How irresposible are the current diet NHS guidelines for T2 and pre diabetics?

ringi · Nov 10, 2017

Guzzler said:
I wonder just how Dr. David Unwin's DNs get around the rules then? Is it that he leads every T2 educational session so that his DNs are not put into the position of losing their livelihoods?

Firstly a nurse can keep to what a doctor tells them to do, even if it is outside of the NICE guidelines. A nurse presenting the Xpert diabetes training is also covered as the handbook presents "low carb" as one of the options someone should consider. (Most CCGs have not noticed that Xpert training now pushes low carb and 5:2, as their GPs approved the course before it was updated..... But a lot of the trainers skip over the low carb bit of the Xpert training.)

A nurse can also tell people about this forum as a source of support, as they are advised to point people towards support groups.... A nurse could also explain how best to use a BG meter, and let people discover low carb for themselves, but CCGs will not allow many people with Type2 to have a prescription for test strips.

A nurse can also say "it seems that people who read XXX book" gets good results, but I have not had time to read to book myself yet....... Or just have some books on display on her/his desk without saying anything about them......

The NICE guidelines say diet advice should be individualised according to the needs of the person, Dr David Unwin says his clients need to reduce their carbs....... (The NICE guidelines also say statins should be OFFERED, but that a GP can record someone has declined to take them. There is nothing stopping a GP offering statins along with explaining how limited the benefits are.....)
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ringi · Nov 10, 2017

Brewers23 said:
With regards to the fuel required by the brain to function, the brain requires a blood glucose level of at least 3.5 mmol, below this brain starts to malfunction in a variety of ways,

Research was done a long-term ago about this, people who were keto adapted having been on a VERY low carb diet for a long time could function with a much lower BG level than 3.5 mmol. The researchers injected the insulin while monitoring BG and having the victims do IQ type tests. The only signs of stress were seen in the doctors, as they know that people should be dead with how low their BG was being taken.....

Details of this experiment are in the "Art and Science of Low Carb Living" book.

woodywhippet61 · Nov 10, 2017

ringi said:
Firstly a nurse can keep to what a doctor tells them to do, even if it is outside of the NICE guidelines. A nurse presenting the Xpert diabetes training is also covered as the handbook presents "low carb" as one of the options someone should consider. (Most CCGs have not noticed that Xpert training now pushes low carb and 5:2, as their GPs approved the course before it was updated..... But a lot of the trainers skip over the low carb bit of the Xpert training.)

A nurse can also tell people about this forum as a source of support, as they are advised to point people towards support groups.... A nurse could also explain how best to use a BG meter, and let people discover low carb for themselves, but CCGs will not allow many people with Type2 to have a prescription for test strips.

A nurse can also say "it seems that people who read XXX book" gets good results, but I have not had time to read to book myself yet....... Or just have some books on display on her/his desk without saying anything about them......

The NICE guidelines say diet advice should be individualised according to the needs of the person, Dr David Unwin says his clients need to reduce their carbs....... (The NICE guidelines also say statins should be OFFERED, but that a GP can record someone has declined to take them. There is nothing stopping a GP offering statins along with explaining how limited the benefits are.....)

.

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Whilst I do agree with nearly all of what you have said I do think that the comparison you made (now edited) was too strong. Mind you I have responded very robustly myself in the past. Given how some treat a lot of us it's hard not to be totally negative about them and to see them as 'the enemy' and I do get very cross/angry when I read about the latest load of information that has been advised to newly diagnosed diabetics.

MikeTurin · Nov 10, 2017

ringi said:
The NICE guidelines say diet advice should be individualised according to the needs of the person, Dr David Unwin says his clients need to reduce their carbs....... (The NICE guidelines also say statins should be OFFERED,]

Exactly. For diet it'sw false that "one size fits all", so giving a boilerplate response on this it a surefire way to make people fail. In this forum the eatwell plate is downturned, but the biggest problem is that eatweel plate in explained wrong and followed worse. Maybe LCHF has more success because people that are on low carb diet have to be more food-aware? The fact that pepperoni pizza is not part of mediterranean diet maybe is not well understood by general public and ill-informed people with diabetes.

Guzzler · Nov 10, 2017

MikeTurin said:
Exactly. For diet it'sw false that "one size fits all", so giving a boilerplate response on this it a surefire way to make people fail. In this forum the eatwell plate is downturned, but the biggest problem is that eatweel plate in explained wrong and followed worse. Maybe LCHF has more success because people that are on low carb diet have to be more food-aware? The fact that pepperoni pizza is not part of mediterranean diet maybe is not well understood by general public and ill-informed people with diabetes.

Big Food and Big Advertising have created the stereotyoical Italian/Mediterranean diet. I suppose it comes down to education in the end.

MikeTurin · Nov 10, 2017

Guzzler said:
Big Food and Big Advertising have created the stereotyoical Italian/Mediterranean diet. I suppose it comes down to education in the end.

May I suggest that als bad school is to blame? I don't know about UK schools, but nobody ever told me at school eating and cooking tips.

I've had awful experiences in school's canteens, both in public and private catholic schools. Trying to shovel in the throat of kids bad but officially healthy food is a sure fire way to make the kids absolutely love Mars bars. I remember the vast differences between say the canteen apples and peaches and the one bought at the farmer's market or the "fish" they served me and the trouts bought from the fishy guy near the river.
Of course the advertising has a big slice on the problem, but it's also a general perception that is wrong.
Heck, even I being in Turin, had a wrong idea about pizza. Then I found a tiny pizza parlor where the cook was from Naples that changed the idea about what proper pizza is.
When I read about what UK and USA people think what is Italian style or typical Italian food I find that is really different on what we eat and what is considered Mediterranean versus actual regional foods.

DCUKMod · Nov 10, 2017

Guys a small number of posts were edited or removed from this thread.

I appreciate this topic can rouse very strong responses, depending on each of our personal experiences, but please do remain civil in expressing your opinions, without implying deliberately criminal intent.

Many thanks.

Brewers23 · Nov 10, 2017

ringi said:
Firstly a nurse can keep to what a doctor tells them to do, even if it is outside of the NICE guidelines. A nurse presenting the Xpert diabetes training is also covered as the handbook presents "low carb" as one of the options someone should consider. (Most CCGs have not noticed that Xpert training now pushes low carb and 5:2, as their GPs approved the course before it was updated..... But a lot of the trainers skip over the low carb bit of the Xpert training.)

A nurse can also tell people about this forum as a source of support, as they are advised to point people towards support groups.... A nurse could also explain how best to use a BG meter, and let people discover low carb for themselves, but CCGs will not allow many people with Type2 to have a prescription for test strips.

A nurse can also say "it seems that people who read XXX book" gets good results, but I have not had time to read to book myself yet....... Or just have some books on display on her/his desk without saying anything about them......

The NICE guidelines say diet advice should be individualised according to the needs of the person, Dr David Unwin says his clients need to reduce their carbs....... (The NICE guidelines also say statins should be OFFERED, but that a GP can record someone has declined to take them. There is nothing stopping a GP offering statins along with explaining how limited the benefits are.....)

[/QUOTE]
The other day I had a patient with a high BM and associated symptoms of thirst and polyuria and as part of the assessment I did suggest this website and possibly reducing carbohydrates etc. Their BM was high, but not spectacularly so; no dangerous levels of ketones in capillary blood test, they’d been directed to A&E by their GP because of a raised venous blood glucose, unfortunately I couldn’t just send them home without a medical review as they’d sen their GP.
On a personal level I no longer take statins as the benefits are questionable when compared with the risks.

kokhongw · Nov 10, 2017

ringi said:
Research was done a long-term ago about this, people who were keto adapted having been on a VERY low carb diet for a long time could function with a much lower BG level than 3.5 mmol. The researchers injected the insulin while monitoring BG and having the victims do IQ type tests. The only signs of stress were seen in the doctors, as they know that people should be dead with how low their BG was being taken.....

I believe you could be referring to this 2009 study done by the Yale School of Medicine. It would seems that MCT oil/VCO could provide some level of protection during acute hypoglycemia.

Medium-Chain Fatty Acids Improve Cognitive Function in Intensively Treated Type 1 Diabetic Patients and Support In Vitro Synaptic Transmission During Acute Hypoglycemia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671041/

I also noted from Dr Keith Runyan's blog that he made the following point:-
https://ketogenicdiabeticathlete.wo.../44-october-2017-update-on-my-t1d-management/

A ketogenic diet and MCT oil used on salads at dinnertime may also provide an alternate/additional brain fuel in the form of ketones to protect the brain when BG does go low. The alternative energy that ketones supply to the brain may prevent or blunt the sympathoadrenal response to hypoglycemia which in turn reduces or eliminates the symptoms of and harm from hypoglycemia. This hypothesis needs to be tested before it can be stated as fact. Having BG close to normal most of the time (some of which are hypoglycemic) also minimizes the symptoms of mild hypoglycemia and potentially the harm from hypoglycemia as well due to lack of activation of the sympathetic nervous system and adrenal gland responses to hypoglycemia i.e. sympathoadrenal-induced fatal cardiac arrhythmia, see here.

The main problem with the mainstream dietary guideline appears to be that they all geared towards hypo/DKA avoidance by ensuring there is more than enough glucose in our system, yet not high enough for DKA...because that is what they often have to deal with at the A&E.

But if we reduce carbs/insulin needs significantly, as per Dr Bernstein's law of small numbers, it actually takes out much of the glucose variability and fluctuations.

gardengnome42 · Nov 10, 2017

Bluetit1802 said:
There is a tick box list they have to complete. There is no box for low carb. My nurse ticked "diet good" and "high fibre diet". She also ticked "patient advised about low fat diet" She is well aware of my LCHF diet and agrees with it. She did ask if I consume enough fibre, to which I replied yes. They are between a rock and a hard place.

Who are the dinosaurs that make these rules I wonder. I've still got an awful lot to learn and it is all so confusing and often conflicting.

gardengnome42 · Nov 10, 2017

Guzzler said:
It may take another generation to see the end of such dietary advice. Thank heavens for the internet and sites like DCUK, eh?

I do so agree Guzzler though some of the sites [thankfully not this one] are allied to the NHS and their crazy guidelines: the other main diabetes site in the UK for starters!

bluecurlylegend · Nov 10, 2017

Alexandra100 said:
Indeed. We are a tiny minority in a society which does its best to stuff us full of carbs, like those poor french geese. The more reminders we can muster that there is another way, the better.

Well, those "poor" French geese actually struggle to jump the queue to get to the corn poured into them. They are not forced.
Watch it some time and you'll probably come to the same conclusion as myself.....geese are birdbrains !

Guzzler · Nov 10, 2017

gardengnome42 said:
I do so agree Guzzler though some of the sites [thankfully not this one] are allied to the NHS and their crazy guidelines: the other main diabetes site in the UK for starters!

I hear that things might have started to change over on the other site. Fingers crossed for the members, eh?

ringi · Nov 10, 2017

@kokhongw No they went a lot lower than that study, sorry I can't provide a link, you will have to read the book as they study is too old to have made it to the web. The study you posted in interesting in that MCT oil/VCO seems to work without a long term very low carb diet.

kokhongw · Nov 10, 2017

ringi said:
@kokhongw No they went a lot lower than that study, sorry I can't provide a link, you will have to read the book as they study is too old to have made it to the web. The study you posted in interesting in that MCT oil/VCO seems to work without a long term very low carb diet.

How much lower did it go? In present day, it would likely be difficult to get approval from ethics committees to go much lower than 2.8 mmol...

ringi · Nov 11, 2017

kokhongw said:
How much lower did it go? In present day, it would likely be difficult to get approval from ethics committees to go much lower than 2.8 mmol...

Sorry can't remember, but the book does point out that no ethics committee would approve a study like it these days.

bulkbiker · Nov 11, 2017

kokhongw said:
How much lower did it go? In present day, it would likely be difficult to get approval from ethics committees to go much lower than 2.8 mmol...

ringi said:
Sorry can't remember, but the book does point out that no ethics committee would approve a study like it these days.

This is mentioned in a video I have seen of Dr Phinney who I think said that they got the subjects down to 1.5 mmol with no ill effects in the 1970s' . He I think said that these results had never been published because it was unethical even then. Unfortunately I have watched so many Phinney videos that I can't remember which one it was... I'll have a quick look around and see if I can find it.

bulkbiker · Nov 11, 2017

I think it is either in this one

or this one..

but I have a dodgy internet connection and it's a total of 2 1/2 hours of video so I'm afraid I can't point to the exact point sorry!

kokhongw · Nov 11, 2017

@bulkbiker Thanks. Will go thru the video again.

kokhongw · Nov 11, 2017

Found it from Reddit, Phinney narrates Cahill's starvation experiments in 1972-73....

How irresposible are the current diet NHS guidelines for T2 and pre diabetics?

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