Standard diet advice vs low carbs

My own experience of eating carbs is like that of an alcoholic. If I start the day eating carbs, even complex ones, I crave them and want more and more until it overwhelms me.

Now, to continue the illustration of an alcoholic - for many people drink is not a problem. Even moderate drink is not a problem. But for an alcoholic it is a toxic substance which triggers an avalanche of problems. So it is best avoided.

Now, with food, its not as clear cut. I understand that. But for me, the consumption of processed carbs in particular, are like alcohol to an alcoholic.

So from that perspective I view them as dangerous and poisonous to me.

and given the anecdotal evidence of my friends, particularly around white bread and chocolate, most of them have craving issues, even though they are not diabetic.

So my view of the food world is that, for many people, consumption of processed cabs is dangerous and they have a toxic effect.

I have always wondered in connection with the above - just what percenage of diabetics actually follow the NHS recommendations
regarding die
They may well have a better or worse diet for their diabetes to begin with , but how many really change to the recommended diet.

I also wonder to what extent complications are due to the recommended diet or if there are other factors present.

My personal belief is that the NhS?DUK diet is more likely to harm those who are eating a diet MORE suitable for diabetes control.
at diagnosis.

Those already eating a carb - heavy diet may actually eat LESS on the NHS diet but might not feel it worthwhile to change.

I can't help feeling that it is not so much the diet "they" want people to eat but the lack of guidance about the alternatives which is the real problem.

Does anyone know of any studies into the extent to which diabeticas change their diet on diagnosis.

There are those , already following an unhealthy {non-diabetic } diet who just stop making any effort to improve on diagnosis .

And probably many more who are totally discouraged by the results of the NHS approved diet I know- but I would be interested to know how much patients are influenced by NHS dietary advice.

lucylocket61 said:

My own experience of eating carbs is like that of an alcoholic. If I start the day eating carbs, even complex ones, I crave them and want more and more until it overwhelms me.

Now, to continue the illustration of an alcoholic - for many people drink is not a problem. Even moderate drink is not a problem. But for an alcoholic it is a toxic substance which triggers an avalanche of problems. So it is best avoided.

Now, with food, its not as clear cut. I understand that. But for me, the consumption of processed carbs in particular, are like alcohol to an alcoholic.

So from that perspective I view them as dangerous and poisonous to me.

and given the anecdotal evidence of my friends, particularly around white bread and chocolate, most of them have craving issues, even though they are not diabetic.

So my view of the food world is that, for many people, consumption of processed cabs is dangerous and they have a toxic effect.

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And this, I think, puts the issue in a nutshell.

I think it is quite reasonable to choose a higher carbohydrate lifestyle so long as you realise and are informed at all times of the consequences of that choice in terms of the medication or insulin you may need to take to keep your levels in safety. Safety is the key and many T1's through insulin and T2's through strong medication or insulin make that choice successfully and can achieve very good control.

In terms of the OP's post then the problem is, in my opinion, the "standard" recommended UK diet effectively denies the majority of T2's that diet only route by recommending a level of carbohydrate that seems to automatically require that the individual will need stronger medication or insulin at some point. Worse still it seems to deny a perfectly safe diet only method that simply involves changing diet to control carbohydrate intake even exists even though it has been proven safe and recommended by other health services.

Personally I want to take that diet only method and simply control the carbohydrate I consume rather than take the stronger medication or insulin route.

During my full and frank discussion re diabetes management with my GP the other day, he mentioned that ,once again there is some pressure to move T2s to insulin therapy. That is because it is seen as the only way for T2s to control the condition.

This is reinforced by the persnal experience of members here , several of whom have encountered nurses who are convinced that there is nothing that T2s can do about high readings. It is obviously what is behind the denial of test strips to T2s.
What is the point of knowing what your bgs are if you can't doo anything about them.?

While , of course , I recognise that insulin may be the best , indeed the only, route for some , there must be many more who are unaware of the other, less drastic options available to them through diet.

They are not being given the information to allow them to give their informed consent to moving onto insulin - which can be problematic for T2s who are still producing insulin.

While there may be new treatments in the pipeline there doesn't seem to be much in the way of new thinking around.
Patients have been fed medications for years which cause weight gain , increased insulin resistance and lead into a spiral
of more meds , more weight, increased meds etc. All in the cause of reaching the targets and not in the best inerests of the individual

I have no problem at alll in understanding why there is another "Push " to put everyone on insulin asap. Given the dietary advice or lack of it , the dearth of self monitoring and the widely held belief that T2s can do nothing to control their own bgs what alternative is there?

Unbeliever said:

I have no problem at alll in understanding why there is another "Push " to put everyone on insulin asap. Given the dietary advice or lack of it , the dearth of self monitoring and the widely held belief that T2s can do nothing to control their own bgs what alternative is there?

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Well those who find here do find a perfectly viable and safe alternative in my opinion but for those who don't or those that don't want to do the alternative then a push to insulin may not be such a bad thing as at least they don't spend years struggling with dangerously high BG's and developing complications while doing so.

I would guess the "drive to insulin" is being driven out of this 2012 document "Management of Hyperglycemia in Type 2
Diabetes: A Patient-Centered Approach" which is the latest American / European statement on best practice for treating Type 2.

http://care.diabetesjournals.org/content/35/6/1364.full.pdf+html

The key factor is the image below. It shows what doctors are being recommended to do with T2 patients who do not meet their hBA1c targets. So if Metformin isn't seen to be working after 3 months then you progress to Metformin + a stronger drug or even directly to Metformin + a basal insulin regime. Reviews of hBA1c are recommended quarterly and the text in the doc that explains the image states

Many months of uncontrolled hyperglycemia should specifically be avoided.

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So if the patient doesn't show control of HbA1c rather than risk developing complications caused by running high levels long term introduce insulin as that will sort the problem which I would guess it does in a majority of cases.

It seems crazy to me for a cash-strapped NHS to increase meds and finally introduce insulin, instead of putting some resources into a proper research initiative into dietary control

what have they got to lose????

lucylocket61 said:

It seems crazy to me for a cash-strapped NHS to increase meds and finally introduce insulin, instead of putting some resources into a proper research initiative into dietary control

what have they got to lose????

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Yes I agree Lucy. Pretty standard insulin therapies are of less cost than many of the better medications and costs are acknowledged as a major driver in that document for example

It must be acknowledged that costs are a critical issue driving the selection of glucose-lowering agents in many environments. For resource-limited settings, less expensive agents should be chosen.

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Seems short sighted that the patently cheapest option which is in my opinion simply telling the patient to reduce carbohydrates and maybe take some low cost Metformin isn't ever considered!

Your last sentence WAS my point xyzzy. When I asked what alternative there was to going onto insulin after being given inadequate information about dietary methods of control and denied a means of self-testing it was a rhetorical question
And I was really asking it from the point of view of the HCPs.

I think it is imposssible to train HCPs adequately to deal with diabetes in a practice setting. The only way to cope with it is by "dumbing down" or reducing everything to the lowest common denominator.

For T2s insulin is no magic bullet. if the HCPs have been unable to cope with he etremely limited number of drugs for t2s which were available until very recently , I personally would doubt their ability to cope with insulin.

That is why I resisted attempts to change me to insulin. It would be starting again with another medication - only this time the complications would not be my drug-induced eye problems but could be my life.

Could I really trust the Practice nurse with my life? Would anyone?

If there is really a serious plan to identify those at risk of diabetes earlier and to prescribe metformin off=licence this may be good news in the long term for many but those of us already diagnosed may well pay the price in the shorter term.

It scares me.

I seriously wonder how long it is going to be before Metformin is going to be available without prescription in this country. People will go the the pharmacy, pay for a blood test, then self-prescribe Metformin themselves without seeing a HCP

I can really see this coming soon.

lucylocket61 said:

I seriously wonder how long it is going to be before Metformin is going to be available without prescription in this country. People will go the the pharmacy, pay for a blood test, then self-prescribe Metformin themselves without seeing a HCP

I can really see this coming soon.

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I imagine you are quite righ Lucy and I am not sure that they will be much worse off. maybe having to do this or seeing others doing it will change the culture and encourage people to feel that that they can take charge of their own health.

Unless the side -effecs of metformin put them off completely!

xyzzy said:

If a diet only T2 wants to take a psychological view that carbohydrates are "toxic" as they find it's a good way of resisting temptations and keep their control within the "eat to your meter" concept then I personally see no harm it it and I also don't see why they can't espouse that view to others as they are simply telling others what works for them.

In reality it just a different way of saying "eat less rice" or similar carbohydrate heavy foods.

If the same person were giving up smoking or alcohol and took a similar view that doing those things was dangerous to their health then I don't see many would find that objectionable if they said that tobacco or alcohol were toxic.

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I do very genuinely believe carbohydrates are toxic to a great many diabetics, more so those on diet alone, or with diet and Metformin. I know people may not agree, but I strongly see them as white poison, and their complex cousins are little better. My only real source of carbs these days is in veg, the idea of eating bread, pasta, rice, potato's, wheat products just feels so totally alien to me. Why would I eat something I know will harm me.

I do appreciate Angie's point, where some people, smokers, drinkers etc know a certain thing is bad for them but they still do it, so this is simply my view for me, and not aimed at anyone else, or how they choose to control their diabetes.

Defren said:

Why would I eat something I know will harm me.

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Jo, your view is as valid as anyone else and I have no problem with you saying it. Personally I tend to draw a distinction that carbohydrate is "toxic" now that I'm T2 but maybe it wasn't prior to being diagnosed. However, saying that, I certainly think the emphasis put on starchy carbohydrate in the standard UK diet and the non regulation of highly processed carbohydrates and sugar does the general population no favours what so ever. A much more balanced and unbiased view of fat needs to built into the UK dietary recommendations in my opinion.

xyzzy said:

<snip>A much more balanced and unbiased view of fat needs to built into the UK dietary recommendations in my opinion.

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Yes.
On that subject, what happened to the push to tax fats to make us more healthy?
A bias towards carbohydrate rich foods pushed by taxation is not going to help anyone on LCHF or any similar approach.

A tax on processed bulk fillers would be a much more sensible option but would get the same sort of resistance from the food industry as we have seen from the tobacco and alchohol industries.

On the other hand, there would be some light relief to see people nipping onto the channel ferries to go over to France on a booze/fags/carbs run to save money :lol:

Cheers

LGC

As xyzzy notes, the ADA have addressed the issue of 50% energy from carbs generally leading to harder to control blood glucose levels.

Their section of what is healthy eating is now quite significantly different to Diabetes UK's and the NHS's
http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices.html

• Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety.
  Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals.
  Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce.
  ...

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and for whole grain foods (within which they include starchy veg)
http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/grains-and-starchy-vegetables.html

For the Plate Method
About ¼ of your plate should come from starchy foods. Remember, only the depth of a deck of cards! This is usually about ¾ to 1 cup of a starchy food.

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I imagine that Diabetes UK will revise their guidelines in due course. I also imagine that consultation and agreement with the Department of Health will be needed before any guidelines are changed, so it could be some foreseeable months, or longer, before any change to guidelines would take place.

Ed

alaska said:

I imagine that Diabetes UK will revise their guidelines in due course.

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I actually think that DUK revising its guidelines becomes less and less relevant as time progresses. As far as I'm aware NICE, the NHS and DUK are three independent bodies and it will effectively be diabetic consultants and especially GP's for T2's that will ultimately determine what treatments are recommended to patients. I would see a campaign to educate GP's as far more likely to succeed than a campaign to change DUK. DUK seems to have dug a very deep hole about low carb and they would have to admit they were wrong for all these years they've opposed it. GP's on the other hand are far more pragmatic especially if they see that something works and can save their practices money.

To me the low carb debate as a safe and effective treatment is totally proven down to that ADA one quarter or 25% carbohydrate level and for precisely the reasons they state. Personally I am far more interested in the debates that now arise because that 25% level has been accepted. For example the ADA are still pushing low fat whereas the Swedes push lchf. My view is the Swedes are telling us the truth whereas the ADA is still being pressured by the food and drink industry to keep the low fat message as billions of dollars rely on keeping that message going.

Grazer
I think the NHS "Safety first"
is not for the patients but for the medics. As in safety from lawsuits!
Hana

hanadr said:

Grazer
I think the NHS "Safety first"
is not for the patients but for the medics. As in safety from lawsuits!
Hana

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That's what i was referring to!

hanadr said:

Grazer
I think the NHS "Safety first"
is not for the patients but for the medics. As in safety from lawsuits!
Hana

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Quite!

hanadr said:

Grazer
I think the NHS "Safety first"
is not for the patients but for the medics. As in safety from lawsuits!
Hana

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We need a class lawsuit against DUK & the NHS for their criminal diet advice. Dr Briffa mentioned the possibility.