Finding a doctor to get safely into low carb WOE

[Robertgray30]

There are private GP's

Thank you, but slightly surprised by that comment. My comment was made on the assumption that people were looking for support from their GP and the NHS. Private medicine is a different topic altogether.

 

[Oldvatr]

Whatever happened to "individualised care" that GP's are supposed to do..
As Low Carb Prog and the RCGP low carb module are both NHS sanctioned then I think his excuse is a tad outdated.. maybe ask them to do the RCGP module on low carb..

Simple question. Have the NICE guidelines for treating adult diabetes patients been updated to reflect on what you say. As you know, I agree with you, but my GP whilst supportive, is not going to stick his head above the parapet until ordered to by his paymasters and seconded by the Practice manager and his CCG.

 

[bulkbiker]

Simple question. Have the NICE guidelines for treating adult diabetes patients been updated to reflect on what you say. As you know, I agree with you, but my GP whilst supportive, is not going to stick his head above the parapet until ordered to by his paymasters and seconded by the Practice manager and his CCG.

Think so
https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#individualised-care

 

[Oldvatr]

Then he should look a bit more - plenty 'evidence' around on here

I think you will find that this site is a NO-NO for most HCP's. I was expressly warned by my GP and my Consultant against using this site and Dr Google, and the teleprompt screens in the surgery waiting room carry this same message and refers patients to the official NHS sites. The 'evidence' presented here is anecdotal, and considered Fake News by those in the know.

 

[Oldvatr]

Think so
https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#individualised-care

View attachment 36882

So, not updated since 2015 which is before the LC program accreditaion was given. So NICE does not sanction a low carb diet at all. I note DUK (the other site) also does not sanction an LC diet but does give passing comment that it may help with control. The diet they are pushing at the moment is the one invoked by DIRECT, i.e. the Newcastle Diet which is their goto for reversal.

 

[HSSS]

I'd guess at Way Of Eating.

Yep

 

[HSSS]

So, not updated since 2015 which is before the LC program accreditaion was given. So NICE does not sanction a low carb diet at all. I note DUK (the other site) also does not sanction an LC diet but does give passing comment that it may help with control. The diet they are pushing at the moment is the one invoked by DIRECT, i.e. the Newcastle Diet which is their goto for reversal.

NICE sanction dr unwins sugar inforgraphics which are based on low carb and from memory don’t actually disallow low carb

 

[Oldvatr]

NICE sanction dr unwins sugar inforgraphics which are based on low carb and from memory don’t actually disallow low carb

Is this in the guidelines that doctors have to sign up to? I did not see any in the 2015 release, I know Dr Unwin did manage to step around the guidance somehow, but it was down to semantics and interpretation from what I remember. My GP surgery and the local nutritionists apply a different interpretation. I think the Tim Noakes saga lives on and malpractice fears rule ok even if proven groundless after the case was in the headlines.

 

[HSSS]

[URL]https://www.nice.org.uk/guidance/ng28 Last updated August 2019.
[/URL]
https://www.nice.org.uk/guidance/ng...rce--sugar-equivalent-infographics-6725426077 infographics link published by NICE

https://phcuk.org/nice/ This is Dr Unwins explanation of how this fits with the guidelines.
https://www.nice.org.uk/guidance/ng...rce--sugar-equivalent-infographics-6725426077
https://www.nhs.uk/apps-library/low-carb-program/ low carb program published by NHS

One would think if these organisations are publishing (and financing in some areas) these things they are supportive of doctors using them.

 

[Oldvatr]

https://www.nice.org.uk/guidance/ng28 Last updated August 2019.
https://www.nice.org.uk/guidance/ng...rce--sugar-equivalent-infographics-6725426077 infographics link published by NICE

https://phcuk.org/nice/ This is Dr Unwins explanation of how this fits with the guidelines.
https://www.nhs.uk/apps-library/low-carb-program/ low carb program published by NHS

One would think if these organisations are publishing (and financing in some areas) these things they are supportive of doctors using them.

Thank you for this info. Looking at the update history since 2015 there has been no changes regarding dietary or lifestyle control. In fact there is only a passing reference to using dietary control, with no advisory or informatory link to other material. So this shows that dietary or lifestyle changes are not mandated in regulation ng28,

The infographics is in an addendum to ng28 introduced in 2015. This is what NICE say about it
"Endorsed resources are complementary to NICE guidance and are not produced by NICE. This resource has been developed by Dr David Unwin and is not maintained by NICE. NICE has not made any judgement about the quality and usability of the resource."

The PHC reference is not one that an HCP would be directed to by NICE so GP;s are probably not reading it.

The inclusion of the APP in the nhs library is good, but again, does not seem to have any link to what the NHS is basing trestment guidelines and regulations on. I am not sure where Eatwell went, but there must be some NHS directive that controls its use, and this is where the LC pathway need to start. It is no longer in the ng28 set of info from what I can see. However, hospital nutritionists must be controlled by something, and this may also extend to other HCP functions such as nursing or vare jomes etc. There will certainly be legal contractual arrangements that are covering the NHS collective backsides otherwise it would be a free for all, and institutions hate an undefined market.

It seems to be here
https://www.nhs.uk/live-well/eat-well/the-eatwell-guide/
I do not have time at the moment to trace back from this to find out how a GP might be regulated by it. Will try to update this later

It is the government controlling this through PHE and SACN
https://www.gov.uk/government/publications/the-eatwell-guide

The government has also published guidelines on carbohydrates
https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report

This latter report is Evidence Based so cannot be challenged easily. Thre is an impressive rreferences section at the end, but I note many of the studies are epidemiological and hence prospective. There are some RCT's in there and loads of meta studies. I see Willetts WC has the odd mention.

Ther is one study on LC diet/keto diet referenced out of all of them
Johnston CS, Tjonn SL, Swan PD, White A, Hutchins H & Sears B (2006) Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets. American Journal of Clinical Nutrition 83, 1055-1061.

That latter paper can be found here
https://www.ncbi.nlm.nih.gov/pubmed/16685046

 

[HSSS]

well there’s a number of drs and dieticians that are offering and perhaps even recommending low carb and the guidelines I’ve found so far do not seem to prohibit advocating low carb. I’ve met a few of them (some tentatively) supporting it as a valid option.

There is a fair amount of evidence based information on the phc website supporting the use of low carb lifestyles. Whilst I accept they may not be seen by GP’s that is in fact one of their goals - to get the evidence seen by the drs/nurses and provide some of that dietary structure that appears to be missing from their guidance to patients. Many T2 patients never see a hospital dietician and rely on their gp and practice nurses.

I personally believe drs refusing to support a low carb dietary option do not want to, rather than are unable to do so within regulations. I’d like to see clearer guidelines and regs more inclusive of lchf but until then the current ones can still be utilised. If I am wrong (it can happen) I’d be interested to see the evidence.

 

[Oldvatr]

well there’s a number of drs and dieticians that are offering and perhaps even recommending low carb and the guidelines I’ve found so far do not seem to prohibit advocating low carb. I’ve met a few of them (some tentatively) supporting it as a valid option.

There is a fair amount of evidence based information on the phc website supporting the use of low carb lifestyles. Whilst I accept they may not be seen by GP’s that is in fact one of their goals - to get the evidence seen by the drs/nurses and provide some of that dietary structure that appears to be missing from their guidance to patients. Many T2 patients never see a hospital dietician and rely on their gp and practice nurses.

I personally believe drs refusing to support a low carb dietary option do not want to, rather than are unable to do so within regulations. I’d like to see clearer guidelines and regs more inclusive of lchf but until then the current ones can still be utilised. If I am wrong (it can happen) I’d be interested to see the evidence.

My GP is responsible for my care as my Named Responder under the individual care scheme. He reports to the Senior Clinician in the CCG that controls funding and admin for the practice. They determine daily priorities and protocols, and determine medication and support strategies at the local level (postcode lottery) So for example they decide which bgl meter I can use, and how many strips if any I am allowed a month. It is bread and butter stuff, but they also look after the District Nurses, and the local Care providers. They also look after the support network such as podiatry, opthamology etc, and replace the older Trust based network. They are only Primary Care, so do not control hospitals.

The Nutritionists are responsible to the health system by another pathway too, and are regulated seperately. GP's do not have nutrition expertise, and are expected to subcontract out to the local support group who are normally attached and run from the District Hospital Trust.

Here is a typical nutritional datasheet currently distributed to all local practices in an area controlled by this CCG.
http://www.sompar.nhs.uk/media/6651/eating-well-with-diabetes-final-190206.pdf

These practies are expeted to support this. It is not for the GP to question this advice since it is deep rooted in government initiatives, so although it maynot be a legal binding, it is a professionsl binding none the less. Since the GP is not a apecialist he must bow to those holding that knowledge and that is determined higher up than tha locaal level.

The dietitians are regulated as shown here
https://www.hcpc-uk.org/

Until these people accept LC diets as being viable, then things will not change in any hurry. This is where regulation comes from, not the local GP surgery. So lets stop dissing the doctors and nurses. It is not their fault that things are pearshaped. As I said initially in my first response here, my GP is supportive of my diet, but cannot recommend it to anyone fur to professional etiquette and possibly contractually too. My GP and I have a very good relationship and he allows me to control my medication as I request. He does not bully or browbeat me so he is indeed following NG28 properly.

At the end of the day most of us here have a right to refuse to accept a GPs advice and eat whatever we want to. They do not have control over what we eat unless we are in dependant care eg nursing home or other institution. They are obliged to support your medical condition, and if going low carb works for you, and your bgl drops, your BP drops, or your weight falls away then they must alter your medication to suit the new you. This is what I did, essentially railroaded my GP to recognise that I was back in control, so cur the meds, please. He was so surprised at my first HbA1c following starting my LC journey that he gave in without a wimper and has been with me since.

So to return to the OP. You do not need the GP to agree to your diet. Just do the research yourself, invest in a test kit and start keeping a food log and plot your progress as you Eat to Meter. Then go back when you have something to discuss. If it works, then it will show up in the next review. If not, then try something else. The main thing is to gain knowledge about how your body reacts to food, and this will give you the amunition to fight for your corner. Such knowledge is invaluable, and the more research you can do the better prepared you will be to take back control for yourself.

 

[Daibell]

Or Way of Existing aka lifestyle changes.

Edit to add: My GP was initially against LCHF, and referred me to a nutrition consultant. I took my spreadsheet printouts that showed my bgl diving down, and I was given a bgl meter and strips since I was getting close to hypoland. My strips still continue to this day, and now my GP is amazed at my recovery. BUT he does not endorse my WOE, or give any other patients the advice. Apparently I am the only one that has shown good control consistently and come off most of my diabetes meds. But his NHS contract forbids him giving advice that is not evidence based. (apparently Eatwell is solidly evidence based?)

Well, we all know that the PHE Eatwell advice is not based on any 'evidence' that would stand up in court. It comes from research funded by the food industry who have a profit agenda and the last Eatwell update had very little medical input. I've not come across any valid scientific evidence that low-carb is bad only that it has not been proven to not cause harm. Since when has food only been allowed to be eaten when it's proven not to be harmful? Rhubarb is poisonous if you eat too much as it contains oxalic acid so should shops be selling it as the presence of poison is evidence-based?

 

[Oldvatr]

Well, we all know that the PHE Eatwell advice is not based on any 'evidence' that would stand up in court. It comes from research funded by the food industry who have a profit agenda and the last Eatwell update had very little medical input. I've not come across any valid scientific evidence that low-carb is bad only that it has not been proven to not cause harm. Since when has food only been allowed to be eaten when it's proven not to be harmful? Rhubarb is poisonous if you eat too much as it contains oxalic acid so should shops be selling it as the presence of poison is evidence-based?

I believe that your comment on rhubarb applies to the raw state, and that cooking removes that risk. Have just discussed on another thread here about the evidence based review that took place recently on dietary studies that SACN use to justify their stances on Eatwell and also indirectly on LC diets.

Well, we all know that the PHE Eatwell advice is not based on any 'evidence' that would stand up in court. It comes from research funded by the food industry who have a profit agenda and the last Eatwell update had very little medical input. I've not come across any valid scientific evidence that low-carb is bad only that it has not been proven to not cause harm. Since when has food only been allowed to be eaten when it's proven not to be harmful? Rhubarb is poisonous if you eat too much as it contains oxalic acid so should shops be selling it as the presence of poison is evidence-based?

Well this is what the Eatwell guide is based on. Plenty of evidence based studies listed in the references section at the end of the report
https://assets.publishing.service.g...file/445503/SACN_Carbohydrates_and_Health.pdf
There are at least 246 studies referenced, and from what I saw only one is Low Carb, and that is a debunker from a few years ago (probably on the original Atkins Diet which was shown to be problematic which is why it has been revamped as an LCHF type of diet instead of the LCHP original.)

 

[HSSS]

Have just discussed on another thread here about the evidence based review that took place recently on dietary studies that SACN use to justify their stances on Eatwell and also indirectly on LC diets.

Can you link or tell us which one? Not sure which it is

 

[Oldvatr]

Can you link or tell us which one? Not sure which it is

See #34 of this thread.

 

[Murphymycat]

We moved 2 years ago so I had to find a new surgery

The first thing they did was book an appointment with a diabetic nurse. She was totally on the ball and we discussed everything including diet. I was very overweight at the time and I indicated that I would like to low carb. Seems she is a huge fan of low carb

I met my new GP a few weeks later and discussed my weight amongst other things. Seems he is a massive fan of low carb and Michael Mosley. Thank god I thought, my GP, my diabetic nurse and I are totally on the same wavelength. I was still struggling with my weight and my Hb1Ac was too high. They thought gliclazide was the culprit so started me on Trulicity instead saying it would help with the weight loss.

3/4 months later (Christmas was in the middle, good thing I don’t like icing but my home made cake was gorgeous) I had lost 41 lbs and my Hb1Ac was drastically reduced. Everything else was within normal range.

Low carbing isn’t easy but I didn’t fall off the wagon once.

Unfortunately over the last few weeks things haven’t been so good as I have been stuck at home and have eaten quite a lot I shouldn’t . I didn’t weigh myself for 4 weeks and when I plucked up the courage I had a bet with myself saying I would have put on 4 kgs. I was gobsmacked. All those wicked Marmite crisps and I had lost half a kilo.

Sorry if this is rambling but sometimes it’s nice to write things down knowing that your prospective audience will understand just how you feel. When I saw my GP we looked at my results and he practically danced a jig around the room.

One last thing, someone asked me “why did you lose all that weight” and I replied “because I tried to”

 

[lucylocket61]

One last thing, someone asked me “why did you lose all that weight” and I replied “because I tried to”

Not all who try are able to lose weight

 

[Robbity]

I'd guess at Way Of Eating.

Which was my guess too - but I always find the phrase "low carb WOE" absolutely hilarious because as far as I'm concerned there's nothing remotely WOEful about eating the best diet to keep glucose levels stable - unless maybe you're addicted to carbs?

 

[DCUKMod]

Which was my guess too - but I always find the phrase "low carb WOE" absolutely hilarious because as far as I'm concerned there's nothing remotely WOEful about eating the best diet to keep glucose levels stable - unless maybe you're addicted to carbs?

I do think Robitty that many find it woeful in the transitional phase, to be fair. Carb addition is real and it's out there, big styleeeeeeeeeee.