My experience with a low carbohydrate diet.
Ian Day May 29, 2012
I was diagnosed type 2 diabetic in 2000 when I was 61. On diagnosis my Dr. told me all the complications could expect – foot amputation, blindness, stroke, heart attack, etc, & helpfully computed my heart attack probability as 25% within 10 years. She also advised me of the NHS help available.My Dr warned me of the consequences of uncontrolled diabetes & referred me to West Middlesex Hospital for a one day basic course by nurse, dietitian, pharmacist & podiatrist.. There I was told to base my diet around whole grain carbohydrates & generally follow a low sugar; low fat; low salt diet & maintain an active lifestyle. That diet was basically as recommended by Diabetes UK. I was also warned that diabetes was progressive, & I would progress from diet to tablets to insulin, while suffering health deterioration.
My principle diabetes symptom was a numb sensation in my right thigh, which my Dr diagnosed as diabetic neuropathy.
At diagnosis, my HbA1c was 8.7, cholesterol 7.6 & weight 13 st 7 lb (86 Kg)
I was in a state of shock for some months, & was careful to comply with the advice. I was already playing tennis & getting plenty of exercise, & was have been health conscious all my adult life. I included cholesterol reducing margarine & oat bran to help reduce cholesterol.
I got on well at first, & after two years I felt I had diabetes under control.
My HbA1c was 6.5, cholesterol 5.4 & weight 12 st 5 lb. (78.5 Kg.) My heart attack risk dropped to 15%. I was very happy with Diabetes UK diet recommendations which I understood as:
Low sugar, low fat/oil, low salt ;
30-40% in the diet of carbohydrates, particularly multigrain bread, basmati rice, pasta;
Plenty of vegetables & fruit.
I even recommended the D UK diet in a radio phone-in in 2002.
My condition progressed slowly, as predicted. In 2003 I started taking metformin & then they wanted to reduce my cholesterol below 4.0 so I was given simvastatin. Simvastatin caused serious muscle pain & I have been unable to take any cholesterol medication.
Complications began to set in: chronic tiredness, muscle pain & the beginning of retina damage.
In April 2008 muscle pain was so serious I feared becoming disabled. It could take 5 minutes to get out of bed. Stairs were a struggle. My active life seemed to be over. My HbA1c was considered acceptable at 6.7. My overnight BG averaged about 7. My Dr suggested hospital investigation.
At that time I joined the
http://www.diabetes.co.uk/ forum. Thousands of people with diabetes ask questions, note news items & contribute from experience. Many contributors had found from experience that a low carbohydrate diet was very beneficial. I had nothing to lose, so immediately cut right down on carbs. My overnight BG dropped to an average less than 6. Within 3 months I was playing tennis again & I was completely out of pain. My weight dropped to about 12 st (76 Kg.)
I have continued a low carb diet ever since. Four years on, I am well & active, playing tennis & table tennis at club standard. I have cooperated with several heart/diabetes research projects, including Imperial College's long term SABRE & Ealing Hospital's LOLIPOP. There is no indication from these projects that my low carb diet is causing any adverse effects.
One blood measurement that my Dr is watching is kidney function, which is slightly low but completely stable since before my change of diet.
What do I eat? Is it complicated or straightforward? Are there problems with eating out, or with friends?
Basically all I do is avoid the obvious carbs – bread, potato, rice, pasta. I have developed some special low-carb recipes.
I showed my healthy eating plate at this point.
Also I make a bread/cake & a porridge based on ground almonds. I snack on cheese & nuts. My friends are used to me refusing biscuits & cakes & savouries. Sweet dishes include jelly flavoured with NAS squash & topped with yoghurt or cream.
A very serious question for D UK is raised by their booklet “Eating well with Type 2 Diabetes” where they assert:
Why is carbohydrate important?
All carbohydrate is converted into glucose and will have an impact on blood glucose levels. As this is the case, some people with diabetes wonder if it would be better not to have any carbohydrate in their diet to keep their glucose levels under control. This is not recommended as:
• glucose from carbohydrate is essential to the body, especially the brain
• high fibre carbohydrates, such as wholegrains and fruit, also play an important role in the health of the gut
• some carbohydrates may help you to feel fuller for longer after eating.
How much do I need?
The actual amount of carbohydrate that the body needs varies depending on your age, weight and activity levels, but it should make up about half of what you eat and drink. For good health most of this should be from starchy carbohydrate, fruits and some dairy foods, with no more than one fifth of your total carbohydrate to come from added sugar or table sugar.
These assertions by D UK appear to be totally without foundation. I have reported to them the benefits to me of low carbohydrate diet & asked for research references. All I get is “if it works for you, keep it up, but we cannot change our diet recommendations.”
I came across the July/August 2003 “Balance”, which had an article "investigating the truth behind a low carb diet."
I won't bore you with warnings of the dangers of "breakdown of vital muscle & body tissues" or "increased risk of heart disease, cancers & bowel disorders" or "the risk of kidney disease." Such a diet may be "suitable ... with medical supervision & with guidance from a state-registered dietitian."
A key paragraph is: "Research into the long-term effects of low-carb diets is now required. And in response to this, Diabetes UK is funding such research."
That was 2003. Dr Daly's work at Exeter was funded by D UK.
Eight years on we have the 2011 D UK “Position Statement” where we read:
"More research is needed to assess the effectiveness of varying degrees of low-carbohydrate diet on weight, glycaemic control, hypertension and lipid profile in people with Type 2 diabetes as well as to investigate the long term effects of these diets."
I can't wait for yet more long term studies - I've too much to lose. I followed their "healthy diet" for 7 years & was crippled by the complications. My low-carb diet started in May 2008. The complications disappeared in 3 months. Four years on I am well & active. There is no hint of any adverse effects in my experience, nor in the SABRE & LOLIPOP studies. My Drs are happy with my level of health & all my blood test results.
D uk state in their “Position Statement” on low carb diets, warn that “there is a lack of evidence related to long-term safety and benefit of following this diet.”
I know of two long term studies:
A 44 month Swedish study, (citation 13 in D UK Position Statement) which states: “ the present high-carbohydrate dietary advice resulting in unnecessary hyperglycemia and insulin resistance seems difficult to support 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.”
Dr. Mark Daly, Consultant diabetologist, the MacLeod Diabetes and Endocrine Centre, Exeter responded to my query:
“We have presented our results at 3 national and 1 international meetings. We found no serious adverse effects over 2 years but not everyone is as good at sticking to low carbohydrate diets as you.”
D UK freely publish leaflets for general distribution that recommend a diet comprising 45-60% carbohydrates. e.g. “Eating well with type 2 diabetes.”
Further, they warn diabetics against cutting out carbohydrates, as doing so will have harmful effects.
We are NOT talking about cutting out carbohydrates, only reducing them. The harmful effects of a high carbohydrate diet are evident – diabetes is progressive & results in complications.
The supposed harmful effects of low carbohydrate are not documented.
Deep in their website is a link to a comprehensive “Evidence-based nutrition guidelines” document which includes on P. 17:
“Low-carbohydrate diets have created some controversy, but both a recent review and meta-analysis suggest that they are associated with significant reductions in body weight and improvements in glycaemic control.......
Concern has been expressed about the potential adverse effects of these diets, especially on cardiovascular risk, but there remains no evidence of harm over the short term.”
What is the Diabetes uk objection to informing the diabetic public of their “Evidence-based nutrition guidelines” with a simple recommendation to restrict carbohydrate foods, & the provision of a revised diet leaflet?
I challenge Diabetes uk to produce ANY evidence to:
(a) support their warnings of the dangers of low carbohydrate diets, &
(b) to justify their recommendation for T1 & T2 diabetics that carbohydrate should make up about half of what you eat and drink.
I have prepared a low carb diet Sensible Eating with T2 Diabetes. leaflet based on the D UK leaflet: “Eating well with T2 Diabetes.”
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My talk finished at this point. There were lots of requests for my leaflet & the organisers asked for names emails & addresses to send out copies. They kept my files on their computer.
Sensible Eating with T2 Diabetes.
Adapted from the D UK leaflet: “Eating well with T2 Diabetes.”
Direct quotations are in blue.
What is Type 2 diabetes?
Diabetes is a common, life-long condition where the amount of glucose (sugar) in the blood is too high as it cannot be used properly. Glucose comes from the digestion of foods containing carbohydrate and from the liver which makes glucose.
Insulin is vital for life. It is a hormone produced by the pancreas, that helps the glucose to enter the cells where it is used as fuel by the body. Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly (known as insulin resistance).
Poorly controlled diabetes can result in many health problems, including heart disease, blindness, amputations, & kidney failure & other debilitating conditions.
Blood glucose is checked medically by the HbA1c test, which for well controlled diabetes will be 5-6.5% (32-48 mmol/mol.) Non-diabetics will be 4.5 - 6.0 (26 - 42 mmol,) & a realistic level to minimise complications will be below 7.5 (55 mmol)
The HbA1c test should be carried out at least every 12 months, & preferably more frequently. It is the primary test used by health professionals to monitor the progress of the disease.
In addition, self testing using a finger-prick device is recommended. This enables the patient to monitor the condition & learn which foods result in high blood glucose. Readings below 5.0 indicate that suitable food should be eaten at once, as blood glucose below 4.0 is a “hypo” condition which is potentially dangerous.
Good blood glucose control is important in the management of diabetes. Because of the link between eating carbohydrate and blood glucose levels, we have answered some common questions about carbohydrate on the following pages.
What should I avoid eating to control diabetes?
Many common foods are rich in carbohydrate, and should be restricted. (Not necessarily eliminated from your diet.) You do not need carbohydrates for good health, nor for energy or brain function. Your body will normally generate the glucose needed from other foods & glycogen reserves.
Starchy carbohydrates include foods like bread, pasta, chapatis, potatoes, yam, noodles, rice and cereals.
Sugars include table sugar (eg, caster, white, brown), and can also be found in fruit (fructose), and some dairy foods (lactose). They can often be identified on food labels as those ingredients ending with – ose.
Processed foods often contain hidden carbohydrates & sugars. Breakfast cereals are mainly carbohydrate, including sugars, & despite manufacturers claims are not sustaining, & result in hunger & snacking before the next meal.
What can I eat to control diabetes?
A diet rich in protein foods including associated fats, together with vegetables, can be eaten freely. Added fats are best avoided. Added salt may also cause problems. Cooking & table sauces may be used – but look at the labels for carbohydrates & sugars.
Protein foods include meat, cheese, fish, eggs, nuts, pulse (beans). Have an extra portion of vegetables, rather than carbohydrate. Nuts & vegetables will normally contain enough soluble fibre to avoid constipation, but you may wish to add bran to your diet.
Rather than puddings (sweet course) you should choose unsweetened yogourt, cheese or fruit, or simply tea or coffee.
There will normally be a rise in blood glucose immediately after a meal, & it is recommended you test after 2 hours. Such readings should be below 7.5.
What can I eat instead of breakfast cereal?
Bacon, egg, saugages, ham, cheese, etc can be eaten. You can include a small piece of toast, or crispbread.
A useful alternative to porridge is based on ground almonds & other nuts & seeds. Because it is rich in proteins & fats, it is more sustaining than commercial cereals.
What about snacks & packed lunches?
Nuts, cheese & fruit, rather than sandwiches, should be provided.
Flour made from nuts can be used for baking, instead of wheat flour. A cake can be made using ground almonds, soya flour, coconut flour, crushed seeds, etc, blended in the usual way with baking powder, spices, eggs, oil/margarine. This can be used as bread for sandwiches, or sweetened with non-sugar sweeteners for make cake.
What can I drink?
Avoid soft drinks sweetened with sugar. All normal drinks, including diet, may be consumed freely, within the recommended limits for alcohol. Pure fruit juices contain 10% natural sugar, & should be diluted with water.
Don’t use diabetic foods or drinks.
They offer no benefit to people with diabetes. They will still affect your blood glucose levels, contain just as much fat and calories as the ordinary versions, can have a laxative effect and are expensive.
Where can I get further advice & recipes?
A forum run by & for diabetics can be consulted on
www.diabetes.co.uk/
You will normally get an answer from experienced patients, some of whom have faced similar problems. Such advice should be received with caution, as it may not apply to you & your condition.
Draft – Ian Day
May 23, 2012