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The NHS T2 Treatment Regime

I used that explanation on the 'other' diabetes list and it was deleted as it was not a proven fact - but I have always put on weight so easily and had a few symptoms when in my teens and 20s that I suspect that I have been heading for diabetes or even diabetic for a long time and whenever I stopped eating low carb - I started in my 20s and had no more symptoms of classic diabetes - I could put on weight just by looking at a picture of a potato.
 
Absolutely all true! It's in NO ONE'S financial or career interest to get people to fix their diets. Or to fix most other problems in the world for that matter. Once a "problem" acquires an "institution" to advocate for it, all is lost.
 
 
Avocado Sevenfold said:
I like Dr Mosley.

https://thebloodsugardiet.com/

He advocates "sticking to a low carb Med style way of eating, with intermittent fasting as needed." Sounds ideal to me!
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Whoops! I accidentally deleted my reply along with the "empty" one I meant to remove. Here goes again: I found the most useful bit of advice in Mosley's 8-Week Blood Sugar Diet book for me was his recommendation of a minimum daily total of 10,000 steps. As soon as I began that regime (last August), my readings started to move out of the "prediabetic" range into something more "normal". Now FBS regularly in mid-to-high 4s (on Accu-chek Aviva Connect; low 5s when I compare with Verio IQ), and latest HbA1c was 5.5% with less-strict low carbing than in July and early Aug of '16, when I had a hard time moving FBS below 6 (Verio IQ).
I don't know if T2s would react the same.
 

This is exactly what happened to me, except my pancreas went into overdrive and I gradually put on a lot of weight.
What comes first? Hyperglycaemia or hyperinsulinaemia?
In the end they both happen to a lot of type two diabetics and diet is the treatment not drugs!
 

I'm in exactly the same boat, though I never isolated what the things were that caused it. I just knew that my weight went inexorably up unless I was actively on a calorie restricted diet so 35 years of low fat muck and an unhappy self image. Being actively diagnosed transformed by life and my figure and my health .
 
JayJamison said:
Absolutely all true! It's in NO ONE'S financial or career interest to get people to fix their diets. Or to fix most other problems in the world for that matter. Once a "problem" acquires an "institution" to advocate for it, all is lost.
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TRUE, My doctor prescribed Metformin and Atrorvaststatin for my type 2 Diabetes. I get Emails almost daily from the 'States about type 2 and how to treat it, but nothing from my G.P.!!!!
 
If I'd not been a retired NHS ward charge nurse I'd not have put myself on the Newcastle Diet & lost 3 stones. My BS is now 38. Neither my GP nor the nurse gave any advice approaching it. The GP was fascinated with the ND sheets I showed him & asked to keep them so I hope others will now be given better advice.
I think all T2s should be mandated to use the ND.
 
TerryinDorset said:
I think all T2s should be mandated to use the ND.
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That is a bit of a sweeping statement. Not all T2's need it, at least not for weight loss. Some T2s are slim to start with. Others manage quite easily to lose vast amounts of weight and gain normal BS by other means (including me), and many couldn't stick to it. It is clear the ND is successful for many in the short term, but it is after the diet has finished that problems can start, as a few people on here can testify. Without correct dietary guidance and a good awareness of the role of carbohydrate the weight is likely to go on again and BS deteriorate, and as things stand, correct dietary guidance is what is lacking in the NHS.
 
I was put on low calorie diets by my doctors, down to 800 and was being pushed to go lower, and to exercise, when I could hardly get to work and back, could not cope with the job and was not eating on some days as I did not have the energy to get to the shops before they closed on Saturdays - it was before Sunday opening was allowed.
On a low carb diet I can cope with a low calorie intake, but I don't have to.
 
Hi I agree completely that treatment programmes need to be individualised.

Meal glycemic load is important too if a meal has too high a glycemic load your insulin dose will struggle to keep up with the dramatic rise in blood sugar. Glycemic load is glycemic index * available carbohydrate g in the food eaten / 100

Glycemic load is rarely discussed as there are few foods for which a GL has been calculated, however if you look at the foods that have a GL and do a multiple linear regression you can estimate GL based on macronutrient (protein, fat, carb, fibre & sugar) content this equation can further be simplified for meals with a GL above 2 as approximately equal to 2+(0.5*available carbs)+(0.25*sugar) where available carbs is total carbs less fibre, all of these amounts are g per meal. low GL is <10 high above 20 but in my opinion many T2 diabetics (dependent on INDIVIDUAL insulin sensitivity) may have to have meals less than 16. This means lower carb as opposed to low carb per say but on an individual basis which can be estimated as outlined below:

The NHS does not believe there is any science supporting glycemic load modification in diets for diabetes, but they do acknowledge that glycemic index (an inferior measure of how a food raises blood sugar) does. What they fail to realise is the reason there is little evidence is there's been no/very little research rather than that there has been lots of research showing no effect. They also fail to realise that as individuals have different rates of insulin sensitivity the affect of glycemic load will be different from one individual to the next. Ideally, what should be done is following a meal plan with different GL meals and measuring blood sugar one day then the next day having meals with the same GL, but in a different order (to take account of the effect of time of day), whilst keeping all other factors constant e.g. exercise, medication etc. this will then allow for a comparison of the effect on an individual of high, low and moderate GL meals and figuring out the relationship between increase in GL and blood sugar for an individual it is then easy to give GL meal targets for that individual. The downside of course is that it still requires carb counting and using databases/back of the packet information to meal plan or lookup a food's nutritional (*carb, fibre, sugar) content, but unlike the NHS approach would allow you flexibility in your meals- doesn't assume you have the same meals every day. Eating out still provides a problem as if a food isn't listed in a database knowing the sugar content is hard especially regarding added sugar (e.g. sugar in sauces).

I'm working on a points based system developed from the diabetic exchange lists that in combination with a dynamic plate model would make estimating what's in an unknown food a little easier, but again this would be a more rough estimate than if you actually knew exactly what had been added to the food. Personally I think not only should restaurants have to post kcal fat protein, carb but also fibre and sugar content of food, especially if they are above a certain size.

*The role of protein and fat in reducing a meals GL is present but seems quite minor compared to these.

Anyway these are my thoughts on a preliminary 'new system' for an individualised approach as I say all the equations are new and will provide rough estimates only and don't apply to GLs below 2 (the longer form equation does). Ive used a 100 items to come up with these equations from a variety of different food groups but this falls short of true validity testing.
 
@The_Health_Therapist

The GI/GL way of eating didn't work for me at all. I gave it a good try right at the beginning of my journey over 3 years ago, meticulously calculating the GL of every meal, which was time consuming. It was far easier just to cut out/drastically reduce the major carbs, and far more successful. Self testing showed me which and how many carbs my individual body can cope with.
 
Glycaemic load is irrelevant for me too - if I hit double figures it doesn't matter how long after the meal it occurs, it happens, it stays high for however long, and then gradually goes down as long as I don't top it up with more carbs.
 
My own experience with low carb. has been amazingly successful. I have always struggled with weight, no diets have ever worked. Low carb. has helped me shed 4.5 stone in 13 months without having to apply too much calculation etc. Eating white bread was my achilles heel (like most Scots I could eat virtually anything between two slices). I changed to eating Rye bread one small slice a day is satisfying and causes me no dietary issues. Chips and or Potatoes are an infrequent treat. Course vegetables, a reflection of my 1950's childhood are enjoyed daily. Fresh meat from a local butcher with fish when available.

Goodbye to Pizza, and most prepared foods from supermarket. All this becomes part of life not a special diet.

Tablet dosages have been reduced and my test results are fine as is blood pressure and chloresterol. Thank goodness for chocolate recipes being changed. They have all tasted too sweet for several years now so I have given up on them.

The low carb. diet has been a life changer for me I think because it is easy to eat and requires no real calculation etc etc. My old Granny actually ate the right foods - lol.

Bill
 
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This is true, I do think the eatwell plate is quite high carb and there is no harm from a nutrient content point of view with a properly planned lower carb diet; this could be a very low carb diet, or just a lower than eatwell plate carb diet (<52%) depending on an individuals insulin resistance.

I still believe in getting carbs through fresh fruit and veg, but the rest of the starchy carb equation is mostly for fibre which can be made up from psyllium husk supplementation etc. Should be noted that when people experience lethargy on low carb diets this is a) temporary as the brain adapts to using ketone bodies as a fuel source, b) doesn't affect everyone to the same degree and c) shouldn't happen if carbs are 30% of kcal or above, which may be enough of a reduction in people with only moderate insulin resistance, again the key is what works for the INDIVIDUAL.

P.S as a whole the NHS will probably never recommend LCHF or high protein diets, most of the evidence behind them shows the affect on weight loss is largely due to satiety or fullness and this effect doesn't work on everybody, a SMALL number of people will not feel fuller and therefore overeat and there is a difference between LCHF at or below true energy balance (energy balance as calculated using equations is crazy rough and may be influenced slightly by protein content of diet, theoretically at least) and LCHF above true energy balance especially if the latter is also very high in sat fat & low in omega 3.

Due to this small risk (that could be completely avoided by a person checking every couple of weeks to make sure they are loosing or at the very least not gaining weight - in which case more omega 3s really reduces the risk too!) in my opinion the NHS will never recommend something that has a small chance of increasing heart disease risk factors even if it will only do so for a very small number of people who fail to lose weight + overeat + eat too much sat fat (not everyone responds to sat fat the same way anyway!) and do not get enough omega 3 (at least 2000mg for heart disease risk modification - make sure its purified to reduce heavy metals - don't exceed 3000mg/day ps check with doctor especially if on anticoagulants as their dose may need changing shouldn't affect diabetes medications, but again please check), people who follow a LCHF, take a soluble fibre supplement and still eat enough veg/fruit for phytonutrients (7 portions (majority veg at least 2 dark green leafy or cruciferous veg)) and have enough vitamins, even if through supplementation, there is no reason why the NHS should not recommend a LCHF diet as said diet would be nutritionally complete.
 
Wow!

To the ordinary Joe, who has just been diagnosed, that is just gibberish!

That is why, even though I do understand most of your posts, I just eat what I know won't affect my blood glucose levels. It is more simple and after finding my balance between protein and vegetables, with little bits of fruit etc.
I don't need supplements!
Testing and experience, doing experimentation on how much food puts you out of ketosis is my only worry now!
Insulin resistance will improve dramatically on a very low carb diet but won't cure the condition.
Control is the key when you have intolerance to certain starchy, sugary foods. Carb restriction rather than reduction can be necessary in a lot of type two patients. Whereas only a small reduction in carbs can be enough for prediabetes.
It all depends on the individual!
This is where the NHS guidelines fail us!
 

This table does the GL per serving http://care.diabetesjournals.org/content/diacare/suppl/2008/09/18/dc08-1239.DC1/TableA2_1.pdf but I am another that tried low GL on the basis of an upbringing and "education" that made low GL sounded a healthier diet than low carb. If health is based on how well I feel Low carb is better. Such test results as I have been able to obtain thusfar agree.
 
AM1874 said:
Why does the NHS promote and deliver a T2 treatment regime that does not work for many (most?) patients .. and how do they continue to do so without any (apparent) change, advancement .. or criticism?
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Trying to think about the original question - which I hope I have managed to cut & paste above - I believe the reason is not quite as conspiracy-theory as some have stated. The main reason can be found in a reply a little further down the forum - with the blogger who tried so hard to advise people who simply could not imagine a diet without chips, or pizza, or bread. It is these people, who are the majority of GPs patients, (not the minority of food-aware explorers like us!) - a majority who would benefit immensely from taking on the "five-a-day" message, and the "eatwell plate" message, whether the meals were home-cooked or ready-meals.
Once they are on a more nutritious diet, then their blood sugars might be stabilised, and THEN they can try reducing carbs to control BS even better.
The other point about the low-carb diet is that there simply hasn't been enough research. Yet. It is coming, but evidence-based practice is vitally important to a free-to-the-end-user system like the NHS and really cannot be circumvented.
 
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