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Counter to anti low-carb stance in NSW

The following is @Southport GP 's diet sheet, as included in his first publication, which he shared with us all, "Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes and pre-diabetes: experience from one general practice "

So what should I eat to control Diabetes or Pre-diabetes?

Reduce starchy carbs a lot (remember they are just concentrated sugar). If possible cut out the ‘White Stuff’ like bread, pasta, rice – though porridge, new potatoes and oat cakes in moderation may be fine. Sugar – cut it out altogether, although it will be in the blueberries, strawberries and raspberries you are allowed to eat freely. Cakes and biscuits are a mixture of sugar and starch that make it almost impossible to avoid food cravings; they just make you hungrier!!

All green veg/salads are fine – eat as much as you can. So that you still eat a good big dinner try substituting veg such as broccoli, courgettes or green beans for your mash, pasta or rice – still covering them with your gravy, bolognese or curry! Tip: try home-made soup – it can be taken to work for lunch and microwaved. Mushrooms, tomatoes, and onions can be included in this.

Fruit is trickier; some have too much sugar in and can set those carb cravings off. All berries are great and can be eaten freely; blueberries, raspberries, strawberries, apples and pears too, but not tropical fruits like bananas, oranges, grapes, mangoes or pineapples.

Proteins such as in meat, eggs, fish – particularly oily fish such as salmon, mackerel or tuna – are fine and can be eaten freely. Plain full fat yoghurt makes a good breakfast with the berries. Processed meats such as bacon, ham, sausages or salami are not as healthy and should only be eaten in moderation.

Fats (yes, fats can be fine in moderation): olive oil is very useful, butter may be tastier than margarine and could be better for you! Coconut oil is great for stir fries. Four essential vitamins A, D, E and K are only found in some fats or oils. Please avoid margarine, corn oil and vegetable oil. Beware ‘low fat’ foods. They often have sugar or sweeteners added to make them palatable. Full fat mayonnaise and pesto are definitely on!!

Cheese: only in moderation – it’s a very calorific mixture of fat, carbs and protein.

Snacks: avoid. But un-salted nuts such as almonds or walnuts are great to stave off hunger. The occasional treat of strong dark chocolate 70% or more in small quantity is allowed.

EATING LOTS OF VEG WITH PROTEIN AND FATS LEAVES YOU PROPERLY FULL in a way that lasts.

Finally, about sweeteners and what to drink – sweeteners have been proven to tease your brain into being even more hungry making weight loss almost impossible – drink tea, coffee, and water or herb teas. I’m afraid alcoholic drinks are full of carbohydrate – for example, beer is almost ‘liquid toast’ hence the beer belly!! Perhaps the odd glass of red wine wouldn’t be too bad if it doesn’t make you get hungry afterwards – or just plain water with a slice of lemon.

Where to get more info?

Abook–‘Escapethediettrap’byDrJohnBriffa(2013).6 Wellresearchedandeasytoread.

Internet – Google ‘about.com low carb diet’ for loads more info and recipes, or look into the closely related PALEO DIET; also Google ‘diabetes.co.uk forum low carb’ for contact, recipes and hints.

BEFORE YOU START get an accurate weight and measure your waist, re-weigh and measure once a week to see how you are doing and ask for help if problems or little progress is being made – GO ON DO IT!!!

Box 1. Advice sheet for patients

This was, of course, advice to known patients, who he would be meeting and holding explanatory sessions with. I wonder if he has updated it as his experience has grown, over recent months? The only thing which didn't entirely ring true for me was the bit about cheese. Some "cheeses" do have all sorts of stuff in them, but the less processed, traditional ones admit to very little, if nothing, in the way of carbs.
Sally
 
Yes, that was it, nearly two years old now, with the phrase, '(yes, fats can be fine in moderation)', as opposed to the high fat diet he is advising now.

If I remember correctly, he's also moved towards saturated fats, so less fish, more meat maybe?

That is why it would be interesting to see the changes he's decided on.
 
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SunnyExpat said:
Certainly better advice, simply low carb, which is good advice for people like me initially, simply eat less, no need to replace the calories I didn't need in the first place.
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That's great for you. Just don't get why you assume that what works for you will work just as well for everyone else.
SunnyExpat said:
Yes, that was it, with the phrase, '(yes, fats can be fine in moderation)', as opposed to the high fat diet he is advising now.
That is why it would be interesting to see he changes he's decided on.
Click to expand...
Why would it be interesting?

IMO, what sets an innovator apart from a conformist is the abiity to revise their recommendations based on the evidence in front of them. Clearly this is a new paradigm to @Southport GP and like many conventionally trained HCPs, he's feeling his way and adapting to changing conditions as his research evolves. Why do you keep hassling the guy because he amends his recommendations as he goes along. Isn't that rational evolution?
 
Indy51 said:
That's great for you. Just don't get why you assume that what works for you will work just as well for everyone else.
Click to expand...

You've hit the nail on the head there.
Let's stop assuming there can only be one diet? A bit of variety is a good thing.
LC is a good diet, no reason to knock it if it works for some.

Indy51 said:
Why would it be interesting?
Click to expand...

You reckon it wouldn't be worth knowing what a LCHF HCP recommends?
You're not even slightly curious? Questions are nothing to be afraid of.
I reckon some would like to know, we don't have that many HCP's on board.
 
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SunnyExpat said:
You reckon it wouldn't be worth knowing what a LCHF HCP recommends?
You're not even slightly curious? Questions are nothing to be afraid of.
I reckon some would like to know, we don't have that many HCP's on board.
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Can't say I am really as I doubt the advice would vary much from the many LCHF books and websites that are out there. I very much doubt that the good doctor has come up with some unique, magical formula. I already have my own version of LCHF worked out, so I'm not too fussed what other people are doing, HCPs or not.
 

Well, if you choose to dismiss him becuase you are alright, and know what you are doing, that's up to you.
But don't dismiss his work for the rest of us.
I'm sure a lot of newly diagnosed in particular would be interested in what a HCP that supports LCHF has to say.
 
Well done twisting my meaning, but I'm not the one challenging everything Dr Unwin says on every post he makes. That would be you.
 
Indy51 said:
Well done twisting my meaning, but I'm not the one challenging everything Dr Unwin says on every post he makes. That would be you.
Click to expand...

No idea what your agenda is, but I'm leaving this to @Southport GP to answer for himself, and letting the thread get back on track.
 

Not sure I get that.
 

My only comment on your apparent criticism of @Southport GP is that many, many, many of us who arrive on this website and others criticise HCPs who are entrenched in the outdated NICE guidelines/Eat Well Plate, whether by ignorance or fear of swimming against the tide, but you seem keen to whittle away at someone who appears to have an open mind to developing and evolving theories, over a portfolio of topics (diabetes, NAFLD and lipids - as evidenced by his most recently published paper). Isn't this open minded approach what we all really want when dealing with important matters like our health? I know I certainly prefer it to someone making diagnosis based on infographics and decision trees.

Of course, you may just be someone who will be driven to swim against the tide on any given day
 
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I think the post is an excellent example of the way the threads often go.

If it's fine to criticise HCP's who are entrenched, and fear swimming against the tide, and then by your admission it's good that southport GP swims against the tide.

So, if I am swimming against the tide by not blindly accepting it's a bad thing to ask him a question, am I a good person in your eyes, or is swimming against the tide now bad?

Either way, I would be of the opinion that he is posting for discussion, not simply to have his every post blindly agreed with, so I think it's fair to say I'll let my questions to him stand as it would be a missed opportunity simply to ignore someone of his standing.

As to the tide question, I don't like water, so I tend not to worry about it.
 
So, what, exactly, is the question you are asking the GP ?
 
Low carb diets were used to treat T2s before oral meds, so I find it disingenuous when dieticians and doctors bleat about a lack of long term evidence. Sulfonylureas were discovered in the 1950s but in the U.S. at least it seems like most diabetes drugs didn't arrive until the 90s - hardly a life time ago.

Nathan Zuntz discovered that same amount of calories and exercise but different amounts of carbohydrates made people put on or lose weight - in 1898.

I have been buying up second-hand books on low carbohydrate diets and diabetic cookery from the 50s and 60s and certainly there were bestselling diets and low carb and carb counting diets for people with diabetes, recommended by renowned doctors and dieticians.

Ancel Keys wasn't a doctor. He had a degree in Economics and Political Science, a Masters in Zoology, a PhD on Oceanography and another in Physiology - but he wrote papers on fish physiology.

Nixon wanted food to be cheap to nullify any unrest. Corn was and still is subsidized by the U.S. government so it's cheap. Ancel Keys' bad science was politically expedient for the Nixon government and McGovern is alleged to have been on a low fat diet.

I think someone should initiate a class action against the Americans because their terrible guidelines and Standard American Diet have directly made millions sick. SAD indeed. I firmly believe that's the reason that governments resist changing the guidelines. They have stats that show obesity went up, diabetes went up etc and they see the nitty gritty. We only get the headlines.
 
You are of course quite correct Sally about the lack of carbs in most cheese - also thank you for pointing out the sheet is what I use as part of a discussion with patients. My view of fats is changing but care is needed for someone who must work as part of a wider NHS team. The basic idea of the diet is to avoid weighing of food which smacks of diet rather than a way of life. Also I think it more important that folk understand the basis of the diet rather than the details.
Recently I was proud to find that my practice spends £20,000 per year less on drugs for diabetes than an average practice.
Only slightly different diet sheet follows:

So what should I eat to control my diabetes?


The problem with having diabetes is your metabolism can no longer deal with sugar, which becomes almost a poison; its consumption needs cutting back dramatically.


Reduce starchy carbs a lot (remember they are just concentrated sugar). If possible cut out the ‘White Stuff’ like bread, pasta, rice – though porridge, new potatoes and oat cakes in moderation may be fine. Sugar – cut it out altogether, although it will be in the blueberries, strawberries and raspberries you are allowed to eat. Cakes and biscuits are a mixture of sugar and starch that make it almost impossible to avoid food cravings; they just make you hungrier!!


All green veg/salads are fine – eat as much as you can. So that you still eat a good big dinner try substituting veg such as broccoli, courgettes or green beans for your mash, pasta or rice – still covering them with your gravy, Bolognese or curry! Tip: try home-made soup – it can be taken to work for lunch and microwaved. Mushrooms, tomatoes, and onions can be included in this.


Fruit is trickier; some tropical fruits like bananas, oranges, grapes, mangoes or pineapples have too much sugar in and can set those carb cravings off. Berries are better and can be eaten; blueberries, raspberries, strawberries, apples and pears too.


Proteins such as in meat, eggs (three eggs a day is not too much), fish – particularly oily fish such as salmon, mackerel or tuna –are fine and can be eaten freely. Plain full fat yoghurt makes a good breakfast with the berries. Processed meats such as bacon, ham, sausages or salami are not as healthy and should only be eaten in moderation.


Fats (yes, fats can be fine in moderation): olive oil is very useful, butter may be tastier than margarine and is probably better for you! Coconut oil is great for stir fries. Four essential vitamins A, D, E and K are only found in some fats or oils. Please avoid margarine, corn oil and vegetable oil. Beware ‘low fat’ foods. They often have sugar or sweeteners added to make them palatable. Full fat mayonnaise and pesto are definitely on!!


Cheese: in moderation – it’s a very calorific mixture of fat, and protein.

Snacks: avoid. But un-salted nuts such as almonds or walnuts are great to stave off hunger. The occasional treat of strong dark chocolate 70% or more in small quantity is allowed.


EATING LOTS OF VEG WITH PROTEIN AND HEALTHY FATS LEAVES YOU PROPERLY FULL IN A WAY THAT LASTS.


Finally, about sweeteners and what to drink – sweeteners have been proven to tease your brain into being even more hungry, making weight loss almost impossible – drink tea, coffee, and water or herb teas. I’m afraid alcoholic drinks are full of carbohydrate – for example, beer is almost ‘liquid toast’ hence the beer belly!! Perhaps the odd glass of red wine wouldn’t be too bad if it doesn’t make you get hungry afterwards – or just plain water with a slice of lemon.
 

Hey now! Let's not talk crazy.

"The Americans" are still perpetuating the SAD and their idea of a reduced carb diet includes: Breakfast = 30 grams, Lunch and Dinner = 45-60 grams, and all snacks = 30 grams. This is the exact recommendations made to me when I was diagnosed with T2. This is the same advice I gave to patients when performing diabetic teaching.

No more. I still have to offer the ADA recommendations to patients, but I am quick to encourage patients to do more research of their own and consider lowering their carbohydrates even further. Especially, the younger generation. They flinch at the idea of introducing medications or even insulin to treat T2 when they are only in their 30's and 40's.

It is very individual. Depending on the severity of T2 or insulin resistance will determine an individual's level of carb intolerance. I could probably eat 50-75 carbs per day and maintain glucose control without an issue. Maybe, even 100 grams.

HOWEVER, I keep it below 35 grams some days and less than 25 grams most days, because it helps control the cravings. I am a sugar/carb addict.
 
If you enjoyed Verner's blogpost, you might enjoy his recent interview with Ivor Cummins of the Fat Emperor blog. There is a lot of discussion about sugar, fructose, carbs, fat, Type 2 and the other modern disease epidemics like CVD, alzheimer's, etc.

 
Edited after further clarification. Thank you
 
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The Dietary Guidelines Advisory Committee reported in February 2015 that "cholesterol is no longer a nutrient of concern" yet the Dietary Guidelines for Americans have NOT been changed to reflect this yet and may not be. The guidelines continue to advise a low fat diet currently.

Here's the page with links to DGAC report

http://health.gov/dietaryguidelines/2015-scientific-report/

Here's the link to the current Dietary Guidelines for Americans published in 2010

http://health.gov/dietaryguidelines/2010/ and you will clearly see on the page that low fat food is recommended.

This webpage shows the evolution of USDA dietary advice from the Basic 7 in 1943 through the Food Guide Pyramid, MyPyramid and My Plate, the latter introduced in 2011.

http://mobile.foodnavigator-usa.com/R-D/From-pyramid-to-plate-Evolution-of-USDA-s-food-guides

I would suggest that the NHS dietary guidelines have very closely followed the U.S. ones with pyramid and plate.

If you Search on YouTube you will find very many doctors coming out against people like Dr Robert Atkins M.D. and Gary Taubes on TV shows. Google and you will the same in newspapers, medical papers etc. The medical and political Establishment in the U.S. and also in the UK don't want to back down on guidelines that have done more harm than good.

And before you say that Gary Taubes isn't a doctor Ancel Keys had a degree in Economics and Political Science, a Masters in Zoology, a PhD in Oceanography and a PhD in Physiology, specialising in FISH physiology. None of those make him an M.D. or nutritionist either.

It is well known that Ancel Keys cherry-picked data for The Seven Countries Study to fit his diet-heart hypothesis and it was IMO scandalous that Nixon and McGovern allowed such incorrect science to shape the way in which millions of people have eaten since the 70s. They did so, because it suited them politically.

The U.S. government continues to subsidise grains. Not only that, it allows growers not to separate out GM crops from non GM for milling, even though many many consumers in other countries don't want to be eating GM.

There are imported US foods here now such as Kraft Dinner macaroni cheese, with stickers stating that they contain GM ingredients, yet these boxes would go unlabelled in the U.S.

The U.S. government also allows hundreds of pesticides and additives banned elsewhere in the world, bovine growth factors, routine antibiotics, CAFO (concentrated animal feeding operations) and Lean Finely Textured Ground Beef aka Pink Slime. There's a dead zone in the Gulf of Mexico, the size of Connecticut, caused by pesticide runoff.

I would suggest that the U.S. government is really not that interested in the health of American citizens and that's why Americans eat more organic food than any other country in the world.

Just because you and your friends and family don't eat SAD, doesn't mean that other Americans don't eat it either.

If Americans weren't eating SAD, there wouldn't be such an obesity problem in the U.S.. Every country which gets McDonald's, Coca-Cola etc from the U.S. ends up with an obesity epidemic.

I'm not anti-American, I have an American stepdaughter in Houston and I've visited lots - I went to school in Canada. Maybe I should have been clearer and said the U.S. government.

Medical science does change over time, even quite rapidly. But Ancel Keys was wrong about cholesterol and Professor John Yudkin was right about sugar.
 
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