The NHS T2 Treatment Regime

[AM1874]

Two recent articles (or new book plugs) by well-known doctors Muir Gray and Michael Mosley focus on pretty much the same thing, ie. Type 2 diabetes is largely self-inflicted. Gray wants to rename T2D as "walking deficiency syndrome" .. for Mosley, it's about being fat, "particularly around the belly".

I have not put this thread up to criticise these articles .. or to generate another round of discussion about their rights and wrongs. I am more concerned, here, with the fact that neither of these eminent authors appear to accept, or even recognise, that their own paymaster, the NHS, bears any responsibility for today's T2D epidemic.

Scattered right across this forum are countless posts from people who have received poor standards of either perceived or actual care from their GPs and HCPs. This ranges from lack of interest, to a "one size fits all" approach, to inappropriate or incorrect advice, to an almost slavish adherence to a treatment mindset that was generated decades ago and has not been updated. There are, of course, a lot of exceptions to this and many T2s do not experience any such problems. Many GPs (mine included - now that I have changed my Doc) offer advice and support outside the NHS guidelines. Mosley himself, for instance, even quotes his wife, a GP, who tells her diabetic patients, "Sorry, but we’ve been giving you the wrong advice for 20 years". Unfortunately, though, many (probably the majority) of GPs and HCPs continue to plough the same dated furrows that the NHS has been cultivating for years.

But we're a stoic lot and we put up with this. We comment on the forum, get a few "

likes" and "winner" ratings .. and then fall back into a stance of resigned acceptance. We CARRY ON and even joke about it .. the "Listen, Nod, Smile, say Thankyou, Ignore" approach to the advice that we receive from Dieticians about the "Eatwell PLate" and starchy carbs just about sums this up.

I would point out, here, that I am talking about T2, rather than any other type of diabetes. Also, all of the issues that I have raised are generalised, rather than specific and I am fully aware that lots of folk on this forum, and their GPs, take a highly positive stance in terms of managing their T2 diabetes and their treatment. But I believe that my main point is valid and important, namely ..

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?

It's not a question of funding .. the NHS now spends more on medication for diabetes than any other condition .. but there has to be something that is preventing the NHS from updating and changing their advice and their treatment regime. I must admit that I'm baffled by this .. and I can't avoid asking myself what would happen if, say, cancer care was run in a similar way

Just my thoughts .. and apologies if this has all been previously discussed

 

[DavidGrahamJones]

Muir Gray and Michael Mosley focus on pretty much the same thing, ie. Type 2 diabetes is largely self-inflicted. Gray wants to rename T2D as "walking deficiency syndrome" .. for Mosley, it's about being fat, "particularly around the belly".

That's because they wear blinkers. The worrying thing is they could very well be overlooking the whole story about weight issues and the "diabetes" epidemic.

I just want to know why skinny people are becoming type II and why some people "being fat, particularly around the belly" are not type II. It is my considered opinion (I@m no expert) that that is an anomaly that they chose to ignore.

I've thought of one other thing, they're both &^%$£%^&*^%$£s.

 

[AM1874]

That's because they wear blinkers. The worrying thing is they could very well be overlooking the whole story about weight issues and the "diabetes" epidemic.

I just want to know why skinny people are becoming type II and why some people "being fat, particularly around the belly" are not type II. It is my considered opinion (I@m no expert) that that is an anomaly that they chose to ignore.

I've thought of one other thing, they're both &^%$£%^&*^%$£s.

I tend to agree .. however Mosley does make at least some attempt to address this ..

"Personal genetics also plays its part. Not everyone who is overweight has problems with their cholesterol or blood sugar levels, and many people with type 2 diabetes have a normal Body Mass Index (BMI). It seems that some people have a greater capacity to carry fat safely than others do. It also depends where you lay it down. The worst sort of fat is the fat around and inside your tummy, also known as visceral fat. We each have, it seems, our own personal fat threshold. Imagine you have an internal bathtub, which is slowly filling up with fat. At some point, it will overflow and start to infiltrate your liver and pancreas. The pancreas is responsible for producing the hormone insulin, which helps keep your blood sugar levels within a normal range. Once it starts to get infiltrated with fat, it does not work as well - and this may then lead to type 2 diabetes. The size of that internal bathtub varies from person to person."

 

[covknit]

The point is precisely because 12% of the world health care expenditure is spent on diabetes management. Who is going to risk their livelihood buy making those in power frown upon them? Why do so many of us get prescribed a statin on our first visit to the diabetic nurse? If a cure for cancer was found what would happen to everyone working in the field of cancer research and the cancer charities? Does anyone know an ordinary member of the public who has benefited from Action for Blind People? Remember what happened to the Head of the RSPCA who supported the ban on hunting with dogs? - He rapidly got replaced. If I get started on Comic Relief I will burst a blood vessel.

BTW in the spirit of research in the light of the fact I get my first well woman examination in May and GP is at last investigating the problems I have with my right side (I first consulted them in 2010) I took a statin pill. I was prescribed statins but not a diabetic drug upon diagnosis last September. Got lectured for not taking statins at my follow up in January. My cholesterol blood tests at the end of April will be compared to the test taken last August i.e before knowing I have diabetes and after 7 mths low carbing with 4 mths lchf. Next day I felt as if someone had kicked me in the kidneys, I had a sprained left wrist and the toes on my right foot tingled a lot. I recall a comment in one of the video's stating that 8 people on the NICE panel have "direct" links to statins. Wish I could remember which one.

 

[Chook]

I think most doctors / medical professionals don't actively encourage LC because they know the vast majority of T2s are happy to rely on medication and GPs just don't have enough time to persuade someone in to doing something completely new.

About a year ago my pharmacist (lovely lady who is VERY interested in low carbing as a form of treatment for T2) asked me to give a little talk about LC to a small group of recently diagnosed T2s. It was hopeless, out of about 40 invited only a dozen showed up and all but one of that dozen said they couldn't live without their chips / cake / porridge / pasta - even though the pharmacist and I offered on-going FREE support. The one that did show some an interest kept in contact with me but gave up when she got carb flu.

The thing is that we, on this forum, are only a tiny fraction of the diabetics world wide - everyone with internet access could also find their way here if they were interested - but they don't. So, presumably, they are happy with their lives as they are.

I must admit after the 'talk' fiasco I have a lot more sympathy for HCPs who suggest lifestyle change as an option.

 

[covknit]

I think most doctors / medical professionals don't actively encourage LC because they know the vast majority of T2s are happy to rely on medication and GPs just don't have enough time to persuade someone in to doing something completely new.

About a year ago my pharmacist (lovely lady who is VERY interested in low carbing as a form of treatment for T2) asked me to give a little talk about LC to a small group of recently diagnosed T2s. It was hopeless, out of about 40 invited only a dozen showed up and all but one of that dozen said they couldn't live without their chips / cake / porridge / pasta - even though the pharmacist and I offered on-going FREE support. The one that did show some an interest kept in contact with me but gave up when she got carb flu.

The thing is that we, on this forum, are only a tiny fraction of the diabetics world wide - everyone with internet access could also find their way here if they were interested - but they don't. So, presumably, they are happy with their lives as they are.

I must admit after the 'talk' fiasco I have a lot more sympathy for HCPs who suggest lifestyle change as an option.

Once I started refusing cakes I discovered I know a lot of people with diabetes. The majority went straight onto medication and tell me I need to get on to the patient liasion service because I should be too. With most people the attitude is "Once I get my medication I can be "normal" again " or "once I get used to the idea I am diabetic I will eat normally again". Everyone seems to have been told to diet and several have tried slimmers world or weightwatchers.

It is not just diabetes either. A very darling friend had a stroke with complications last year and has to have a low salt diet. This means he has unsalted butter and given up certain processed meats such as salami. He still has ready meals every evening and bought precooked meats for lunch. Cereal for breakfast.

 

[CherryAA]

My on doctor ( a private GP ) told me he saw little point trying to roll out what I was doing amongst has patients because they also use the NHS and take the medications.

My little rant in Waitrose yesterday was a result of feeling that one should at least try to get the message out. I now have two male friends each of whom has lost 28 kilos as a result of low carbing and one who has reduced by 10 kg and reduced insulin.
Funnily enough I have found my female friends much more resistant to the idea, maybe because they ( like me) spent so many years going low fat. whereas for each of the guys the whole idea that diet could matter so much was a complete revelation which once embraced they did not find too difficult to follow. (Its actually quite a "macho" way of eating )

 

[Nicksu]

The problem is that we have had the whole low fat thing shoved down our throats for years - and it is difficult to change the mindset of people when they are so entrenched in the whole idea. Unfortunately changing people's attitudes takes time - particularly in the NHS - so nothing will change in a hurry. Its going to take time and patience - and a few celebrities no doubt to endorse the whole thing - look at Alec Baldwin for example - he went low carb when he was diagnosed with pre-diabetes.

 

[Bluetit1802]

The Government and thereby the NHS receives advice about nutrition from several sources, one of which is the British Nutrition Foundation. This is a charity. Have a look at it's members and financial contributors.

https://www.nutrition.org.uk/aboutbnf/supporters/memberorganisations.html

Kelloggs, Coca Cola, Heinz, Greggs, Warburtons, Weetabix ..... need I say more.

 

[Nicksu]

The Government and thereby the NHS receives advice about nutrition from several sources, one of which is the British Nutrition Foundation. This is a charity. Have a look at it's members and financial contributors.

https://www.nutrition.org.uk/aboutbnf/supporters/memberorganisations.html

Kelloggs, Coca Cola, Heinz, Greggs, Warburtons, Weetabix ..... need I say more.

Carbs and sugar galore!

 

[Avocado Sevenfold]

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!

 

[carol43]

I know plenty of T2s and when I have talked to them about their 'diet' but they do not want to change. Two of my on-line friends, not diabetic, have followed LCHF, after me posting a photo of before and after, one has lost a considerable amount and the other one got carb flu, which I explained to her and she is now losing weight. OH has now started LCHF and is slowly losing weight.

If there was a cure found? I wouldn't go back to eating carbs as I feel so much better.

 

[Geordie_P]

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!

Yes, I also think there's a reasonable amount of difference between him and Muir Gray. Dr Gray takes the line that T2 doesn't exist, everything is your fault, you're just fat etc. Totally unhelpful and pointless. Dr Mosely had T2 himself and reversed it with diet and exercise, and now he encourages everyone who can do likewise to try it. He acknowledges you can be slim and get T2, he also acknowledges that people who haven't been T2 for very long have a better chance of reversing it. I think that's pretty fair, on the whole.

 

[Resurgam]

I lost weight before I went to the diabetes education sessions, then it stopped - my insulin resistance dropped.
My results were bewildering to the education team - my second test results should be obtained if I had 'been good' and lost weight - and I hadn't - I'm not sure if they suspected witchcraft or a miracle - either way it was inexplicable.
Couldn't possibly be eating the right foods - Atkins is a fad diet from the past, not a well established method of managing blood glucose.

 

[DavidGrahamJones]

Couldn't possibly be eating the right foods - Atkins is a fad diet from the past, not a well established method of managing blood glucose.

Couldn't tell if you were being serious or not.

Would I be right in thinking that you are aware that an undertaker named William Banting who wrote a book entitled Letter on Corpulence Addressed to the Public as far back as 1863, basically advocating low carb diet. The diet had been recommended by
Dr. William Harvey, a Fellow of the Royal College of Surgeons: an ear, nose and throat specialist.

Dr. Harvey had recently returned from a symposium in Paris where he had heard Dr Claude Bernard, a renowned physiologist, talk of a new theory about the part the liver played in the disease of diabetes. A low carb diet had been recommended by Bernard as a way of treating people with diabetes.

I found the story fascinating http://www.second-opinions.co.uk/banting.html#.WOY9zLgVv9w and the story of Claude Bernard even more so because he went to Paris having written a play and was persuaded to become a medic.

I'd never call the Atkins diet a fad diet and I'm beginning to wish I never Googled it. Classic case of the more you read the more confusing it all is.

 

[Lamont D]

Vested interests is the answer!
Also within doctors training, the low carb higher fat is shunned and dismissed as one of those dietary fads. Also, the one size fits all for prediabetes and newbie type two.
The reason behind this thinking has to be that most doctors have not had the experience of actually having T2 diabetes and not had the freedom to think outside the guidelines. This is changing though!
The major theory behind treatment for type two is not dietary but getting blood glucose levels down and therefore most are given meds to treat it.
However, there are many reasons why type two develops and this treatment doesn't include it in the treatment protocols. As anyone who has been on this forum long enough, we are all different, other variables have to be taken into consideration.
Type two can be a dietary condition and should be treated as such, hyperinsulinaemia, hyperthyroidism, and other hormonal imbalance conditions are sometimes dismissed as incidental. But can lead to complications if treated by meds instead of diet!

Through my experience, with misdiagnosis and our medical practitioners not having a clue with other rarer types of endocrine conditions, the knowledge is not there.
Theoretically, we all need glucose to give us our brain function, we cannot do without it! But too much glucose is bad!
We need the right balance of insulin to offset this.
We need other hormones as well, within our own individual balance.
When it goes out of balance, that is where it all starts.
But our doctors believe and are taught that healthy carbs, those that are slow to digest to provide that healthy balance. But if you are glucose intolerant or cannot risk more insulin into our blood, how is that healthy?
Most of everything is poisonous in quantity, so is glucose, insulin, too much is not good, too little is not good.
Balance is having your blood glucose levels near normal for longer periods is good and healthy.
Other than low carb, there is nothing that can do this! And is sustainable!

I might add that my GP and endocrinologist are supportive in my choice of diet and has brought in low carbing for most of their patients with some real success.

 

[Nicksu]

Yes, I also think there's a reasonable amount of difference between him and Muir Gray. Dr Gray takes the line that T2 doesn't exist, everything is your fault, you're just fat etc. Totally unhelpful and pointless. Dr Mosely had T2 himself and reversed it with diet and exercise, and now he encourages everyone who can do likewise to try it. He acknowledges you can be slim and get T2, he also acknowledges that people who haven't been T2 for very long have a better chance of reversing it. I think that's pretty fair, on the whole.

What I liked about the Blood Sugar book is that Dr Mosley acknowledges that everybody has an individual tipping point at which they will develop diabetes - and that many can carry excess weight and not develop it and yet others do. It all depends on the person and what amount of fat the liver has. Fascinating really - but still a nuisance!

 

[Daibell]

Hi. This topic regularly comes up and I agree that's unacceptable the NHS so often gets it badly wrong with diabetes and I would include my surgery with that. There are many reasons as others have listed. The food and pharma lobby are very strong and there are many vested interests with 'snouts in the pot'. The food industry wants to sell carbs and the pharmas medication. GP training for diabetes is woeful. My new diabetes GP who had just come off the training course didn't know about late onset T1 for example. From posts on this forum you can see overweight T2s being given Gliclazide as the GP doesn't understand how this drug works. You see overweight T2s then having insulin added and wondering why it doesn't help. You see people being prescribed vanilla Metformin and having weeks of bowel problems and no help e.g. SR version from their surgery. I wonder how many GPs know that T2s have excess insulin and T1s too little (yes, a generalisation). The problem is that GPs are by definition generalists. They should not be diagnosing complex conditions as there are too many conditions and too many drugs. There is no way they can keep up. There should be more referrals to consultants but there aren't enough of them and the cost would be too high. I'm currently reading a good called 'Black Box Thinking' which compares the aircraft industry with the medical industry. The former measures failures, feeds back and hence has excellent control and few failures now. The medical industry refuses to accept measurement and feedback as good process so the speed of learning is very slow. It's interesting to se how slow Diabetes UK (not this site) has been in adopting changing knowledge and has largely ignored the posts on this forum preferring to follow the 'experts' who in turn have their research funded by food and pharmas. I don't see any way thru this failed scenario.

 

[Resurgam]

Couldn't tell if you were being serious or not.

Would I be right in thinking that you are aware that an undertaker named William Banting who wrote a book entitled Letter on Corpulence Addressed to the Public as far back as 1863, basically advocating low carb diet. The diet had been recommended by
Dr. William Harvey, a Fellow of the Royal College of Surgeons: an ear, nose and throat specialist. .

No - not at all serious. There is so much misinformation about Atkins - like poor William Banting he as astonished at his good fortune in finding a way to help people, and perplexed by the reaction to his trying to spread the word.
I have been harangued into trying to eat carbs over and over - giving in when I was pregnant with my second child made me very ill and I lied to my doctor in order to avoid going into hospital and being fed a healthy high carb diet - I was already unwell with pre eclampsia after three weeks eating according to the doctors diet sheet. Low carb foods rapidly changed things, but my second child has not been as healthy as my firstborn - but I was foolish enough to boast of how well I had been and how strong a baby the first one was.

 

[ukuleleplayer]

I tend to agree .. however Mosley does make at least some attempt to address this ..

"Personal genetics also plays its part. Not everyone who is overweight has problems with their cholesterol or blood sugar levels, and many people with type 2 diabetes have a normal Body Mass Index (BMI). It seems that some people have a greater capacity to carry fat safely than others do. It also depends where you lay it down. The worst sort of fat is the fat around and inside your tummy, also known as visceral fat. We each have, it seems, our own personal fat threshold. Imagine you have an internal bathtub, which is slowly filling up with fat. At some point, it will overflow and start to infiltrate your liver and pancreas. The pancreas is responsible for producing the hormone insulin, which helps keep your blood sugar levels within a normal range. Once it starts to get infiltrated with fat, it does not work as well - and this may then lead to type 2 diabetes. The size of that internal bathtub varies from person to person."

Moving away from Mosley's ideas, try this for size (sorry for pun!).
Just suppose that the pancreas is producing less than ideal insulin. It does not react properly with all of the glucose generated by carbs. Some is taken into muscle cells as energy fuel. The rest stays in the blood stream. And this is after a "healthy" starchy, high carb meal. Soon the diner will feel the need for more energy...and eat more. The same scenario will repeat itself. The person concerned will put on weight, regardless of how active he or she is. (Worth noting that exercise isn't an effective means of weight loss, diet is.)
The point is, which comes first? How many are tested for T2D while they're not "overweight"? Precious few, I'm guessing.
The testing usually follows the weight problem and a higher than normal reading is obtained. You are diagnosed as T2D and then told to follow a diet pretty similar to the one you've been on.
Assuming you're sensible you then do a little homework, join the forum and the LCHF programme.