People with diabetes have been lowering daily intake of carbohydrate as a means to achieve better diabetes control for years but, despite many enjoying great success with this, lower carbohydrate diets have yet to receive large scale advocation from health organisations such as the NHS.
Throughout the 21st Century, as was the case in much of the latter half of the 20th Century, the focus of the Department of Health’s recommendations has been to follow a low fat, so called balanced diet. The US Department of Agriculture developed a ‘food pyramid’, which advised starchy carbohydrates to be the foundation of the diet, and the UK recommendations followed suit.
However, as a number of commentators have pointed out, it has been over this period that BMI values have risen consistently to the point whereby being of normal weight in middle age has now become distinctly abnormal.
Why have low carb diets been ignored?
Arguably, one of the biggest problems in low carb not being adopted is that health organisations have based their views on low carb diets by looking at the most extreme and least balanced examples.
Mention low carb diet and many people will think ‘Atkins diet’ and imagine a diet full of bacon and sausages with no vegetables within sight –a view that comes from the fact that some low carb diets, such as the Atkins Diet start off with a short but extreme induction phase.
Health organisations have therefore written off low carb diets as extreme despite the fact that the kind of low carb diets being followed around the world by people with diabetes are frequently well balanced and far from extreme.
Another reason, frequently cited by health organisations, for not recommending low carb diets is on the basis of little evidence of long term safety. This point has been derided by some critics as low fat diets were adopted as the primary recommended diet without having demonstrated long term safety either.
In fact, if you look into the results of research into low fat safety, you’ll soon come across the Women’s Health Initiative Dietary Modification Trial which reviewed, over an 8 year period, whether a low fat diet would help women lose weight and protect against heart disease. The results were judged to be disappointing as the low fat diet showed no evidence of helping with weight loss or in reducing incidence of heart disease.
What does research say about low carbohydrate diets?
With the ‘lack of long term safety’ being frequently cited as the reason for not recommending low carb diets, researchers have been keen to test whether or not low carb diets show longer term safety. Note that because long term dietary studies involve keeping large numbers of participants on one diet for a number of years they are neither easy nor cheap to undertake.
In 2008, a two year study found low carb and Mediterranean diets to both outperform a low fat diet in terms of both weight loss and in improving cholesterol and triglyceride levels.
In terms of studies into low carb diets in people with diabetes, in April 2014, results were published of an 8 year study which showed that a low carb Mediterranean diet was more successful than an equal calories low fat diet. The low carb diet outperformed the low fat diet in terms of HbA1c, better adherence and longer length of time before needing to go onto diabetes medication.
Recent research is also mounting in favour of making a distinction between sources of saturated fat. For decades, the saturated fat in dairy and meat products has been grouped as being as unhealthy as the saturated fat found in processed foods such as crisps, pastries and biscuits. This association has resulted in the food industry and health organisation becoming obsessed with low or zero fat dairy products.
Suffice to say, research doesn’t support the notion that whole milk is a health risk. In September 2014, a notable Swedish study showed that full fat dairy was associated with a 23% lower risk of type 2 diabetes over a 14 year period.
Research has also shown benefits in terms of type 1 diabetes control. A Swedish study from 2012 showed that good adherence to a low carbohydrate diet resulted in lasting improvements in HbA1c levels over a 4 year period and evidence of improvement in terms of cholesterol levels.
When will recommendations catch up with the science?
There is evidence that the message is getting through -albeit slowly. In 2013 the American Diabetes Association released a position statement recognising that a low carb diet has benefits and is a legitimate choice of diet, along with low fat and Mediterranean diets, for helping with weight loss and type 2 diabetes management.
In the UK, Diabetes UK have recently toned down their previous advice, which was to eat plenty of starchy carbohydrates at each meal, and now focus on choosing an appropriate amount of carbohydrate based upon a number of factors such as your age, activity level and whether you are looking to weight or need to improve your blood glucose levels.
Diabetes UK still regard saturated fat as a form of fat that should be avoided and make no distinction between the saturated fat found in dairy and meat and the saturated fat used in processed foods. We will need to wait and see whether Diabetes UK will update their advice with regard to the different sources of saturated fat in the future.
The X-PERT diabetes programme, which is one of the structured diabetes education courses offered to people with diabetes on the NHS, has recently embraced the low carb high fat diet and lifestyle, having recently issued a new handbook entitled ‘Eat Fat – Step-by-Step Guide to Low Carb Living’. Dietitian, Founder and Chief Executive of X-PERT, Trudi Deakin has this week made headlines in stating that she follows an 82% fat diet (including plenty of vegetables) and her life is all the healthier for it.
In terms of advice from the NHS for the general population, despite more and more studies calling the long term health effects of low fat diets into question, there has been little in the way of noticeable change away from the low fat approach. However, if lengthy and well run studies continue to show benefits of low carb diets and high-profile health practitioners continue to advocate the low carb lifestyle, we may yet see a change in the general diet advice for the UK.
Want to get ahead of the recommendations?
Dr David Cavan has written a comprehensive step-by-step plan to control type 2 diabetes in association with Diabetes.co.uk. Reverse Your Diabetes fits in with the scientific evidence showing low carbohydrate diets to be helpful in controlling and even reversing type 2 diabetes. The book guides you, one step at a time, through adapting your diet and lifestyle to most effectively adopt a low carbohydrate approach and take control of your diabetes with reduced dependence on medication.