Dec 2014 update: New research on the Low Carb Diet in general practice

Southport GP · Oct 31, 2014

Andrew Colvin said:
@Southport GP That is excellent. You need to get the work out to more GP practices.

For info I am 32kg down (down 28% of my original mass) and my HbA1c is now 35 mmol/mol from 91 mmol/mol. I started low cal/carb but now on normal diet. If you ask me it is definitely the weight loss that has the largest impact and not the low carb. However without the low carb it is hard to get control so I do see it necessary and if it becomes a lifestyle choice that is great.

A couple of questions if I may indulge (the scientist in me):
1. How low did your patients go with the low carb and did they reduce calories at the same time?
2. Are your patients aiming for further reductions and will you think about testing their "diabetes" when/if they hit normal BMI?
3. Have you taken them off of medication since their reduction?

What is so interesting is that patients just used the diet sheet printed for you in the article -we never mentioned weighing food or calorie counting this was one of the features they like best about the approach -one lady put it very well 'a diet is something you are on, with all its weighing and measuring , something you will someday come off. the low carb approach is away of life'
So the great majority of them stop on the diet because I suspect their diabetes will deteriorate if they go back to carbs. Though as you say weight loss by itself does help type two diabetes but until I started recommending the low carb diet I personally had not had much success in inspiring weight loss that lasted. I have a theory that carbs are addictive which could explain my observation.
We continue to check HbA1c levels in them all-partly at their request because I'm told it helps prevent 'carb drift.'
Yes a number have come off meds and others have managed to avoid insulin (I should repeat the work was not on Insulin dependent type one diabetics)

Southport GP · Oct 31, 2014

NoCrbs4Me said:
Nice paper. I'm going to give a copy to my diabetic nurse when I see her again in January. She was sceptical of my diet last time I saw her.

However, I have a question regarding a statement in the "what to eat" section. It says: "Cheese: only in moderation – it’s a very calorific mixture of fat, carbs and protein." I'm pretty sure there's not much carbs in cheese. Am I wrong?

No you are correct it was an error I have since corrected in the most recent diet sheet -well spotted! it should read
a very calorific mixture of fat, and protein'- some cheeses do have carbs in but probably not that much

alliebee · Oct 31, 2014

Southport GP said:
That is so great - if you have time perhaps you could print your GP a copy of the article off
http://www.practicaldiabetes.com/Sp.../March 2014/PP Unwin final proofs revised.pdf
and add the work came in the top five for the finals of the British Medical journal Diabetes team of the year 2014, also I have great stats on well over 60 cases now with very similar results. Many folk have mentioned how much more energetic they feel too.
PS 'Starch is concentrated sugar!'

I certainly will. I think he would be very interested. Thankyou so much for replying. You are doing such great work. Its so refreshing to hear

NoCrbs4Me · Oct 31, 2014

Southport GP said:
No you are correct it was an error I have since corrected in the most recent diet sheet -well spotted! it should read
a very calorific mixture of fat, and protein'- some cheeses do have carbs in but probably not that much

It's still good advice to have cheese in moderation.

andcol · Oct 31, 2014

Southport GP said:
What is so interesting is that patients just used the diet sheet printed for you in the article -we never mentioned weighing food or calorie counting this was one of the features they like best about the approach -one lady put it very well 'a diet is something you are on, with all its weighing and measuring , something you will someday come off. the low carb approach is away of life'
So the great majority of them stop on the diet because I suspect their diabetes will deteriorate if they go back to carbs. Though as you say weight loss by itself does help type two diabetes but until I started recommending the low carb diet I personally had not had much success in inspiring weight loss that lasted. I have a theory that carbs are addictive which could explain my observation.
We continue to check HbA1c levels in them all-partly at their request because I'm told it helps prevent 'carb drift.'
Yes a number have come off meds and others have managed to avoid insulin (I should repeat the work was not on Insulin dependent type one diabetics)

Thanks for the reply.

I am interested in this statement,
"I suspect their diabetes will deteriorate if they go back to carbs"
I decided to go back on the carbs and in doing so my HbA1c reduced further. Now I do not know if it would have continued falling if I had continued with the low/medium carbs. I have not found carbs, as such, to be addictive. I do find at times I crave nuts, especially peanuts (yeah I know not really nuts) and find when I have these cravings I can polish off a 1/2 kg bag. What is amazing is this has no impact on my BG levels or weight. I do not quite understand the craving but I do indulge it as I assume it is my body telling me I need something it requires that I am not providing in other ways (maybe I am not eating enough fats or it wants the combination of fats and carbs in the nuts to top up my fat stores.

Have you looked at the fasting levels of those on low carb. I have a theory that as you go lower in carb amount the level rises and your BG levels become more stable throughout the day. This makes it look like people have developed insulin resistance when they haven't. I wonder if there is a study/paper in there to determine a statistical correlation.

Are you testing their HbA1c yearly or more frequently? After my first 3 month HbA1c my surgery decided I didn't need one for a year as I was in normal range. Personally I do feel this is not often enough and would allow too much "carb creep". I therefore test every few days around my main meal to ensure I am not getting drift but do find spot checking is difficult for trending and I am trying to not be as obsessive with my testing like I used to be (I was able to predict my HbA1c with some accuracy and I had to show my GP how I did it with all my calculations). Out of interest did you get your trialists to test their BG levels as they went to provide them with even further incentive and if so did you need to explain the levels they were obtaining?

Sorry, more questions, just ignore me if you wish.

this is too difficult two · Oct 31, 2014

What is you carb intake now Andrew?

Brunneria · Oct 31, 2014

NoCrbs4Me said:
It's still good advice to have cheese in moderation.

I am rather immoderate

IanD · Oct 31, 2014

Brunneria said:
I am rather immoderate

I'm also immoderate with cheese, & very nutty.

andcol · Nov 1, 2014

this is too difficult two said:
What is you carb intake now Andrew?

250 g to 300 g per day

Andy12345 · Nov 1, 2014

Andrew Colvin said:
Thanks for the reply.

I am interested in this statement,
"I suspect their diabetes will deteriorate if they go back to carbs"
I decided to go back on the carbs and in doing so my HbA1c reduced further. Now I do not know if it would have continued falling if I had continued with the low/medium carbs. I have not found carbs, as such, to be addictive. I do find at times I crave nuts, especially peanuts (yeah I know not really nuts) and find when I have these cravings I can polish off a 1/2 kg bag. What is amazing is this has no impact on my BG levels or weight. I do not quite understand the craving but I do indulge it as I assume it is my body telling me I need something it requires that I am not providing in other ways (maybe I am not eating enough fats or it wants the combination of fats and carbs in the nuts to top up my fat stores.

Have you looked at the fasting levels of those on low carb. I have a theory that as you go lower in carb amount the level rises and your BG levels become more stable throughout the day. This makes it look like people have developed insulin resistance when they haven't. I wonder if there is a study/paper in there to determine a statistical correlation.

Are you testing their HbA1c yearly or more frequently? After my first 3 month HbA1c my surgery decided I didn't need one for a year as I was in normal range. Personally I do feel this is not often enough and would allow too much "carb creep". I therefore test every few days around my main meal to ensure I am not getting drift but do find spot checking is difficult for trending and I am trying to not be as obsessive with my testing like I used to be (I was able to predict my HbA1c with some accuracy and I had to show my GP how I did it with all my calculations). Out of interest did you get your trialists to test their BG levels as they went to provide them with even further incentive and if so did you need to explain the levels they were obtaining?

Sorry, more questions, just ignore me if you wish.

This amazes me, you are eating 300g of carb a day and have a falling Hba1c? you could be "cured"? i know there isn't a cure but you don't sound very diabetic to me, are you doing crazy amounts of exercise etc? or perhaps the weight loss was the only thing that you needed to be "cured"? i am not really suggesting it as a cure because i think if you were to regain the weight you may have the same problems unfortunately

The "I assume it is my body telling me I need something it requires that I am not providing in other ways" worries me, not that you are eating the nuts, just the assumption that your body can out wit your mind and tell us what we need rather than our minds being in control of our bodies and translating the want into a need, for example I'm pretty sure before diagnosis my body needed 10 mcdonalds a week due a deficiency in another area, perhaps the chinese takeaways where not providing me with enough vitamin No.32 SFR?

andcol · Nov 1, 2014

Andy12345 said:
This amazes me, you are eating 300g of carb a day and have a falling Hba1c? you could be "cured"? i know there isn't a cure but you don't sound very diabetic to me, are you doing crazy amounts of exercise etc? or perhaps the weight loss was the only thing that you needed to be "cured"? i am not really suggesting it as a cure because i think if you were to regain the weight you may have the same problems unfortunately

The "I assume it is my body telling me I need something it requires that I am not providing in other ways" worries me, not that you are eating the nuts, just the assumption that your body can out wit your mind and tell us what we need rather than our minds being in control of our bodies and translating the want into a need, for example I'm pretty sure before diagnosis my body needed 10 mcdonalds a week due a deficiency in another area, perhaps the chinese takeaways where not providing me with enough vitamin No.32 SFR?

lol @Andy12345 yes I know what you mean. I would agree with you on that last statement. Although I never went into the 10 mcdonalds but I did go for bounty bars, snickers, etc. I can't explain the nuts any other way as I just do not understand it. As for the cured, I am not counting my chickens yet. It is still only 11 months since I was diagnosed so time will tell. This brush with D was a shock to my mortality and up to then I was still in the young "I'm immortal" period of my life. I am not doing stupid amounts of exercise (I wish I was as fit as those of you that run marathon races). I still find some foods that I am not really happy with eating because they push me to my peak every time (and it isnt things like sweets either) no matter how much carb I have been eating in the days prior. May be that is just normal and I am being paranoid. I will continue to push the boundaries ever mindful that I know my way back if it starts to go pear shaped (low carb). I have no idea about the years prior to diagnosis and what damage I have caused. As I said before I consider myself fortunate and fingers crossed "fortune favours the brave" will be correct for me.

PS I don't feel very diabetic either. I read on here the horrors some of you suffer and I have just never seen that at all. Was it just the fat and inactivity or was it the gastric issues I was having for the previous 2 years until I worked out I have an allergy to bananas. I have noticed that I no longer receive high peaks but lower longer sustained levels after eating. I wrote a thread on this http://www.diabetes.co.uk/forum/threads/interesting-bg-levels-what-do-you-think.65983/ It is interesting and @pheonix provides some links to some rather interesting articles but there is no conclusion of the thread.

Anyway that is another ramble. Keep well @Andy12345 and all

Spiker · Nov 3, 2014

I have spoken to a very senior person at DUK who is watching the Southport work with interest. I don't think they are as backwards as we sometimes think.

Spiker · Nov 3, 2014

@Southport GP
Maybe contact me to make sure we are all on the same page re Diabetes UK.

Enclave · Nov 3, 2014

Southport GP said:
That is so great - if you have time perhaps you could print your GP a copy of the article off
http://www.practicaldiabetes.com/SpringboardWebApp/userfiles/espdi/file/March 2014/PP Unwin final proofs revised.pdf
and add the work came in the top five for the finals of the British Medical journal Diabetes team of the year 2014, also I have great stats on well over 60 cases now with very similar results. Many folk have mentioned how much more energetic they feel too.
PS 'Starch is concentrated sugar!'

I know if I printed this off and gave to my DBN she would put it straight in the bin without looking at it, she has done this in the past with figures that she asked to be bring in... Sometimes you have to just find your own way and forget about any med help

noblehead · Nov 3, 2014

Enclave said:
I know if I printed this off and gave to my DBN she would put it straight in the bin without looking at it, she has done this in the past with figures that she asked to be bring in... Sometimes you have to just find your own way and forget about any med help

That's annoying, I wonder if the Southport GP also provided additional information on what percentage of carbs, fat & protein his patients followed (over the course of his research) this may be beneficial to some members.

msmi1970 · Nov 3, 2014

just found out that based on my much improved blood results, my young cardiologist is himself trying out low carb. he was absolutely amazed by the improvements in my A1C and cholesterol in spite of the tons of eggs and butter i consume. he has decided to give it a go.

douglas99 · Nov 3, 2014

noblehead said:
That's annoying, I wonder if the Southport GP also provided additional information on what percentage of carbs, fat & protein his patients followed (over the course of his research) this may be beneficial to some members.

It would be nice to see a ratio, but as it would seem to be a completely unlimited diet, in theory it could be any combination, so long as the carbs are low by quantity.

Enclave · Nov 3, 2014

Would be intresting to see how many gp's would read this report .. I know mine wouldn't .. I have never know such a bunch of closed minded people in my life. I do worry how many of their patients will be wrongly diagnosed as having Dementia.. Then they can earn more money from the gov.

noblehead · Nov 3, 2014

douglas99 said:
It would be nice to see a ratio, but as it would seem to be a completely unlimited diet, in theory it could be any combination, so long as the carbs are low by quantity.

Thanks Douglas, but better if the Southport GP answered as providing this information would be enormously beneficial to those who are wanting to pursade their HCP's that a lower carb diet is possible with type 2 diabetes.

douglas99 · Nov 3, 2014

noblehead said:
Thanks Douglas, but better if the Southport GP answered as providing this information would be enormously beneficial to those who are wanting to pursade their HCP's that a lower carb diet is possible with type 2 diabetes.

It would, but he tends to be infrequent on his posts unfortunately. I'd like to know it there were ratios as well.

Dec 2014 update: New research on the Low Carb Diet in general practice

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