Diabetes UK implying we need to eat carbohydrate?

[pdmjoker]

Low carb GP Dr David Unwin makes prestigious list of influential GPs in the UK

From here:

https://www.diabetes.co.uk/news/201...st-of-influential-gps-in-the-uk-91444560.html

It ends saying "Also, among his achievements, he was asked to contribute to Diabetes UK's dietary guidelines for 2018."

That's sounds good - they could do with the help. (However, did they use his contribution?) Here's the prior "Position statement - Low-carb diets for people with diabetes" from Diabetes UK:
https://www.diabetes.org.uk/resources-s3/2017-09/low-carb-diets-position-statement-May-2017.pdf

It says "Most carbohydrates are broken down into glucose which is an essential fuel for the brain [2]." which I suppose is meant to infer we need to eat carbohydrate?

Reference 2 is: Mergenthaler P, Lindauer U., Dienel G. A, Meisel A. (2013). Sugar for the brain:the role of glucose in physiological and pathological brain function. Trends Neurosci. 2013 Oct;36(10):587-97.

The paper begins "The mammalian brain depends upon glucose as its main source of energy...". The paper then describes Ketogenic diets as being "a diet that has a high fat and low carbohydrate content so that plasma levels of ketone bodies (acetoacetate and β-hydroxybutyrate) rise and serve as an alternative oxidative fuel." So another fuel does exist, namely β-hydroxybutyrate. Perhaps the brain doesn't depend on glucose for the main source of energy, then?
(After a few weeks on a Keto diet, the brain adapts to using ketones bodies and research has found that the astrocytes in the brain and spinal cord can also produce ketone bodies, which can be used as substrates for neuronal metabolism: https://www.ncbi.nlm.nih.gov/pubmed/14769487 Brain fuelled by ketones: https://www.ncbi.nlm.nih.gov/pubmed/27826689)

The paper in question doesn't, though, mention gluconeogenesis (as far as I can see) where the body will make whatever glucose it needs. Erythrocytes (red blood cells) have not got mitochondria to metabolize fatty acids/ketones so do need glucose. I gather the brain possibly needs 25% glucose?

If "The mammalian brain depends upon glucose as its main source of energy" were true, then what would happen to the brains of people who eat almost no carbs on a Keto diet prescribed for epilepsy, say, which is a treatment approved of by the paper?

Either way, people do not need to eat carbohydrate, so the implication that they do by Diabetes UK seems somewhat misleading and isn't even scientifically backed-up by the paper they cite.

Or am I misunderstanding something?

 

[bulkbiker]

Or am I misunderstanding something?

Highly unlikely.. DUK seems incapable of looking at their Type 2 advice and being a bit more open minded. Personally I think they still have a bit of a blame culture where Type 2 is concerned "it's all their own fault" otherwise why do they stick to the dogma of carbs are essential maybe they are trying to punish us all!

 

[Guzzler]

All I know is that David Attenborough has never shown film of lions (mammals) chowing down on carbs.
And n=1 my cognitive functions are fine, thank you very much!

 

[pdmjoker]

Highly unlikely

Thank you! I read recently in a published paper that the reason for the obesity and diabetes epidemics is assumed to be the lack of compliance with the dietary guidelines, rather than the guidelines being wrong or ineffectual....

In the 3rd Dietdoctor.com website podcast it was explained how engineers and other scientists use more rigorous methods of problem-solving than those in the medical field and are encouraged to look for "black swans" - counterexamples which disprove their hypotheses - whereas medicine has a history of ignoring (or suppressing) "inconvenient data". Pretty bizarre considering the complexity of the human body and the importance of getting things right!

 

[Honeyend]

I work with a lot of elderly people who in general have had their lives made miserable, because most of like eating, because they are supposed to eat low fat, for heart health,and then told because they have diabetes, usually Type2 they have to cut down sugar but can eat some carbs. Which leads to still high blood glucose and a feeling of defeat, and extremely limited food choices, basically low fat yoghurt, a sandwich( usually white bread), a jacket potato, macaroni cheese and the frozen ready meal.
Most of the people on this website are trying to understand their disease and keep themselves well by research, then making informed choices. A lot do not have that opportunity, they and their families are given the eat well plate which then gets converted into something in real life that bares no resemblance to the good choices, the only thing is consistent is the carbs.

I just wish these people would work in the real world, go round some homes, look in the fridge and the cupboard, it wouldn't take that many and find out what people are actually eating, not because they are non compliant but because they lack the knowledge or the ability to eat that way.
If I was king for a day the first thing I would do is put the total carb content of every ready meal/tin in big easy to read letters on the front, not in the weeny weeny writing on the back. So what ever the amount of carb they think is 'safe' to eat there would be some way of achieving that goal.
I can not for the life of me understand why this has not been lobbied for, but perhaps blaming people for making bad choices is just easier.

https://www.diabetes.org.uk/resources-s3/2017-09/low-carb-diets-position-statement-May-2017.pdf
There is so much in this that is inconsistent it beggars belief.
You give fruit juice to treat a hypo, so encourage people to eat fruit? No mention of what type of fruit. So the fruit bowl is full of bananas. Nice and easy to eat when ripe, especially if you have false teeth. See what I mean about the real world.

 

[pdmjoker]

I work with a lot of elderly people who in general have had their lives made miserable, because most of like eating, because they are supposed to eat low fat, for heart health,and then told because they have diabetes, usually Type2 they have to cut down sugar but can eat some carbs. Which leads to still high blood glucose and a feeling of defeat, and extremely limited food choices, basically low fat yoghurt, a sandwich( usually white bread), a jacket potato, macaroni cheese and the frozen ready meal.
Most of the people on this website are trying to understand their disease and keep themselves well by research, then making informed choices. A lot do not have that opportunity, they and their families are given the eat well plate which then gets converted into something in real life that bares no resemblance to the good choices, the only thing is consistent is the carbs.

I just wish these people would work in the real world, go round some homes, look in the fridge and the cupboard, it wouldn't take that many and find out what people are actually eating, not because they are non compliant but because they lack the knowledge or the ability to eat that way.
If I was king for a day the first thing I would do is put the total carb content of every ready meal/tin in big easy to read letters on the front, not in the weeny weeny writing on the back. So what ever the amount of carb they think is 'safe' to eat there would be some way of achieving that goal.
I can not for the life of me understand why this has not been lobbied for, but perhaps blaming people for making bad choices is just easier.

https://www.diabetes.org.uk/resources-s3/2017-09/low-carb-diets-position-statement-May-2017.pdf
There is so much in this that is inconsistent it beggars belief.
You give fruit juice to treat a hypo, so encourage people to eat fruit? No mention of what type of fruit. So the fruit bowl is full of bananas. Nice and easy to eat when ripe, especially if you have false teeth. See what I mean about the real world.

Thank you for your reply. It is very sad indeed how many peoples' lives have been negatively affected by the incorrect dietary advice over the decades. Blaming the patient for the errors in the guidelines is the awful cherry on the high-carb cake...

 

[zand]

Diabetes UK know that low carb is best for T2s. They must realise by now that we need to swap the carbs for something and that higher fat is also the way to go. They won't say so though for fear of upsetting the companies who fund them. That stinks. Ordinary folk give their money to DUK in good faith believing that they are there to help all diabetics. They aren't. It's criminal. How any of them sleep at night I just don't know.

 

[pdmjoker]

They won't say so though for fear of upsetting the companies who fund them.

Which companies? Just curious...

 

[bulkbiker]

Which companies? Just curious...

Tesco for one..

 

[Squire Fulwood]

I never expect DUK to pay attention. On the very rare occasions I have spoken with them they asked how much money I was going to donate. They pay attention to that.

On one occasion they were giving something away for free (possibly a booklet on diabetes). I phoned the number but never got the book since I said I wasn't going to donate.

 

[Squire Fulwood]

How any of them sleep at night I just don't know.

Counting the money.

 

[Resurgam]

I go to band practice each Monday evening and see the menus on the board - there is nothing I could eat served there it is all carbs and more carbs.
The turn over in the apartments is quite high, and there are diabetics living there, blind and in wheelchairs as they deteriorate. It is very sad.

 

[zand]

Counting the money.

And the poor sheep that follow their bad advice...

 

[Squire Fulwood]

I go to band practice each Monday evening and see the menus on the board - there is nothing I could eat served there it is all carbs and more carbs.
The turn over in the apartments is quite high, and there are diabetics living there, blind and in wheelchairs as they deteriorate. It is very sad.

I feel the need to know more of this story. Apartments full of blind and immobile diabetics? Where is this (although I am not seeking personal information @Resurgam) just give us a country or so.

 

[Resurgam]

I feel the need to know more of this story. Apartments full of blind and immobile diabetics? Where is this (although I am not seeking personal information @Resurgam) just give us a country or so.

Not full, but over the time I have been going there we have seen people worsening - then they stop coming down to listen to us and then there is a little heap of discarded household equipment left out with a notice to say 'free' or 'please take if of any use'.
I do wish that I could make a difference - but just what could be done I do not know - the meals all conform to current guidelines for high 'healthy' carbs and low fat, made from fresh ingredients.
The place is not far from Bournemouth railway station.

 

[Squire Fulwood]

Not full, but over the time I have been going there we have seen people worsening - then they stop coming down to listen to us and then there is a little heap of discarded household equipment left out with a notice to say 'free' or 'please take if of any use'.
I do wish that I could make a difference - but just what could be done I do not know - the meals all conform to current guidelines for high 'healthy' carbs and low fat, made from fresh ingredients.
The place is not far from Bournemouth railway station.

There are some tragic stories on the board today and this one is worthy of a film as is the one about the undiagnosed child.

 

[Bananas 2]

The paper in question doesn't, though, mention gluconeogenesis (as far as I can see) where the body will make whatever glucose it needs. Erythrocytes (red blood cells) have not got mitochondria to metabolize fatty acids/ketones so do need glucose. I gather the brain possibly needs 25% glucose?

Good catch. Yeah, I have read reports, research that the brain works best on a combination of glucose and ketone.
Here is one such source:
https://www.healthline.com/nutrition/low-carb-ketogenic-diet-brain#section3

If "The mammalian brain depends upon glucose as its main source of energy" were true, then what would happen to the brains of people who eat almost no carbs on a Keto diet prescribed for epilepsy, say, which is a treatment approved of by the paper?

Either way, people do not need to eat carbohydrate, so the implication that they do by Diabetes UK seems somewhat misleading and isn't even scientifically backed-up by the paper they cite.

Or am I misunderstanding something?

I find, as in the above, that authors of such papers often confuse or conflate glucose with available carbohydrate. They are not the same thing. Glucose can be arrived at with more than one source. By leaving out any discussion of gluconeogenesis, it leaves some readers with misunderstandings.

@Guzzler
Lions -- good example. And there's the Inuit population who have survived for millennia on seal meat and blubber, etc. Yeah, not much vegetation (carbs) growing in the arctic circle...

 

[pdmjoker]

I find, as in the above, that authors of such papers often confuse or conflate glucose with available carbohydrate.

Perhaps the writers don't entertain Keto as a possible scenario?

Nice link to "How Low-Carb and Ketogenic Diets Supply Energy For The Brain" - thanks!

 

[pdmjoker]

https://www.diabetes.org.uk/resources-s3/2017-09/low-carb-diets-position-statement-May-2017.pdf
There is so much in this that is inconsistent it beggars belief.

I know! The first sentence is: "Low-carbohydrate diets can be safe and effective in the short term in managing weight, and improving glycaemic control and cardiovascular risk in people with
Type 2 diabetes." Obviously, only short-term, since who would want long-term weight management, glycaemic control or reduced cardiovascular risk? Not me!!! :***: