.”
Editor – HealthInsightUK.org
Dr Unwins’s Post
My work formed the basis of an article published in the March 2014 edition of Practical Diabetes. The title reads:
‘Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes and pre-diabetes: experience from one general practice’
There follows an abstract and also the diet sheet we are still using; the full article can be accessed here.
I am not a diabetic but have been on the diet for about two years now. I started it as a gesture of support for my patients but find I am more alert and need less sleep on it. Surprisingly it seems to help me run faster too! I recently finished a 10 K road run in less than 46 minutes, my best time for years.
Since writing the article my practice has been given a small grant which means we have now helped 37 people with type two diabetes. Interestingly the results are very similar to our original cohort including the improved cholesterol, despite a diet higher in fat which makes one wonder…
Another surprise was that the results of a test for fatty liver disease showed that the risk had dropped. The conventional explanation for an increased level is drinking too much.. The fact it dropped when carbohydrates were reduced suggested they might well be contributing to the problem. I’m working on a paper on this at the moment.
Diabetics have long been exhorted to give up sugar and encouraged to take in complex carbohydrate in the form of the starch found in bread and pasta (especially if ‘wholemeal’). In fact bread should be seen as concentrated sugar which explains why it has a higher glycaemic index than table sugar itself. As there are no essential nutrients in starchy foods and diabetics struggle to deal with the glycaemic load they bring, we question why they need form a major part of their diet at all.
The recent increase in screening in general practice along with epidemic of ‘central obesity’ is revealing large numbers of pre-diabetics and diabetics (diabesity). At a time when there are questions about drug safety, which diet is best is of particular importance. Many patients are already experimenting with the ‘low carb’ approach as it is so widely advocated on the internet. We wanted to see how effective and well tolerated it was.
A series of 19 type 2 diabetics and pre-diabetics volunteered to go on a low carbohydrate diet backed up with ten minute one-to-one sessions with a GP or practice nurse, and regular group education. After 7 months only one had dropped out, of the rest all had significant weight loss (average 8.63 Kg) and the average HbA1c was down from 50.68 to 39.9. Despite the higher fat intake on this diet the cholesterol dropped and liver function improved for nearly all participants.
We conclude this approach is easy to implement, brings rapid weight loss and improvement in HbA1c using a diet that the great majority of patients find easy to live with.
The following diet sheet was used in my practice with all patients who agreed to take part – always check a new diet out with your doctor to ensure it’s safe.
So what should I eat to control my weight?
Patient diet sheet.
Reduce starchy carbs a lot (remember they are just concentrated sugar). If possible cut out the ‘White Stuff’ like bread, pasta, rice – though porridge, new potatoes and oat cakes in moderation may be fine. Sugar – cut it out altogether, although it will be in the blueberries, strawberries and raspberries you are allowed to eat freely. Cakes and biscuits are a mixture of sugar and starch that make it almost impossible to avoid food cravings; they just make you hungrier!!
All green veg/salads are fine – eat as much as you can. So that you still eat a good big dinner try substituting veg such as broccoli, courgettes or green beans for your mash, pasta or rice – still covering them with your gravy, Bolognese or curry! Tip: try home-made soup – it can be taken to work for lunch and microwaved. Mushrooms, tomatoes, and onions can be included in this.
Fruit is trickier; some have too much sugar in and can set those carb cravings off. All berries are great and can be eaten freely; blueberries, raspberries, strawberries, apples and pears too, but not tropical fruits like bananas, oranges, grapes, mangoes or pineapples.
Proteins such as in meat, eggs, fish – particularly oily fish such as salmon, mackerel or tuna are fine and can be eaten freely. Plain full fat yoghurt makes a good breakfast with the berries. Processed meats such as bacon, ham, sausages or salami are not as healthy and should only be eaten in moderation.
Fats (yes, fats can be fine in moderation): olive oil is very useful, butter may be tastier than margarine and could be better for you! Coconut oil is great for stir fries. Four essential vitamins A, D, E and K are only found in some fats or oils. Please avoid margarine, corn oil and vegetable oil. Beware ‘low fat’ foods. They often have sugar or sweeteners added to make them palatable. Full fat mayonnaise and pesto are definitely on!!
Cheese: in moderation – it’s a very calorific mixture of fat, and protein.
Snacks: avoid. But un-salted nuts such as almonds or walnuts are great to stave off hunger. The occasional treat of strong dark chocolate 70% or more in small quantity is allowed.
EATING LOTS OF VEG WITH PROTEIN AND FATS LEAVES YOU PROPERLY FULL IN A WAY THAT LASTS
Finally, about sweeteners and what to drink – sweeteners have been proven to tease your brain into being even more hungry making weight loss almost impossible – drink tea, coffee, and water or herb teas. I’m afraid alcoholic drinks are full of carbohydrate – for example, beer is almost ‘liquid toast’ hence the beer belly!! Perhaps the odd glass of red wine wouldn’t be too bad if it doesn’t make you get hungry afterwards – or just plain water with a slice of lemon.