Balance magazine - November/December

They've published my letter criticizing the "Chewing the Fat" article.
See page 52.
Thanks, Editor, for publishing.

I have now added scans of the offending article - see posts 15/16

This is my letter, published in full with minor changes.

Dear Editor,

I was disappointed to read the article “Chewing the Fat” as it did not address the issues. The emphasis appeared to be cholesterol control rather than blood glucose control.

Is there a need for an alternative strategy for the treatment of diabetics of all types, or is the present system satifactory? - Definitely, as the figures quoted in the editorial, & in the National Diabetes Audit show that diabetes complications account for 10% of the NHS budget, & that well over half of diabetics do not achieve satisfactory control.

The point is that, as Diabetes UK points out clearly in its literature, “Include Carbohydrates ..... These are important sources of energy ... They all break down to glucose, so they will cause your blood sugar levels to be high if you eat large amounts....” High blood glucose causes the real & distressing diabetic complications including neuropathy.

Fat is also an important energy source, & does not break down to glucose, so substitution of selected fatty foods is a real alternative.

We're not spreading butter on our cheese, washed down with olive oil. Nor are we eating deep fried fast foods. We include the fats as they come, eating cheese, nuts, meat, oily fish, along with vegetables & salads, & vegetable oils. And, of course, we monitor our health, blood pressure, weight & blood glucose. We also note the progress or easing of complications resulting from our diet.

Internet forums where diabetes patients are contributors, sharing experiences, challenge the NHS & DiabetesUK carbohydrate diets for diabetics, and many thousands have sustained a low carbohydrate, increased fat diet (LCHF) with good control & reversal of complications for many years.

Some health organisations have taken note of our experience & have done their own studies of the medical literature. Their reports show the way forward for improved health, reduced obesity & diabetes control.

This is their email reply to me, substantially as published, with minor editing:

Many thanks for your feedback. As you indicated the article in Balance was addressing fats specifically in relation to cholesterol, which is one of the three targets to reduce risks of diabetes complications. [As I discussed with you on telephone a few weeks ago,] it is not only high blood glucose levels that drive complications in diabetes.

The article sought to look at how diet can help achieve better cholesterol and we think this is useful for people who may want to make dietary changes to get to their cholesterol targets.

It was also an opportunity to let our audience know of Diabetes UK’s position on the recurrent debate on saturated fats. We did not include glucose control in the article because that was not the subject of the article.

Please note that we have various other publications including content on our website to deal with issues of glucose control, blood pressure, and cholesterol and this article happened to one that dealt with cholesterol. Be assured that all three outcomes are important to us as a diabetes charity, and the fact that this particular article dealt with one doesn’t mean that the others are less important.

We know that the amount of carbohydrates that the person eats determines the rise in glucose levels after eating, but as I mentioned, in Type 2 diabetes there is more consistent evidence for weight loss in long term overall diabetes management than there is in reducing carbohydrates per se. That is not to say reducing carbohydrates is not effective in some people, but it goes to prove that there are different ways to achieve weight loss and HbA1c control. We as an organisation use the best consensus of evidence to inform the dietary information we provide to people with diabetes. Interpreting dietary research is not without disagreements, and we are happy to say that our interpretation of the evidence is not sacrosanct. Of course there are other ‘experts’ who proffer different opinions, but we are confident that the best consensus in the world of diabetes supports out position. Whilst different people swear by the efficacy of one diet over the other based on personal experience and preferences, we cannot say that one particular diet should be a default for everyone when in fact the evidence is inconsistent. Until there is robust consistent evidence to the contrary, we will continue to promote the different approaches which are all based on evidence and we will encourage people to make their choice of approach based on their personal preference. I’m aware you have benefited from a low carb diet, and we have many other people who have also benefited from low carb, which is great. But we have also heard from people who have benefited from different approaches such as very low calorie diet, low fat diet, Mediterranean diet so we have to recognise individual preferences whilst being fair to the evidence.

I hope you find this explanation helpful.

We are concerned with healthy living with diabetes for many years, whereas the Newcastle diet lends itself to the sort of randomised controlled trials (RCT) beloved by researchers & counted as 'evidence' by DUK, it is by its very nature unsustainable. Only LCHF presents itself as a sustainable & effective lifestyle rather than an RCT diet.

The experience of members of this forum is of no interest to the DUKs of this world. Besides, they would have to acknowledge they have misled the diabetes world for a generation AND as a result ruined a million lives.

My reply to the Balance reply to my letter was:

Thanks for your prompt reply to my letter to Balance.

I'm sure you have also seen the recent BBC programmes which addressed the problems -

http://www.bbc.co.uk/iplayer/episode/b07xwstx/fat-v-carbs-with-jamie-owen

which was basically a very successful short-term dietary experiment, and

http://www.bbc.co.uk/programmes/b07yklv8

“Diabetes – the hidden killer” which was a very serious & depressing programme offering amputation or stomach surgery as the ultimate treatments for diabetes.

Again the statistics presented in the 'Balance' editorial highlighted the relevance of both programmes, & seemingly the inadequacy of NHS/DUK advice. The GP commenting on Jamie Owen's experiment seemed very dubious.

The Panorama programme clearly underlined your own emphasis on weight reduction, though offering no help. The help-line recommended contacting DUK.

Contrary to the 'Chewing the fat' article, the concern was for blood glucose clogging the blood vessels, rather than cholesterol. The claimed link of blood cholesterol with CVD is questionable. The primary concern for diabetes patients must be blood glucose, which causes & aggravates other health problems.

We must therefore agree that diabetes linked to ever-increasing incidence of obesity, & the resultant complications, present a very serious problem for the health of the nation.

Is Diabetes UK, trusted by the vast majority of health professionals, doing enough, in your position of providing sound advice to minimise the health dangers we live with?



Or is Diabetes UK failing in providing the information needed by diabetics as they live with a “hidden killer” or even providing out-dated information that does not take into account the reassessment of the evidence you rely on?



I am appending relevant links (including your own 'Position Statement') that question the claimed evidence that fat consumption significantly increases CVD risks.

Commenting on “What we say” (red box, P.49) there is NO justification for maintaining your dietary recommendations, particularly “a diet high in ... wholegrains...” Note that your Position Statement concludes: “When saturated fat intake is replaced by carbohydrates (wholegrain and unrefined only), there is evidence for cardiovascular benefit. Substitution with refined carbohydrates appears to increase cardiovascular risk. Therefore, it is important to consider recommendations both from the perspective of what should be reduced and the likely effect of the substituting nutrients. “

That indicates that carbohydrate per se is harmful, but the effect of components of unrefined carbohydrate moderates the adverse effect of the carbohydrate itself.

A key statement in the article, evident in your email is: “Following a specific type of diet, e.g. Low carbohydrate diet, should be done with support from your diabetes healthcare team.” In other words, Diabetes UK can give no information, no advice regarding the diet actually under discussion in the article. You may be lucky enough to have a 'diabetes healthcare team' willing & able to help with a low carbohydrate diet, but you will be going against all the 'evidence' & putting your health at risk if you try it without professional support.

You will remember that my stated & restated reason for writing is:

I hope I have given enough food for consideration for DUK to undertake a proper review of its dietary recommendations, & so produce a low carbohydrate diet document for issue to diabetes professionals giving suggested diet recommendations for patients, together with any cautions considered advisable so that practitioners can make the necessary checks.

I am sure that the Public Health Collaboration team, with includes professionals implementing low carbohydrate diets with their patients will be pleased to work with you. I will be pleased to help you in any way I can.

I fear that that the attitude of DUK to diet discourages patients trying the low carb diet (LCHF) that many patients have found successful. Warnings about missing nutrients may be valid, but like diabetes itself may take years to take effect, & medical data will become available. I challenge you to list such nutrients, & suggest non carbohydrate foods containing them – or even supplements.

I would rather take such an unspecified risk with a LCHF diet that has completely restored my health, than follow the carbohydrate-based diet that DUK knows will fail - “diabetes is progressive” - which was destroying my health.

Links & comments on links follow.

Yours, in the interests of other diabetics.

Daibell said:

Good reply but as I'm sure you know it will be ignored as they are so far down the wrong path that they will not admit it. I do note however that the diet wording on their website gradually changes each year so they will get there but it could take 5 to 10 years and many more amputations during the mean-time.

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I've had correspondence with two of their senior men over several months. They claim to support low carb, but insist that fat should also be low. They didn't respond to the need for energy from either carb or fat, so their reduced carb cannot be sustained. I did refer to several RCTs & reviews of published data, but they did not respond.

I had a further reply to my further letter.

An important point again they did not respond to is that one of them said he had been type one for many years:

We do continually review the evidence base – which is why our recommendations on diet have changed quite dramatically in the 21 years I’ve worked at Diabetes UK - and we certainly try to be less dogmatic about any one approach, hopefully giving people enough options that they can find a way that works for them. As an individual with Type 1 diabetes, I personally have seen the benefit in reducing overall carb intake – but certainly don’t stick to any one approach, as I enjoy potatoes too much! For me it has been about finding a balance that works for me and enables me to eat happily (and healthily) whilst maintaining excellent blood glucose control (HbA1c of 6.5%).

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He's one of the remarkable less than 10% T1s with a satisfactory HbA1c. I challenged him to publish his diet secret for the benefit of the 90% with a control level that will lead to complications. We're still waiting.

This wonderful site for diabetics allows us to benefit from each other's experience. Pity about Diabetes UK.

They're more like ostriches than DUKs.

Mbaker said:

Bravo @IanD. Are you a lawyer, you have placed "them" in a sticky situation which would only deepen the hole they are in - check mate. It would be good if your letter was discussed at DUK board level. John Maynard Keynes famously said "When the Facts Change, I Change My Mind". For me the link https://www.diabetes.org.uk/Guide-to-diabetes/Enjoy-food/Eating-with-diabetes/The-Eatwell-Guide/ suggests they are not up to date. It seems crystal clear that this site, Diet Doctor, Dr Fung, Dr. Sarah Hallberg and the like are gaining momentum; official so called representatives should take stock and embrace.

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I'm not a lawyer, but a retired professional scientist who can understand & critique their references, and I am used to preparing reports for others.

Also I am a Gospel preacher (now occasional) so analysis of texts & presentation of arguments goes with the position.

I did challenge them of the Eatwell Guide - I'd looked up its references where it actually states that diabetics were excluded from consideration, but that didn't phase the DUKs.

I asked them if there were any T2s of the staff I could talk to. No reply.

This is the offending Balance article:

Continued - I consider that the presentation is offensive, especially bearing in mind I had previously written to Balance & had an exchange with senior DUK staff who told me they were reviewing their diet advice. This appeared to be the result of their review !!!

Cumberland said:

Well done @IanD

Twice I have written to Balance

No reply for either time

Maybe 3rd time lucky

Your letter is excellent

Cheers
Cumberland (aka Ian)

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My correspondence with DUK included many hours - days - of study of references & net information, including cross examination of DUK's "position statements." Plus they felt guilty when what purported to be a letter to me was an exact copy of an email sent nearly a year before.

For instance:

My letter - not printed by Balance -

Also a study of the “evidence” - the citations given to support the DUK “Position statement” did NOT support the recommendations in the position statement, though the positive conclusions pointed to the need for long term study to assess the safety of LCHF.

In fact, in my study of the literature, I have not found any valid evidence against adopting a low carbohydrate, high fat diet.

The Position Statement citations 11,12,13 were cited to assert:
“Despite the increases in weight and HbA1c values, these values remained lower than those at the start of the trial which could suggest that low carbohydrate diets may have lasting effects (11,12,13)."

You ignored Nielsen's conclusion (13):
“the present high-carbohydrate dietary advice resulting in unnecessary hyperglycemia and insulin resistance seems difficult to support [17, 18, 19] and for diabetes patients, current dietary recommendations seem to be a major part of their problem rather than being part of the solution.Carbohydrate restriction, however, reverses or neutralises all aspects of the metabolic syndrome [20, 21].”

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Their reply to my above comment - the last word in the exchange:

Thanks for your follow up email. I’m hoping that we can get a clearer outcome this time. From the various discussions, the summary of our positions are as follows:

·does Diabetes UK support low carb diet as an approach to managing diabetes – Diabetes UK’s answer is Yes. We see low carb as one of the many approaches.

·does Diabetes UK support low carb diet as the default approach to managing diabetes – Diabetes UK’s answer is No. This is based on the fact that other approaches are also beneficial so we think people should choose an approach based on their personal preference and that they are likely to stick to.

These are positions that have been informed by robust review of the research. Unfortunately, you disagree with our positions and there appears to be is very little chance of us resolving such disagreements with our conversations.

Whilst Diabetes UK highlights personal success stories through our various channels it is important that our nutrition guidelines are based on published evidence. I’m afraid it would be unhelpful to keep changing our position on a very topical subject like diet based on personal accounts. Apologies for my simplicity of thoughts, but if we were to say today that everyone with diabetes should follow low carb diet, what do we do when we are approached by someone else who has put their Type 2 diabetes into remission with very low calorie diet? That will be a recipe for confusion especially when there is no consistent evidence to support one approach over the other.

With regards to Diabetes UK providing low carb booklets, it would be difficult to justify that if we are not providing specific booklets on other approaches. As a charity, we have made changes to the way we provide written resources for people with diabetes based on feedback. For example, we used to provide specific booklets on each diabetes complication, but that was not cost-effective so we had to rethink. So you’ll realise that our current Enjoy Food guide has summary information on the different approaches. The main booklet looks at the overall diet – there is information to reduce carbs, choose better carbs, reduce fats, choose better fats, reduce sugar, reduce salt etc and we think people can then use this information to tailor an approach that suits their personal preferences. I think there is also some misunderstanding as to what Diabetes UK does. We do not provide individualised dietary information. Because our audience come from different backgrounds, with varied personal circumstances, medical history etc we give general information to people with diabetes, and support healthcare professionals with guidelines so that they can tailor the information to their patients. I have also explained that we are starting the processes to update our 2011 nutrition guidelines, which will review the current evidence to inform our guidelines to healthcare professionals. Until this exercise is complete, or robust evidence emerges, I think it is important for Diabetes UK to continue supporting all the different approaches to diet that are currently based on evidence, and encourage people to make informed choices from these approaches.

My understanding is that the key to your original query was whether Diabetes UK supports low carb diet as an approach to managing diabetes? And I’m hoping that question has been answered. Going forward, I’ll suggest to the Enjoy Food booklets review team that we expand the information on each dietary approach in our next update. Unfortunately, it would be difficult to persuade them to single out specific booklets on low carb alone.

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Notice that whatever diet they "approve" a key factor is always LOW FAT. So there is no way a low carb diet can provide adequate energy. Likewise a low calorie diet is unsustainable. They don't join the dots.

The claim that "our nutrition guidelines are based on published evidence" is demonstrably untrue - simply by looking at the citations used to justify their guidelines.

The latest BALANCE - Spring 2017 - declares on the cover:


Then on page 48 they report:


The text below reports research by University College London & two universities in Brazil. I was thinking about rushing out & buying fruit juice & high sugar Cola instead of tap water & unsweetened tea, when I noticed, in a completely separate column, contrary opinions, and "research on the topic was lacking."

Meanwhile, on page 12, the "Eatwell Guide" is promoted as a way of preventing T2 diabetes to the extend of 780,000 new cases a year.

There are NO references in the text to these studies, only a link to the DUK website - eatwell-guide.

Trouble is, I've only just renewed my subscription to DUK & Balance.