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

Yorksman · Mar 6, 2014

Scandichic said:
Are Puy lentils acceptable on LCHF?

In my opinion yes. The labelling can make it look as if they are relatively high in carbs but they conatin a lot of fiber and also a lot of resistant starch.

Carbs come in different forms, alpha carbs, which humans can mostly digest and beta carbs which humans mostly cannot digest. Beta carbs are the sort of carbs cows digest, which is why they lay on the ground chewing all day and why they have four stomaches. It's been a long time since humans ate leaves and our appendix isn't what it used to be.

Alpha carbs come in different levels of complexity and starches are broken down into the simpler sugars for digestion. Legumes in general are high in a group called oligosaccharides which are resistant to being broken down. We lack the enzymes which can do the job. What happens is that those parts of a lentil meal which have not been broken down by enzymes get broken down by bacteria in the gut. This causes gassing and wind, typical of beans, lentils and peas. What it means for diabetics though is that only a part of every lentil is turned into glucose and the remainder is either fibre or resistant carbohydrate. They are an excellent source of fiber, folate and manganese, a very good source of iron, and a good source of copper and thiamin.

The list of legumes is considerable and you can have great fun trying lots of them out. They work well with various asian cuisines. Have a look at Indian Vegetarian Cooking and have a quick look at this list of legumes.

Bluetit1802 · Mar 6, 2014

I am very new to all this and trying to learn, but am afraid to say I'm just as confused as ever.

Mongoose39uk · Mar 6, 2014

Bluetit1802 said:
I am very new to all this and trying to learn, but am afraid to say I'm just as confused as ever.

Your not the only one................. it lacks anything to get a grip on. It seems to be weight loss, education and reduced cards.

I know what works for me so I am afraid I am giving up on getting a straight answer.

xyzzy · Mar 6, 2014

Bluetit1802 said:
I am very new to all this and trying to learn, but am afraid to say I'm just as confused as ever.

The whole debate can be summed up very easily. At its simplest it is

"Avoid anything with sugar in it and significantly cut down on things that contain starch - rice, pasta, potatoes, cereals, bread and other things that contain flour"

If you do that you will eat a diet that contains less carbohydrates than the traditional diet recommended to diabetics (and everyone else) and you will be following "low carb". It really is that straightforward.

Thousands of people have followed that advise on this site and got excellent results.

Southport GP · Mar 6, 2014

Sid Bonkers said:
Interesting diet suggestions and almost identical to the diet that I have eaten for the last 5 years and one that has brought my bg down from 29 mmol/L and an hba1c of 12.6% to 5 years of hba1c's in the 5%'s. And I also lost 4 stone in the first year although I was much stricter then and drank little or no alcohol and no more than 60 to 80g of carbs, then I relaxed my diet to the one you have outlined above and have lost another stone over the last four years.

The only differences that I see between your diet suggestions and my diet are that I dont eat enough oily fish as frankly I dont like it, when I saw a dietician she made the same comment but its hard to change your diet to include things you dont like.

The other differences are that I do eat small portions of basmati rice which due to its molecular structure and unlike other types of rice is extremely difficult for the human stomach to break down into glucose so a couple of spoonfuls has little or no effect on my bg levels. I also eat small oranges and the occasional non ripe banana too. Everything else though is as I eat and have eaten for the last 5 years.

I have to admit to being pleasantly surprised as when you first posted here I was unsure of you both as a doctor and about the advice you were proposing as this forum has seen more than its fair share of low carb trouble makers over the years hence the troll remark and yet you are now advising an almost identical diet to the one I have eaten successfully for the last 5 years.

By the way I apologise for the troll remark,I believed you to be not what you seemed as I said before this forum has seen many low carb trolls over the 5 years since Ive been a member here.

I wish you luck for the future and for your patients futures too and for the award that you have been nominated for also.

THANKYOU for your honesty Sid I have thought a lot about that diet sheet

Southport GP · Mar 6, 2014

xyzzy said:
The whole debate can be summed up very easily. At its simplest it is

If you do that you will eat a diet that contains less carbohydrates than the traditional diet recommended to diabetics (and everyone else) and you will be following "low carb". It really is that straightforward.

Thousands of people have followed that advise on this site and got excellent results.

Yes well put it is that simple It's what to replace the bread pasta etc with that causes confusion for a while

xyzzy · Mar 6, 2014

Southport GP said:
Yes well put it is that simple It's what to replace the bread pasta etc with that causes confusion for a while

That's pretty easy too.

I don't think anyone would disagree that you replace with :

a) Extra green veg
b) Some extra protein in the form of meat, fish etc. To be non-controversial then simply leave it to the person to decide if they want their meat lean or the fat left on.

The only "controversial" bit is whether after doing a) and b) you end up with a calorie deficit i.e. you risk ending up on a permanent diet. In that event the "controversial" non standard "low carb" advice is to up natural saturated fats (eggs, cheese, butter etc) to compensate rather than upping carbohydrates which as a diabetic will increase your blood sugar levels.

There are also good arguments that upping natural saturated fats makes you feel full as fat is the mechanism the brain uses to tell people they're no longer hungry. A "controversial" claim is therefore that low fat diets are harder to adhere to than low carb ones as you don't get the signals to tell you that you are not hungry on a low fat diet. As I've only ever done a low carb diet successfully and found it pretty easy to shed 4 stone in six months I can't comment on low fat regimes.

The other "controversial" area is how much you need to drop your starchy carbs. Regardless of peoples low fat / high fat preferences the probable consensus of opinion on this forum is you can eat as many carbs as you blood sugars allow i.e. you "Eat to your meter". This introduces a debate on self testing for newly diagnosed T2's which many of us see as just as critical as reducing carbohydrates but that's a different debate.

DiamondAsh · Mar 6, 2014

lizzief said:
I was diagnosed as Type2 in late September of last year and after 2 weeks on the high carb diet I'd been told to follow I found this forum and I'd say that was the evening that changed, if not saved, my life. I found out about testing and low carb diets so I started both. I weighed 120KG, had hypertension, raised cholesterol, possible early renal damage and a 12% HbA1c. By the end of December, 10 weeks into the LCHF diet, I'd lowered my BP to 125/70, my cholesterol level was well within a normal range and the signs of renal problems had gone. My HbA1c was down to 6.2%. My weight today is 95kg. In real terms, that means that in 4 months I've dropped from wearing a size 28 dress and a BMI of 44.7 to a size 18 and a 35.9 BMI which is still far too high but a whole heap better than it was.

My GP has said he will halve my Metformin at the next review if all's still well, with a view to stopping it completely at the following one. But he and the DN at the practice still insist that I'm an anomaly, that their high carb advice is what works and that I 'didn't give it a fair chance'. I gave it more than a fair chance because from the way my body reacted to losing the carb intake, I'm sure it was the 'healthy eating' advice that made me fat and diabetic in the first place.

Thank you to Southport GP, low carb dietitian and any other HCPs who are listening, researching and swimming against the tide by speaking out. We need more like you.

What a great story.. well done! I can't believe you were told that you'd not given it a fair chance.

redfox · Mar 6, 2014

Sorry still confused.
If you are diabetic 2 but not obese[other than that exacerbated by insulin injection causing weight gain] how do you find a diet which

a satisfies[especially if you are highly stressed [ ? hair trigger adrenaline release even by thought alone] where food is a craving/sleep helper]
b fits with heart arrythmia[but low bad cholesterol] so exercise is problematic and blood pressure requires warfarin and beta blockers/ vascular dilators
c fits with standard mantra "eat more oily fish, eat more fruit" -- for general health balance
d squares off carbs v calories
e squares off with fatty liver
f fits with newcastle study [not sure of what this comprises diet wise]
g corrects failure of nhs diabetic specialists to give any practical advice eg fail to carry out standard test of fast + standard carb ?cal input +blood test at set time intervals to trace sugar rise/drop back, so that total cals eg per tin of food can be predicted to cause "n" level of b.sugar rise for "X minutes" --yes obviously varies from person to person and depends on exercise level but sedentary situation is a start and would of course be the situation during sleep -so what do you eat at bedtime to prevent too low a b.sugar level on waking[being woken by falling level] The standard eat every 4 hours isn't much help--eat what/how much ?carbs ?cals
h explains variability of post prandial b.sugar rise eg > 2 hours to register because of slow digestion [a patient variable which could be informed by personal standard testing]
i explains how long short insulin and long insulin actually take to work so that you can correlate short insulin input with b.sugar rise due to food input-- for this test g could be repeated on a different occasion introducing "n" units at the same time as the first cal/carb input
and how that correlates with advice to take metformin and short insulin before meals-- how can you predict how much insulin if you don't know your standard "n" cals. input needs "x" units of insulin
j explains how/why b.sugar level can be 7 at 6am but have risen to 10 at 9am despite NOTHING being eaten or drunk other than water and having taken long acting insulin approx. 24 hours previously

Wouldn't the nhs save millions if there was a more scientific approach to patient care including literature. If the tests at g and h above were done on say 1000 patients surely that would give a rough estimate for practical purposes[could easily be extended to 10,000 patients if that gives a statistically better result].

If newcastle/carb restricted diet is thought to be valid why not suggest it to all type 2 patients on a voluntary basis- again use of volunteers countrywide would give an enormous test pool and could save millions in drugs/patient deterioration even if only some patients followed/partly followed it. Going a step further why not prepacked set cal./carb. foods/meals to provide a balanced diet eg this can is self contained main meal "n" cals/carbs or this can contains "n" legume/fruit/fat etc cals./carbs. for you to make up your own meal. Presumably those selected for newcastle trial must be issued with something like this to make the trial valid. Are they issued with a can marked slow sugar release to take before going to bed?

Scores more Qs but hope these spur someone into a scientific response- perhaps more modern endocrinologists could give their minds to
practical real life situations especially how to utilise a more holistic approach rather than say separate diabetician/heart/liver specialists looking at only their bit of a patient and hence how to head off/reduce expensive [? soon to severely rationed] drug use

Request please- can all b.sugar figures be given on this site in all variants, failing which have a comparison table in the forum side bar, likewise fahrenheit/centigrade- some of us recognise 98.4 and rises almost instinctively but heavens knows what equivalent centigrades are[or should that be "degrees celsius" !]

Thank you.

xyzzy · Mar 6, 2014

redfox said:
Sorry still confused.
If you are diabetic 2 but not obese[other than that exacerbated by insulin injection causing weight gain] how do you find a diet which

a satisfies[especially if you are highly stressed [ ? hair trigger adrenaline release even by thought alone] where food is a craving/sleep helper]
b fits with heart arrythmia[but low bad cholesterol] so exercise is problematic and blood pressure requires warfarin and beta blockers/ vascular dilators
c fits with standard mantra "eat more oily fish, eat more fruit" -- for general health balance
d squares off carbs v calories
e squares off with fatty liver
f fits with newcastle study [not sure of what this comprises diet wise]
g corrects failure of nhs diabetic specialists to give any practical advice eg fail to carry out standard test of fast + standard carb ?cal input +blood test at set time intervals to trace sugar rise/drop back, so that total cals eg per tin of food can be predicted to cause "n" level of b.sugar rise for "X minutes" --yes obviously varies from person to person and depends on exercise level but sedentary situation is a start and would of course be the situation during sleep -so what do you eat at bedtime to prevent too low a b.sugar level on waking[being woken by falling level] The standard eat every 4 hours isn't much help--eat what/how much ?carbs ?cals
h explains variability of post prandial b.sugar rise eg > 2 hours to register because of slow digestion [a patient variable which could be informed by personal standard testing]
i explains how long short insulin and long insulin actually take to work so that you can correlate short insulin input with b.sugar rise due to food input-- for this test g could be repeated on a different occasion introducing "n" units at the same time as the first cal/carb input
and how that correlates with advice to take metformin and short insulin before meals-- how can you predict how much insulin if you don't know your standard "n" cals. input needs "x" units of insulin
j explains how/why b.sugar level can be 7 at 6am but have risen to 10 at 9am despite NOTHING being eaten or drunk other than water and having taken long acting insulin approx. 24 hours previously

Wouldn't the nhs save millions if there was a more scientific approach to patient care including literature. If the tests at g and h above were done on say 1000 patients surely that would give a rough estimate for practical purposes[could easily be extended to 10,000 patients if that gives a statistically better result].

If newcastle/carb restricted diet is thought to be valid why not suggest it to all type 2 patients on a voluntary basis- again use of volunteers countrywide would give an enormous test pool and could save millions in drugs/patient deterioration even if only some patients followed/partly followed it. Going a step further why not prepacked set cal./carb. foods/meals to provide a balanced diet eg this can is self contained main meal "n" cals/carbs or this can contains "n" legume/fruit/fat etc cals./carbs. for you to make up your own meal. Presumably those selected for newcastle trial must be issued with something like this to make the trial valid. Are they issued with a can marked slow sugar release to take before going to bed?

Scores more Qs but hope these spur someone into a scientific response- perhaps more modern endocrinologists could give their minds to
practical real life situations especially how to utilise a more holistic approach rather than say separate diabetician/heart/liver specialists looking at only their bit of a patient and hence how to head off/reduce expensive [? soon to severely rationed] drug use

Request please- can all b.sugar figures be given on this site in all variants, failing which have a comparison table in the forum side bar, likewise fahrenheit/centigrade- some of us recognise 98.4 and rises almost instinctively but heavens knows what equivalent centigrades are[or should that be "degrees celsius" !]

Thank you.

I think you're making it far more complicated than it needs to be and in reality no regime will meet all requirements.

No one much disagrees that cutting down on your carbohydrate intake i.e. avoiding sugar, and limiting starchy foods such as rice, pasta, potatoes, bread, cereals and other flour based things is a good thing for diabetics to try as that will help stabilise your blood sugars. How much you need to cut out is very much down to the individual and should be driven by your 2 hour post prandial readings. No one will be able to tell you precisely how much as that's the individuals responsibility to find out.

As to the measurements used on this site then the vast majority of posters are from the United Kingdom and hence BG's measured in mmols will naturally predominate. Confusing the majority by adding yet another set of BG figures would not be a good thing imo. If you want to translate between mmol's and dl measures for BG's (or Farenheit and Centrigrade) then there are ample conversion sites you can refer to on Google

douglas99 · Mar 6, 2014

xyzzy said:
Good grief looks like there is nearly a concensus of opinion with all sides claiming its the diet they've followed for years. Good stuff.

The diet is just missing two key ingredients, lard and low fat yoghurt

Sent from the Diabetes Forum App

Add lard - that's the high fat version
Add low fat yoghurt, - that's the low fat version.

I agree though it is interesting how all sides are happy with a

porridge, new potatoes and oat cakes
blueberries, raspberries, strawberries, apples & pears
olive oil, butter, coconut oil

diet.

If low carb is defined as about 130g of carbs (as per the debate) it could easily fit any profile, depending on the amount of the above in it.

It does seem a good starting point, which any diet usually is as an improvement on most peoples previous diet.
After that we all personalise them.

xyzzy · Mar 6, 2014

douglas99 said:
If low carb is defined as about 130g of carbs (as per the debate) it could easily fit any profile, depending on the amount of the above in it.

It does seem a good starting point, which any diet usually is as an improvement on most peoples previous diet.
After that we all personalise them.

Many of us have suggested that 130g starting point for a number of years. The bottom line is to recognise that it is just a starting point and depending on how screwed your pancreas is and / or how insulin resistant you are you may need to adjust that lower for a prolonged period. Whether or not you have to keep lower than 130g then largely depends how much beta cell function you have left after you have shifted insulin resistance and how much medication you want to take imo.

In any event its nice to see "the establishment" is finally catching up with the thousands of posters on this forum over the years who despite having differences on the fat debate all recognise the importance of carbohydrate restriction. I just hope they take it that one stage further and not only introduce a low(er) carb option but also a self testing option so that people can educate themselves on how much they need to restrict.

Personally I really don't care much about the fat debate as effectively that ends up as an individual choice. Total carbohydrate consumption and self testing are the real things that need evangelising.

Scandichic · Mar 6, 2014

xyzzy said:
That's pretty easy too.

I don't think anyone would disagree that you replace with :

a) Extra green veg
b) Some extra protein in the form of meat, fish etc. To be non-controversial then simply leave it to the person to decide if they want their meat lean or the fat left on.

The only "controversial" bit is whether after doing a) and b) you end up with a calorie deficit i.e. you risk ending up on a permanent diet. In that event the "controversial" non standard "low carb" advice is to up natural saturated fats (eggs, cheese, butter etc) to compensate rather than upping carbohydrates which as a diabetic will increase your blood sugar levels.

There are also good arguments that upping natural saturated fats makes you feel full as fat is the mechanism the brain uses to tell people they're no longer hungry. A "controversial" claim is therefore that low fat diets are harder to adhere to than low carb ones as you don't get the signals to tell you that you are not hungry on a low fat diet. As I've only ever done a low carb diet successfully and found it pretty easy to shed 4 stone in six months I can't comment on low fat regimes.

The other "controversial" area is how much you need to drop your starchy carbs. Regardless of peoples low fat / high fat preferences the probable consensus of opinion on this forum is you can eat as many carbs as you blood sugars allow i.e. you "Eat to your meter". This introduces a debate on self testing for newly diagnosed T2's which many of us see as just as critical as reducing carbohydrates but that's a different debate.

Still struggling. Hubbie lost 1 stone 3lbs. First stone came off in 4 weeks. Lost nothing for 2 weeks. Infact put on over course of week but lost so that nothing was lost overall that week. Same this week. Very frustrating. Sugar is peaking an hour after breakfast to 9 then gradually going down. This has happened for the past 3 days. Feel **** for 2 hours after. Sit at desk at school, praying no one comes in and teaching lesson from desk. Weird cold which is only present first thing in morning, gone by the time I leave the house and back by 7:30 pm. feeling sorry for self.

xyzzy · Mar 6, 2014

Scandichic said:
Still struggling. Hubbie lost 1 stone 3lbs. First stone came off in 4 weeks. Lost nothing for 2 weeks. Infact put on over course of week but lost so that nothing was lost overall that week. Same this week. Very frustrating. Sugar is peaking an hour after breakfast to 9 then gradually going down. This has happened for the past 3 days. Feel **** for 2 hours after. Sit at desk at school, praying no one comes in and teaching lesson from desk. Weird cold which is only present first thing in morning, gone by the time I leave the house and back by 7:30 pm. feeling sorry for self.

Keep at it! Not sure how long you've been diagnosed but it took me around 8 weeks of very low carb to get all my numbers consistently below 8. Morning levels are notorious and 9 o'clock is my highest reading too. As for stalled weight loss that happened as well. Its called hitting a plateau but in the end it will start to shift. If you are doing very low carb your cold could be Atkins flu that happens to lots of people as they adjust to low carbs. It should pass. How are your levels at other times of the day?

Sent from the Diabetes Forum App

modesty007 · Mar 6, 2014

Scandichic said:
Still struggling. Hubbie lost 1 stone 3lbs. First stone came off in 4 weeks. Lost nothing for 2 weeks. Infact put on over course of week but lost so that nothing was lost overall that week. Same this week. Very frustrating. Sugar is peaking an hour after breakfast to 9 then gradually going down. This has happened for the past 3 days. Feel **** for 2 hours after. Sit at desk at school, praying no one comes in and teaching lesson from desk. Weird cold which is only present first thing in morning, gone by the time I leave the house and back by 7:30 pm. feeling sorry for self.

Extra water and some extra salt might help. If you check the forum at the Swedish version of dietdoctor you can probably find several advice on some changes if the weight plateau persist, like cutting more carbs and be more strict, nuts and diaries can stop weight lost in some (especially women it seems, in this unfair world it looks like men having it a lot easier losing weight on LCHF).

Charles Robin · Mar 6, 2014

Scandichic said:
Still struggling. Hubbie lost 1 stone 3lbs. First stone came off in 4 weeks. Lost nothing for 2 weeks. Infact put on over course of week but lost so that nothing was lost overall that week. Same this week. Very frustrating. Sugar is peaking an hour after breakfast to 9 then gradually going down. This has happened for the past 3 days. Feel **** for 2 hours after. Sit at desk at school, praying no one comes in and teaching lesson from desk. Weird cold which is only present first thing in morning, gone by the time I leave the house and back by 7:30 pm. feeling sorry for self.

Read Dr Bernstein's diabetes solution. It will answer a huge number of your questions about low carbing. The book advocates a very low carb diet which the author follows himself. You may not feel the need to stick as rigidly as the book recommends, but even so it does an excellent job of explaining the low carb way of life. It's fairly pricy in hardback, but far less on Kindle.

FatGenes999 · Mar 7, 2014

I haven't yet met with the clinical "Diabetes Team" that my GP referred me to,, but, so far, the specialists that I have seen to keep check on DB complications have said that I am doing a good job of using the LCHF diet. This is a good sign, because it might mean that when I finally get around to seeing the Diabetes Team I might be pleasantly surprised to find that they, too, are up on the diets that really work for us. Maybe there is a common-sense standard operating among clinicians, here in the States.

It seems that almost every health professional I have spoken to, including my dentist and my chiropractor, are convinced that the LCHF is the way to go. It isn't only the practitioners who have the highest amount of patients with diabetes, such as podiatrists and neurologists, who are up on this. I can assume from this that the medical profession, in general, is starting to come down to earth, at least from what I personally observe, here in the States.

My GP doesn't seem to care one way or the other how I'm getting my BG numbers under control, as long as I do it. However, she has already tried to push Rx drugs on me, which I have refused.

I appreciate that clinicians, such as yourself, care enough about people who have diabetes to do the work, putting in the time and energy to do the research. The neurologist I met with today actually used the word "cure" in reference to the track that I am trying, and he said that he wished that all of his patients were doing what I am doing. So, there is hope.

kesun · Mar 7, 2014

douglas99 said:
all sides are happy with a

porridge, new potatoes and oat cakes
blueberries, raspberries, strawberries, apples & pears
olive oil, butter, coconut oil

diet.

I don't want to belong to a "side", but I can't eat porridge, new potatoes, oat cakes, raspberries, strawberries, apples or pears without raising my BG back into the diabetic range. For me, low carb means no grains and almost no fruit. I can occasionally manage blueberries in whipped cream. And I practically live on olive oil and butter, which as far as I'm concerned are the secret to making vegetables palatable.

Kate

douglas99 · Mar 7, 2014

kesun said:
I don't want to belong to a "side", but I can't eat porridge, new potatoes, oat cakes, raspberries, strawberries, apples or pears without raising my BG back into the diabetic range. For me, low carb means no grains and almost no fruit. I can occasionally manage blueberries in whipped cream. And I practically live on olive oil and butter, which as far as I'm concerned are the secret to making vegetables palatable.

Kate

Southport GP has made a good diet here, if t's not low carb, it's certainly a good point to start out at, I think we all agree.

xyzzy · Mar 7, 2014

kesun said:
I don't want to belong to a "side", but I can't eat porridge, new potatoes, oat cakes, raspberries, strawberries, apples or pears without raising my BG back into the diabetic range. For me, low carb means no grains and almost no fruit. I can occasionally manage blueberries in whipped cream. And I practically live on olive oil and butter, which as far as I'm concerned are the secret to making vegetables palatable.

Kate

The key is to realise it is just a starting point. Telling many newly diagnosed people to go cold turkey onto a sub 50g vlc regime is both unrealistic and of course people are naturally suspicious of giving up foods they've been told to believe are ok for diabetics. I was "taught" by the probably the most vociferous very low carb advocate this forum ever had (a T2 85% fat intake half marathon runner) yet he also advocated that 130g as a staring point to newly diagnosed people. I don't for one moment dispute that you may need to do a vlc diet to maintain your BG's but for many it can be a perfectly valid lifestyle choice not a necessity. The amount of carbs required to "eat to your meter" varies considerably person to person anything from sub 30g to around 200g a day in my experience.

It is eating to your meter that counts not the diet you choose to follow that really matters imo

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

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