Standard diet advice vs low carbs

[test_positive]

I am recently diagnosed and starting to get used to the idea of diabetes. This site has been great in providing information and support. As has my doctor.

But I really don't get it about diet. It seems that most people who actually have diabetes T2 find a low carb diet works best. I have moved to this and have noticed like others that when I have muesli, oats, bagels etc that my blood glucose goes really high 2 hours after. So I've moved to largely remove carbs and have low GI carbs when I have them. Seems to keep my blood glucose from dramatic peaks. All well and good and I'm feeling pleased that I've managed this.

So why is it that when you see official advice (NHS, dieticians, various charities etc) they seem to say you should have a 'balanced diet' with significant amounts of carbohydrates at every meal? It seems that what people with diabetes are saying largely is that the official advice doesn't work for them. So isn't there something wrong with the official advice?

Many of these people are bright and have multiple degrees. So why is it that they continue pushing the 'balanced diet' approach with high carbs?

I just don't get it. :?

 

[Grazer]

Not all health authorities around the world offer the same advice. The answer is very long, but I believe the NHS plays it safety first. It Doesn't distinguish in its advice between type 1s, type 2s on insulin and similar and type 2s on diet only. It simply offers one piece of advice on a "healthy diet". Unfortunately, what MAY be healthy for a non diabetic isn't healthy for a type 2 on diet only like you. The ONLY way that you can control your blood sugar levels is by type and amount of carbs. So, like most of us in the same situation, you have to either ignore their advice or follow it and take stronger (probably increasingly stronger as time goes by) medication. I personally choose not to go that route.

 

[IanD]

The simple answer is that health professionals (HPs including DUK staff) do their training in their 20s, & at that age, some are T1, but NONE are T2. They have, therefore NO personal experience of T2. The advice is adapted from T1, where BG is controlled by the balance of carbs & injected insulin. We don't need insulin, so the BG is controlled by the balance of carbs, medication & exercise, plus weight loss - because they "know" that the primary cause of T2 is being overweight.

The result is that HPs simple give flawed diet advice, because that is what they are taught. They also know that diabetes is progressive, & will require increasing medication, complications, etc. Only a few enlightened HPs give serious consideration to a low carb/high fat diet, that works well for many real diabetics. If low carb does work, they tell you it's because you've reduced your calorie intake, NOT because they are wrong.

 

[Daibell]

Hi. Welcome to the wonderful NHS world of diabetes mis-information. Yes, as Grazer says part of it is playing it safe. You will find comments in some of the NICE journals that low-carbing has not been proven safe hence you should stay with the (unhealthy, dangerous etc etc) balanced diet which is gradually making the population obese. The NHS is like a large oil-tanker and takes years to change it's views. You will find this in many other areas of medicine. The food industry lurks in the background feeding mis-information whenever it can to keep the carbohydrate band-wagon going. Sadly many of us have found since diagnosis that it is essential to do your own research on diet, medication etc amongst the many other people with diabetes and find a solution that works for you. Many GPs, mine included, assume diabetes will progress and hence are only too ready to prescribe more medication. My GP said to maintain a healthy balanced diet which for a diabetic is wrong. As diabetics cannot process carbohydrates properly then they need a slightly 'unblanced' diet lower in carbs; obvious really

 

[SouthernGeneral6512]

I get the impression that the health establishment (especially in this country) is REALLY conservative and it takes forever for new ideas to come though.

I've been reading about hypnotherapy and how useful it can be and yet it is still very much the poor relation of pills and potions on the nhs

 

[Unbeliever]

I otally agree with you Daibell. Particularly with your last sentence. A friend of mine has heart and bowel problems and the recommended diet for each condition contains elements which are not recommended for the other. His Dr is only too happy to try to help him work out an appropriate diet tailored to his needs.

The very nature of any type of diabetes suggests that some adjustment to diet should be necessary and a "normal " diet might not be entirely appropriate. if b a "normal healthy diet" means a diet containing all essential nutrients then noone would argue with this
but hiow to achieve it for the individual is he difficulty. I am sure we would all appreciate individula help and advice.

I don't understand why diabetes s on the one hand considered to be an epidemic which can bring the NHS to is knees and on the other something which can be left to the practice nurse..

I wonder how my friend would react to being sent to the nurse for advice about either of his serious conditions?

 

[Anonymous]

I echo what our friends above have said.

There is also a political dimension to this in that the food industry, knowing that refined carbohydrates are addictive, is an incredibly powerful vested interest that has biased and distorted the advice we receive as diabetics.

A sensible diet, inclusive of carbohydrates, is fine for a majority of the population. Unfortunately, a large part of the population do not follow this dietary advice because of the poor-quality food laden with sugars and other refined carbs which cause an insulin response and hence further overeating putting them at risk of obesity, heart disease and Type 2 diabetes. Advice against this sort of diet has been slow to take off because of these commercial pressures.

The reality for most T2s is that carbohydrate is toxic, and restricting its consumption is really the only way forward. The message is gaining ground, but only slowly.

 

[SouthernGeneral6512]

I think that refined carbohydrates are addictive possibly more to some individuals than to others but I know they certainly are to me :sick:

 

[Sloan973]

Hi everyone
I feel moved to join in with the debate as newly diagnosed and having experienced all of the same NHS advice, guidelines, information and rhetoric. My experience is compounded by the fact that I was already on a weight reduction programme run by my local hospital when I was diagnosed with type 2. On a regular meeting with my weight loss dietician, I told him I was now diabetic, and all he did was produce the standard 'balanced diet' leaflet that everyone gets. By that point I had found this really helpful website and was able to argue with him that the NHS was wrong and that my belief was I now needed to low carb for life. He gave up and politely escorted me out!
Here's my real problem and point. Can I (we) really contemplate a life without our chips, mash, French bread, custard tarts, chocolate bars and biscuits etc. Always? Forever more? Just a thought.
Eddie

 

[Anonymous]

Just an added observation. Whilst my DSN is supportive of my diet, I have a friend who is also a DSN.

Whilst we don't talk about my diabetes often (we would argue), she says that many of her patients 'try that Atkins thing' and then give up. I think the NHS views their diet advice as achievable, or perhaps low-carbing as unachievable. I think they also take this position more readily if the patient is older (which I happen to think is an appalling excuse).

 

[IanD]

Here's my real problem and point. Can I (we) really contemplate a life without our chips, mash, French bread, custard tarts, chocolate bars and biscuits etc. Always? Forever more? Just a thought.

Yes - when you realise that all those "foods" are damaging your health. Crippling muscle pain is a good incentive. I reduced them to about 1/3 & felt the benefit so cut them out completely. In 3 months I was well.

 

[Mileana]

Also, I think, if you want to 'officially' recommend a diet like this, it would take a few check-ups to be sure that 'everyone' also those with a bit more complicated histories than 'just' diabetes did not get in trouble. It would be a scandal if the 'possible' side effects of LCHF diet started messing with peoples health and I think they are concerned about this.

When say epileptics do a very strict LCHF diet to treat their condition with ketones (fasting ketones, not high blood sugar ones), they are monitored very closely for factors like kidney function, bone demineralization and blood electrolytes and so on.

I believe they would find this 'hassle' compared to what a 'normal' diet does.

I tend to disagree as I don't 'know' what is more safe, nor do I know how prevalent these side effects are - I DO know that there is an aspect of complications that seems to be linked to high blood sugars (big surprise, we all know that) and that at least for the people who don't get the results they want with the standard advice, it would be extremely good to have an array of options to ask them to try, like LCHF.

I think it is... umm inconvenience and perhaps a bit of fear that the thing would escalate out of their control/area of expertise?

 

[borofergie]

Here's my real problem and point. Can I (we) really contemplate a life without our chips, mash, French bread, custard tarts, chocolate bars and biscuits etc. Always? Forever more? Just a thought.

I don't know. Can you contemplate a life without toes and with bleeding eye-balls? At some point you have to accept that you're a diabetic and some things will have to change. If someone had told me when I was diagnosed "just don't eat any chips, mash, French bread, chocolate bars or biscuits and you won't have any complications" I would have literally bitten their hand off in enthusiasm. If you decide those things are more important to you than your long-term health, then go ahead and eat them.

Diabetes is a terrible condition but, for the majority of us, it has a rather simple solution, just adjust your diet a bit and you'll be fine.

There are of course other options, you might be able to eat some of the things that you list if you were on insulin (although it still wouldn't be sensible to eat them in large quantities).

 

[Unbeliever]

I agree with Borofergie. The current policy in the NHS appears to be to give the newly diagnosed very little information as well as no way of measuring their progress for themselves. Patients are supposed to leave it all to the Nurse who will est and medicate accordingly.

This may well make life easier for the HCPs and for some patients in the short term bu we are not all alike and many of us want to take charge of our own health .

It is all ovewhelming for many of us a first and too much information could be counterproductive but it ought to be available for when the patient might need it. As everyone agrees that here are many different ways o control the condition then as many as these as possible should be at least touched upon in any hand outs.

It is also very imprtant that the patient understands the seriousness of the condition. Not in order to scare them but so that they
are aware of the necessity to keep their levels under control by any means which work for them.

It is doing them no favour to molly coddle them are gibve them false reassurances.

Then when the cost of complications threatens to overwhelm he NHS the same patients who have been advised not to worry and leave it all to Nursie are castigated and treates as pariahs on th estate.

I think so much of the problem is a result of forcing different parts of the NHS to vie with each other for funding and to ry to offload unprofitable patients rather than working together in the best interests of all. I am suere a great deal of money is actually squandered under this system.

So we find surgeries quibbling over the few pounds needed for HBA1C tests and the hospitals then spending thousands dealing with the complications which result from undeteced side effects. Just one example. I won't even mention test strips.

Alll very sad and unnecessary.

 

[IanD]

Comments in blue

Also, I think, if you want to 'officially' recommend a diet like this, it would take a few check-ups to be sure that 'everyone' also those with a bit more complicated histories than 'just' diabetes did not get in trouble. It would be a scandal if the 'possible' side effects of LCHF diet started messing with peoples health and I think they are concerned about this.
The HPs have been warning against 'possible' side effects for years. Apart from digestive disturbances, NONE have been identified (prove me wrong) & careful studies in Sweden & Exeter have established their safety over up to 4 years. Sarcasm warning: OTOH new diabetics are warned that diabetes is 'progressive' to complications & ever-increasing medication. But that, of course, is the disease, NOT the known side effect of the high carb diet.

When say epileptics do a very strict LCHF diet to treat their condition with ketones (fasting ketones, not high blood sugar ones), they are monitored very closely for factors like kidney function, bone demineralization and blood electrolytes and so on.

I believe they would find this 'hassle' compared to what a 'normal' diet does.
Before I started LCHF, my kidney function was slightly impaired - eGFR=62. After 4 years LCHF diet, it has improved slightly to 70.

I tend to disagree as I don't 'know' what is more safe, nor do I know how prevalent these side effects are - I DO know that there is an aspect of complications that seems to be linked to high blood sugars (big surprise, we all know that) and that at least for the people who don't get the results they want with the standard advice, it would be extremely good to have an array of options to ask them to try, like LCHF.
A lot of threads have discussed ways of communicating the benefits of LCHF to HPs but only occasionally have we reported any individual success. DUK are a major obstacle to a sensible T2 diet. The promised revision of their "Eating Well" booklet is still awaited - "Next review February 2012." One research project concluded sadly: "

A 16-week pilot diet intervention trial also demonstrated that a low-CHO, ketogenic diet can improve glycaemic control in obese type 2 DM patients (mean BMI 42), such that diabetes medications were discontinued or reduced in 17 of the 21 participants.19 However, to date there has been no randomized controlled trial in type 2 DM patients and health care professionals remain wary of their use, particularly as standard dietary advice from Diabetes UK does not support this approach.7
http://qjmed.oxfordjournals.org/content/100/10/659.full

I think it is... umm inconvenience and perhaps a bit of fear that the thing would escalate out of their control/area of expertise?
The insuperable difficulty is that the positive experience of real diabetics using LCHF does not constitute acceptable evidence to DUK.

 

[Anonymous]

I cannot, for the life of me, understand why the heathcare establishment just cannot grasp that they are fundamentally wrong. I just find the whole issue exhasperating really.

I cannot help but think there is some conspiracy here because, at its most basic, we have what appears to be wilful ignorance amongst some of the most well-educated people in our country. I can't, for the life of me, understand what is going on here.

My only guess is pressure from the food industry.

 

[Defren]

Can I (we) really contemplate a life without our chips, mash, French bread, custard tarts, chocolate bars and biscuits etc. Always? Forever more? Just a thought.
Eddie

I am absolutely certain I can, because my terror of complications outweighs my desire for chips, cake, biscuits etc. I do have a steely determination that carries me through things, and even the idea that I may never have another crumb of the tasty sweet/carbohydrate foods I used to love, is something I can easily deal with while I know not having them keeps complications at bay. It is simply my own dread that I could lose my sight, my feet, or have heart/liver/kidney failure that makes me look at the things I once loved and shudder (and I really do). Having to put those things in my trolly for other members of my family is bad enough, and I wish they would avoid them too, but I have to be reasonable, and not allow my paranoia to effect them, while giving them all the tools to try to prevent them becoming diabetic later on.

 

[susanmanley]

As a recently diagnosed type2 [I think as have not been told any different] I feel that the information I was given only related to the tick sheet on the computer screen and was not balaced in any way to my needs. I have several medical problems, some of which counter each other re diet.
I have to have a low fibre diet and basically ignored the advice given, read up what I could find out and took advise from people who KNOW what it is like to have this disease.
This diet has helped not only my glucose levels but my other gut problem dramaticly. Previously I have always been advised to have a balanced, high carb diet and now [through this site] I have found out how wrong that was for me. I have even been able to stop one sort of medication.
Also the fact that I was advised to have their diet and see how that went but given NO way of monitoring this was a real stress for me that has now been solved thanks to this site again.
Having had to battle against standard and government [therefore financially led] advise all my life I am glad there are places where reall experience and knowledge can be shared

 

[Grazer]

Good post Susan

 

[ladybird64]

I think we have been here before haven't we? :wink:

A couple comments. Why do they peddle the diet that doesn't work? Dunno. We can argue all the pernickity details until we are blue in our respective faces, bottom line is that people should NOT be told that carbs are necessary at every meal. There is no real basis for this information (that I am aware of?). Nor the "base your meals around starchy carbs" info either.

Next comment. Personally a fear of possible complications is not enough for many to change, this has to be acknowledged. If you can take it all on board and put this fear ahead of eating in a certain manner then that is brilliant..many can't. I include myself in that category because although for the majority of the time I eat well and my levels are within my own limits, there are times I go off the rails and I know I'm not alone. Some of us have psychological difficulties with food. Not an excuse, fact and anyone that thinks it is an excuse, come and walk in my shoes for a while. Tolerance and understanding is needed and is ten times more helpful than criticism.

Same with smokers and drinkers. The knowledge of the sure and certain damage it does is there so why continue to smoke or drink..same with carby foods methinks. These are the people who need the support, the advice that they can make gradual changes. Telling them no, no and no will make them run a mile. This still doesn't mean that they should be given lousy advice!

Some of us have doctors who are wise to the effects of the diet proposed by..ahem..you know who. But I have seen an interesting trend on here recently, albeit a teensy weensy trend.
Things are changing, doctors are starting to listen. It is dead simple really and no rocket science is needed. As carbs are lowered, HbA1c's are coming down too. These are facts, carb reduction is working and the kickback is beginning against the advice given out at present. Show us an argument where someone has been diagnosed (T2), reduces their carbs and their Hba1c goes up.

The times are changing and the outdated advice is showing it's advanced age. I would love to live long enough to be around for its funeral.