At last in the British Medical Journal !!

tim2000s

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I congratulate you on your article. I am an english GP and I too advocate a low carbohydrate diet for weight loss and type 2 diabetes. I hate the feeling that I am risking censure for recommending a diet based on 'real food' . I know it works having lost weight on it mysef, and also feeling so much more healthy.
I think this is what people don't understand in relation to the care that you guys provide. It's totally wrong that by recommending something that in the worst case is going to have no effect, but in many cases (and more evidence is coming to the fore that it does) will have significant effect and should improve health by providing better nutrition can cause you this level of punishment.
 
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GeoffersTaylor

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As I mentioned at the start there is a real chance for any of you to have your thoughts published under the 'rapid responses' option that occurs by the artical This is not just for doctors and I see one person has already got one in
It's one way for your voice to be heard why not have a go ?

I've written a response. Whether it gets published is another matter!
 

cocacola

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I can't believe I am reading this. I had the exact same symptoms since being on Metformin for more than 7 years. Even the slow release Metformin didn't make much difference.
I have had bowel investigations too. I thought I had IBS. I know I already had diverticular disease, which has worsened over the years due to Metformin.
I stopped taking the Metformin due to having a CT scan. My bowel symptoms improved. I haven't taken any medication now for about 3 months and yes my HbA1c has risen and my GP wants me back on meds.
I am working on diet and exercise and back at the gym and have bought myself a treadmill to use at home.
Thank you for posting this and making me rethink that it is possible to reverse things.
 
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ButtterflyLady

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I can't believe I am reading this. I had the exact same symptoms since being on Metformin for more than 7 years. Even the slow release Metformin didn't make much difference.
I have had bowel investigations too. I thought I had IBS. I know I already had diverticular disease, which has worsened over the years due to Metformin.
I stopped taking the Metformin due to having a CT scan. My bowel symptoms improved. I haven't taken any medication now for about 3 months and yes my HbA1c has risen and my GP wants me back on meds.
I am working on diet and exercise and back at the gym and have bought myself a treadmill to use at home.
Thank you for posting this and making me rethink that it is possible to reverse things.
Just curious, how does metformin make diverticular disease worse?
 

ButtterflyLady

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Acceptance of health treatment claims that are not adequately supported by evidence. I dislike it when people sell ineffective and even harmful alternative health products to exploit the desperation of people with chronic illness.
Constant diarrhoea does not help bowel habits.
I have always thought that constipation was linked to diverticular disease, since that is the conventional wisdom. But I found this study showing that diarrhoea-dominant IBS was linked to diverticular disease.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857983/

I'm sure IBS, constipation, or diarrhoea can all contribute to diverticular disease, and it's best to aim for a happy medium between constipation and diarrhoea. (I know how difficult that is, having IBS myself). I wasn't aware that chronic diarrhoea made diverticular disease worse. Oh well, you learn something new every day. It does sound like Metformin is not the right med for you.
 
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Southport GP

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Just look how well this low-carb article is doing world –wide! Partly due to this blog and the powerful responses that some of you have had published alongside the article itself
Latest statistics from the international Altmetric monitoring system:
A patient request for some deprescribing Published in British Medical Journal (Clinical Research Edition), August 2015
Authors David Unwin, Simon Tobin
All articles #16,786 of 4,147,728 articles
Articles in British Medical Journal (Clinical Research Edition) #465 of 23,334 articles
Articles of similar age #753 of 96,237 articles
Articles of similar age in British Medical Journal (Clinical Research Edition) #30 of 546 articles
'Altmetric has tracked 4,147,728 articles across all sources so far. Compared to these this article has done particularly well and is in the 99th percentile: it's in the top 5% of all articles ever tracked by Altmetric.'

Hurrah !!
 
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sally and james

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Well done Southport GP. If you haven't looked up the link in Southport's first post in this thread recently, have another look. There is a new (14 August) response from Ian D, which is well worth reading, especially for anyone newly diagnosed or in need of a bit of encouragement.
Sally
 
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sanguine

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Brilliant David :)
 
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Pipp

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@Southport GP thank you.
I have multiple print offs of this, which I will be taking to every medical consultation with me, (There are quite a lot of these) to present to every HCP that wants to tell me how to manage my T2 with the Eatwell plate.
 
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Indy51

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Well done Southport GP. If you haven't looked up the link in Southport's first post in this thread recently, have another look. There is a new (14 August) response from Ian D, which is well worth reading, especially for anyone newly diagnosed or in need of a bit of encouragement.
Sally
Thanks Sally - great advice - some really excellent responses have built up now :)
 

AndBreathe

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Just look how well this low-carb article is doing world –wide! Partly due to this blog and the powerful responses that some of you have had published alongside the article itself
Latest statistics from the international Altmetric monitoring system:
A patient request for some deprescribing Published in British Medical Journal (Clinical Research Edition), August 2015
Authors David Unwin, Simon Tobin
All articles #16,786 of 4,147,728 articles
Articles in British Medical Journal (Clinical Research Edition) #465 of 23,334 articles
Articles of similar age #753 of 96,237 articles
Articles of similar age in British Medical Journal (Clinical Research Edition) #30 of 546 articles
'Altmetric has tracked 4,147,728 articles across all sources so far. Compared to these this article has done particularly well and is in the 99th percentile: it's in the top 5% of all articles ever tracked by Altmetric.'

Hurrah !!

Do you have any idea of the proportion of BMJ subscribers who read paper versus online? The only disappointment I felt for you, when I looked at the Altmetric stats on the BMJ site was the proportion of readers declaring themselves as members of the public (74%), versus Practitioners (16%).

To be fair though, I didn't align myself to the Practitioner title, as I am no longer practising my first profession, and no longer on on the relevant register. But, I digress.

I'm assuming what the Altmetric statistics actually evidence is the tip of the iceberg? Would I be correct to assume, most BMJ subscribers will still receive a paper edition, and that may their primary reference point? In your shoes, I just know the data monster in me, would be battling with my super-king-sized ego to understand how many people my article actually got in front of.

As I've said before, you must feel justifiably proud. :)
 
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jude.osey

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I think i have managed to crack the low carb way of eating...basic and boring at first but fast moving results motivating me.
Now i can adapt recipes and enjoy trawling internet for ideas,tips and hints.
I was an unbelievable carb freak believing they filled me up the low fat way...i was taught fats were bad...I was always dieting,losing a bit but putting it back on and more.Always hungry and craving with digestive issues.
I now eat well the low carb way, regularly and good portions. I do not crave stodge or sugar any more. I do not need large portions to fill me. I still have occasional treats...a sandwich,a small pud or glass red wine but do not stress about it.
I have lost weight, my body shape is changing esp round the middle and have dropped almost 2 dress sizes. My blood results are pleasing.
Cant quite believe it myself,sound like a saint.Really i am not.....weak resistance when hungry. Now known as " carb police" at work. I am determined and so glad i dont have to be hungry . I feel well which hasnt been the case for years.
Thankyou Dr Unwin for rolling out the concept at our surgery.
judy baylis
 
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Southport GP

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Do you have any idea of the proportion of BMJ subscribers who read paper versus online? The only disappointment I felt for you, when I looked at the Altmetric stats on the BMJ site was the proportion of readers declaring themselves as members of the public (74%), versus Practitioners (16%).

To be fair though, I didn't align myself to the Practitioner title, as I am no longer practising my first profession, and no longer on on the relevant register. But, I digress.

I'm assuming what the Altmetric statistics actually evidence is the tip of the iceberg? Would I be correct to assume, most BMJ subscribers will still receive a paper edition, and that may their primary reference point? In your shoes, I just know the data monster in me, would be battling with my super-king-sized ego to understand how many people my article actually got in front of.

As I've said before, you must feel justifiably proud. :)
The paper version of our article was only published today which possible explains the preponderance of non-doctor interest so far. Another reason is the huge number of intelligent folk internationally who feel let down by conventional medical advice around diets for people with diabetes, This explains the large number of published responses to the article (32 so far, from all over the world) -many of which are very moving and can be found here:http://www.bmj.com/content/351/bmj.h4023/rapid-responses
I thought I would reproduce just one response that shows at least one other doctor agrees with what we are doing- though I notice this response has already had 42 likes!

Re: A patient request for some “deprescribing”
As an obesity medicine physician who uses low carb high fats diets in all of my patients I cheer the publication of this article. Nowhere in medical school or after is the concept of taking someone OFF medications discussed. Why should we? Patients are supposed to just get sicker, right? This attitude is not only pervasive but more important WRONG. They get sicker only when they are taught to eat a diet that makes them sicker. Unfortunately, this is the low fat diet pushed by all so called "patient advocacy groups" such as the American Diabetes Association. When taught to eat a whole foods low carb high fat diet patients do get better and "deprescribing" is a daily occurrence in our clinic. We need to stop using medicine to treat food! Doing this requires teaching the patients why and not just telling them what to do. The idea that patients don't want to or are not capable of change is not true if you teach them to do something where they can actually see change.
01 September 2015
Sarah J Hallberg
Physician
IU Health
1500 Salem Street Lafayette, Indiana 47904
 
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NoCrbs4Me

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If LCHF works so well, I wonder how well zero carb would work for type 2 diabetics? I reversed my type 2 with LCHF, but now I am zero carb (no plants, all meat and eggs) and feel great. No, I don't have scurvy.
 
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Lamont D

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If LCHF works so well, I wonder how well zero carb would work for type 2 diabetics? I reversed my type 2 with LCHF, but now I am zero carb (no plants, all meat and eggs) and feel great. No, I don't have scurvy.
I agree with this but I still have leafy salad.