Eatwell?

[librarising]

This is what I don't get. They're not fools. They must be aware of the numbers of people who have taken what is a relatively simple action - reduced their overall carb intake - and who have consistently returned both better bg and A1c numbers, which would imply less complications and lower treatment costs. So why would they continue to give advice that's not effective and potentially even harmful? Surely if there was uncertainty about whether certain advice was harmful you would tone it down, or qualify it?

I get that perhaps it takes the tanker of "scientific consensus" a long time to change course, and that things like NICE and/or the DoH must have to be convinced not just by anecdote but by evidence - but is this happening? Are there research projects going on which can bring about this change in course, and the mainstreaming of "diabetic experience" in the treatment protocols?

It also implies to me that this forum (and I guess there are other fora like it) must get approached about participating in research projects, since you provide an excellent cohort and a significant sample size? And if you do get approached - and perhaps even participate, I'm new so I don't know - would that suggest that maybe the tanker is turning?

I'm sure these sorts of things must have been done to death on the forum over the years, I'm just starting my more abstract "information gathering" phase (as opposed to my very subjective "what do I need to do for my health" phase), so if anyone can point me to any relevant threads rather than having to type loads of stuff our again, I'd be grateful!

It's the occasional brave GP who is willing to go outside of NHS guidelines, and who doesn't believe in 'essential' carbohydrates.
One such is GP Dr David Unwin, who has been on this forum in the past. He's on Twitter as @lowcarbGP
Here he is promoting the cause, and touching on the benefits you outline. For GPs with ever tighter budgets, his message has to be a persuasive one

Geoff

 

[Member496333]

I prefer to call it Profit Well.

 

[dbr10]

Friend of mine posted this on Facebook, it seems very much at odds with what I've read here - why is there such a disconnect between mainstream advice and the experience of people actually suffering with diabetes?

https://www.bda.uk.com/foodfacts/diabetes_type_2

Paid for by food manufacturers

 

[Alison Campbell]

This is what I don't get. They're not fools. They must be aware of the numbers of people who have taken what is a relatively simple action - reduced their overall carb intake - and who have consistently returned both better bg and A1c numbers, which would imply less complications and lower treatment costs. So why would they continue to give advice that's not effective and potentially even harmful? Surely if there was uncertainty about whether certain advice was harmful you would tone it down, or qualify it?

I get that perhaps it takes the tanker of "scientific consensus" a long time to change course, and that things like NICE and/or the DoH must have to be convinced not just by anecdote but by evidence - but is this happening? Are there research projects going on which can bring about this change in course, and the mainstreaming of "diabetic experience" in the treatment protocols?

It also implies to me that this forum (and I guess there are other fora like it) must get approached about participating in research projects, since you provide an excellent cohort and a significant sample size? And if you do get approached - and perhaps even participate, I'm new so I don't know - would that suggest that maybe the tanker is turning?

I'm sure these sorts of things must have been done to death on the forum over the years, I'm just starting my more abstract "information gathering" phase (as opposed to my very subjective "what do I need to do for my health" phase), so if anyone can point me to any relevant threads rather than having to type loads of stuff our again, I'd be grateful!

Diabetes.co.uk Low Carb Program is doing award winning work, check the data and youtube videos.
Virta Health in the USA also have data and research papers.

There never was useful scientific data for the base your meals around carbs diet and it has turned out to be one big experimental failure if the rates of pred-d and type 2 are the outcome.

There is a huge problem with science and nutrition, how do you control all the other variable such and smoking, exercise etc? How do you confirm exactly what people are eating?

 

[kokhongw]

From what I have gathered over the years...

It is not quite possible to detach the deeply entrenched and pervasive influence of big food and pharma in med schools and public health agencies.

Fasting is bad for business...even if it does help to generate new brain cells...

 

[Daibell]

As others have said if you look at the history of the Eatwell Guide or Plate you will find SACN advising PHE on the right diet for diabetes. If you look who formed the majority of the those who signed off the Eatwell Plate you will find the food industry. SACN have very close links to various university professors who have their research funded by the food industry. There is very little valid medical or other research evidence in any of this. It's a convenient club where the interests of those with diabetes don't figure. DUK (not this site) has been guilty of being part of this club but is finally and quietly changing it's advise about carbs. It's a reminder to do your own wide research and be careful not to just trust the 'experts' who include many GPs who are obliged to follow this advice. BTW even the mention of calories by PHE shows their ignorance of the body's metabolism where in practice calories in are largely irrelevant as a measure.

 

[LooperCat]

Just out of interest, in the piece it mentions a difference between starchy carbs and sugary carbs. In my opinion the difference is minimal but how do those with T1 see it? I mean in general terms apart from hypo treatments.

Carbs is carbs. I have to count them all the same and dose for every single one - whether it comes from chocolate or leaves. The only difference is timing.

 

[Pinkorchid]

"A palm size of meat or fish..." That sound you can hear? That's me laughing my leg off.

Quite big enough for me but then I only have a small appetite

PS that was probably about the size of the piece of smoked haddock I had for my main meal yesterday

 

[Guzzler]

Quite big enough for me but then I only have a small appetite

PS that was probably about the size of the piece of smoked haddock I had for my main meal yesterday

I must have hands like a heavyweight prize fighter then.

 

[Pinkorchid]

I must have hands like a heavyweight prize fighter then.

I only have small hands but thinking about it it really depends on the size of our hands as to how big a palm size piece would be if we judge it on our own palms

 

[briped]

I’d be starving!

Sometimes I wonder if that isn't the point ... ? Starve them and make them sweat. They deserve it, the greedy, gluttonous [nasty expletive]. Sorry. Just my frustration speaking.

 

[Oldvatr]

Paid for by food manufacturers

https://www.bda.uk.com/about/workwithus/currentcorpmembers
https://www.vegansociety.com/society/whos-involved/partners/british-dietetic-association

 

[Scott-C]

Just out of interest, in the piece it mentions a difference between starchy carbs and sugary carbs. In my opinion the difference is minimal but how do those with T1 see it? I mean in general terms apart from hypo treatments.

In general terms, we pay attention to the carb count, but also think about the likely absorption/digestion rate, which depends a lot on the GI/starchiness, and as @slip says, that may influence the pre-bolus timing, whether I'll need to consider a split bolus, along with things like whether I'm levelish or trending up or down (I might eat the 'faster" carb components of a meal first if I'm dropping/been too generous with the pre-bolus, and vice versa if rising), and whether the combination of other macros will change it - some pasta with a fat free tomato sauce will act differently to a creamy sauce, and also if I'd had a starter of fatty olives. So, we're not just looking at the carbs in isolation, but the whole context to try to guesstimate the absorption rate.

I know that, "all carbs turn to sugar", but the rate at which they do so is important to us.

For example, I tend to steer clear of white rice, as it is very unpredictable for me - I'll either get a savage spike within 30 mins or maybe 3 hours later or sometimes not at all.

Brown rice (and buckwheat), though, presumably because of the fibre, can actually give me very smooth levels for extended periods.

The absorption rate of brown rice just seems to match the time pattern of novorapid, for me. Although, having said that, if I can't be bothered cooking, I'll sometimes just microwave an Uncle Bens wholegrain Mexican spiced rice packet, chuck some mackerel on top, usually get steady results from that, so it might not be so much the GI, but the fact that it has been cooked, cooled and reheated may have changed the chemistry - pretty sure there's been posts about this.

 

[Guzzler]

In general terms, we pay attention to the carb count, but also think about the likely absorption/digestion rate, which depends a lot on the GI/starchiness, and as @slip says, that may influence the pre-bolus timing, whether I'll need to consider a split bolus, along with things like whether I'm levelish or trending up or down (I might eat the 'faster" carb components of a meal first if I'm dropping/been too generous with the pre-bolus, and vice versa if rising), and whether the combination of other macros will change it - some pasta with a fat free tomato sauce will act differently to a creamy sauce, and also if I'd had a starter of fatty olives. So, we're not just looking at the carbs in isolation, but the whole context to try to guesstimate the absorption rate.

I know that, "all carbs turn to sugar", but the rate at which they do so is important to us.

For example, I tend to steer clear of white rice, as it is very unpredictable for me - I'll either get a savage spike within 30 mins or maybe 3 hours later or sometimes not at all.

Brown rice (and buckwheat), though, presumably because of the fibre, can actually give me very smooth levels for extended periods.

The absorption rate of brown rice just seems to match the time pattern of novorapid, for me. Although, having said that, if I can't be bothered cooking, I'll sometimes just microwave an Uncle Bens wholegrain Mexican spiced rice packet, chuck some mackerel on top, usually get steady results from that, so it might not be so much the GI, but the fact that it has been cooked, cooled and reheated may have changed the chemistry - pretty sure there's been posts about this.

Thanks, very interesting. Yes, the resistant starch method of which I tried using Basmati rice and still spiked.
It sounds as if there's little to no room for a bit of spontaneity, no wonder people rebel or burn out at times - not everyone, obviously.

 

[JohnEGreen]

I suppose it would be like being in a slow motion road crash end result the same just takes longer to get there.

 

[Scott-C]

It sounds as if there's little to no room for a bit of spontaneity, no wonder people rebel or burn out at times

Yes, we have to think ahead a lot more than the average Joe/Josephine, but you'd be surprised by the amount of leeway there is.

There's a lot of tricks we can pull with pre-bolusing, split doses and insulin stacking.

On the burnout issue, the docs in my area, NHS Lothian, where there's about 1000 T1s with libre on script, have published preliminary "before and after" results, mainly focusing on a1c (statistically significant drops across the entire range - sub-48 doubling, above 70 halving), but the interesting thing is that they've also reported that their patients are happier than ever and the societal/psychological aspects shouldn't be underestimated.

I'd usually post links/images for those statements, but I've just got a new phone, so don't have them to hand - they're available through Drs Fraser Gibb and Anne Dover's twitter feeds for anyone interested.

That fits with my experience of libre, and the reason is obvious. We're meant to keep bg in a tight range. With strips, we're blind most of the time, just getting brief glimpses, so it's no darned surprise we get narked off with it and don't bother.

With libre, we can see what bg is doing, and proactively tweak things. It makes us more engaged, we can co-operate with it, we're, as the docs say, happier, less prone to burnout.

 

[Guzzler]

Yes, we have to think ahead a lot more than the average Joe/Josephine, but you'd be surprised by the amount of leeway there is.

There's a lot of tricks we can pull with pre-bolusing, split doses and insulin stacking.

On the burnout issue, the docs in my area, NHS Lothian, where there's about 1000 T1s with libre on script, have published preliminary "before and after" results, mainly focusing on a1c (statistically significant drops across the entire range - sub-48 doubling, above 70 halving), but the interesting thing is that they've also reported that their patients are happier than ever and the societal/psychological aspects shouldn't be underestimated.

I'd usually post links/images for those statements, but I've just got a new phone, so don't have them to hand - they're available through Drs Fraser Gibb and Anne Dover's twitter feeds for anyone interested.

That fits with my experience of libre, and the reason is obvious. We're meant to keep bg in a tight range. With strips, we're blind most of the time, just getting brief glimpses, so it's no darned surprise we get narked off with it and don't bother.

With libre, we can see what bg is doing, and proactively tweak things. It makes us more engaged, we can co-operate with it, we're, as the docs say, happier, less prone to burnout.

The day that CGMs are offered to all those on insulin can't come soon enough. Thanks again for all the insight you've given.

 

[Scott-C]

The day that CGMs are offered to all those on insulin can't come soon enough. Thanks again for all the insight you've given.

Cheers, Guzzler.

I can still remember when we went from colour-changing strips (where you had to compare the colours on the strip to the colours on the side of the container), to electronic meters.

The meters were these new, fancy, expensive things and the bean counters were saying why do they need them.

A while later, meters became par for the course, and everyone forgot why it had been an issue at all.

History is repeating itself here - the bean counters say why do they need cgm when they've got strips?

Aye, well, I can think up a few answers to that...

 

[jjraak]

Great post @paulmh

it does seem strange, to say the least that any one overseeing the health of the diabetic population, would not be able to discern that a particular group/s have deviated from the Govt / nhs line...and getting pretty remarkable results while doing so.

Which begs the question.

IF our health was the over riding importance that it SHOULD be,

Wouldn't they begin by checking it's suitability... simply by adding up the numbers of those who have reduced, and dare i say lowered their HBA1c results to pre diabetic range, if not normal range, from each individual method of treatment.?

Measure that over say 3 years..(doctors would have details surely ?)
and IF proof of either methods efficacy was shown, then investigate deeper, conduct trials look for guinea pigs.
( Pretty sure many on here would volunteer to be monitored, for low carb diet, Doing just what they are doing now if volunteers were hard to come by. )

Anything less and sadly they do open themselves up to conspiracy theories.

Because if they don't, what else makes any sense of what they ARE doing..?

 

[Robbity]

To be honest, I'm not convinced it's that great for the general population.

Certainly not for me! My husband eats a high carb diet and foisted it off on me when he took over shopping and cooking, and I spent a 5-6 years in an increasingly brain dead zombie like condition due to that diet, although at the time I wasn't aware of the cause. However, after I was diagnosed with T2 and starting reducing my carb consumption back down again, all that debilitating brain fog also miraculously disappeared.

Robbity