What happens when our personal experiences disagree with research.

Jamrox said:

It's neither , it's the national guidelines . Healthcare staff HAVE TO go by the national guidelines and standards unless they have a genuine reason not to . Without the evidence to prove lower carb then they go with national guidance.

I have had discussions with dieticians and nurses about it . The message is out there and things are changing , hence the publicity about it .

I object to busy healthcare workers being called lazy or incompetent.

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I consider the people who came up with the guidelines to be part of the NHS and these people are clearly incompetent or lazy. It took me a very short amount of time to discover that the guidelines appear designed to make type 2 diabetes progressively worse. How can it be that doctors and nurses who treat type 2 diabetes can't figure this out as well? I find it extremely perplexing, since the information is readily available. Anyway, here's a genuine reason to not follow the guidelines and standards for type 2: THEY DON'T WORK!!

None of this is evidence that the current guidelines are correct, it is just evidence that the current guidelines are the current guidelines. Thousands of people are discovering, for themselves, that the current guidelines are a farce, our doctors are being taught, by one well informed, experienced patient at a time!

It will take a generation before our doctors and eventually the guidelines catch up with the reality. Type 2 diabetes, in the majority of cases, can be improved, put in remission or reversed by simple lifestyle and diet changes, which we are discouraged from making, in case there are unspecified 'long term consequences'. What long term consequences can there be from eliminating processed garbage from our diets and replacing them with real food and fresh vegetables? It's bizarre that it's not totally obvious to everybody!

You know what I'm not even going to waste my energy going over it all again .
I agree they need changed , if the robust scientific evidence is there and you have it then please send it to NICE and SIGN then they can re write their guidance .

I do always advocate for a low carb diet by the way . I have been in the national press telling my story . I shout it to anyone who will listen but I can see why they can't change national guidance until the robust evidence is there . Unfortunately that's the way it is .They aren't lazy or incompetent , they are cautious because what happens if there are complications with low carb down the line etc . Please give them a chance , I know it's frustrating but it will come .

I wish I had your optimism. I am a retired Health Service worker, I do not knock the NHS or its personnel, but there are too many people with closed minds, inappropriately resistant to change. It is not possible to do long term randomised trials on dietary changes - it simply isn't possible. We couldn't fully know about the long term effects of dietary changes without following people who have made those changes, maybe for 20 years. But we can look back at history and we can look at populations who eat a low carb diet as the norm, and look at their health. And we can look at what changes have happened to our diets in the last 30 years that have caused the epidemic of Type 2 Diabetes that we presently have.
And we can compare the potential, possible downside of dietary change to the known downside of poor control and increasing medication.

The trouble is that the NHS is too busy looking after the failing diabetics to question and ask how a good diabetic does care for themselves...
Same with NICE... They are too busy looking at medicines and cost cutting and don't spare time to look at the whole picture.
And of course NICE officials seem to have enjancements of some description from all drug companies...they aren't squeaky clean unbiased professionals..

There certainly was't any robust scientific proof that the high carb low fat dietary guidelines would improve health for anyone, never mind people with diabetes.

I suspect the issue is cognitive dissonance:

"Cognitive dissonance is a psychological phenomenon which refers to the discomfort felt at a discrepancy between what you already know or believe, and new information or interpretation. It therefore occurs when there is a need to accommodate new ideas, and it may be necessary for it to develop so that we become "open" to them.

Beyond this benign if uncomfortable aspect, however, dissonance can go "over the top", leading to two interesting side-effects for learning:

• if someone is called upon to learn something which contradicts what they already think they know — particularly if they are committed to that prior knowledge — they are likely to resist the new learning.
• and—counter-intuitively, perhaps—if learning something has been difficult, uncomfortable, or even humiliating enough, people are less likely to concede that the content of what has been learned is useless, pointless or valueless. To do so would be to admit that one has been "had", or "conned"."

Jamrox said:

http://www.sign.ac.uk/pdf/sign116.pdf the level of evidence and the references are clear to see.

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Lots of references, and I don't have time right now to read the entire guidelines - but here is what it seems to boil down to:

"Eating healthily is of fundamental importance as part of diabetes healthcare behaviour and has beneficial effects on weight, metabolic control and general well-being.116,117 Salt restriction in the general population is discussed in the SIGN guideline on risk estimation and the prevention of cardiovascular disease (SIGN 97).72 One meta-analysis of 11 RCTs investigated the efficacy of different diets to improve glycaemic control in people with type 1 and type 2 diabetes aged from 10 to 60 years.118 Pooled data for six trials measuring HbA1c showed a mean reduction of 0.5% (5.46 mmol/mol) (95% CI 0.8 (8.74) to 0.2 (2.19), p=0.001) for patients on low glycaemic index (GI) diets compared with higher GI diets. In two studies a low GI diet was associated with reduced reports of hypoglycaemia. The authors note that some randomisation information was inadequate and bias from unblinded assessors cannot be ruled out. There is insufficient evidence to make a recommendation about specific diets for improving glycaemic control. There is no evidence on patient satisfaction, quality of life or hospital admission rates with reference to particular diets. Insufficient evidence exists to make a comparison of hyper and hypoglycaemia rates between different diets. High dropout rates and poor compliance with carbohydrate- and energy-restricted diets demonstrated in trial settings would suggest that such diets are not widely applicable or acceptable to patients.119,120 Short term (six months) low carbohydrate diets containing as little as 50 g carbohydrate per day (13% of daily energy)120 or 110 g per day (33% of daily energy)119 appear safe in type 2 diabetes whether treated by diet, tablets, insulin or a combination. In patients who adhere to a low carbohydrate diet a reduction in insulin and/or oral hypoglycaemic agent dose is likely to be necessary."

So, despite there being no evidence for the "well plate," (sorry if I don't have the name quite right - I'm from the US), the well plate appears to be being pushed and LC actively discouraged.

(The UK site is not well enough organized for me to quickly find dietary advice.)

Well I have been diabetic for nearly 4 years ( probably longer but officially
diagnosed ) . I am reduced carbs and increased activity .NO meds !!! I know what works for me . I am an individual. People should take responsibility for their diabetes and not devolve responsibility to healthcare providers , then blame the healthcare providers . Only you will know what works for you .

There's plenty advice on here . My GP advised me to go on DCUK and I m glad she did.

I believe that 'High drop-out rates and poor compliance' are exacerbated hugely, because the important people don't believe in it. If your Diabetic Nurse, or your Doctor or Dietician for instance, is highly sceptical of the Low Carb approach, you will approach it warily, not wholeheartedly. It is strange initially, and after half a century of the 'saturated fat is bad message', it's central to our thinking. That's why, I believe, proper support is essential and could make the difference. I don't understand why the GP practice in Southport who has changed the advice to their diabetic patients, actively promoting the low carb approach to those who find it acceptable, resulting in huge improvements in HbA1c and budget savings in medication. They must be getting something right. Why their practice has not been evaluated and rolled out nationwide mystifies me. I think the turning point will be the Tim Noakes trial in South Africa. Has anybody else been glued to it?

AtkinsMo said:

I believe that 'High drop-out rates and poor compliance' are exacerbated hugely, because the important people don't believe in it. If your Diabetic Nurse, or your Doctor or Dietician for instance, is highly sceptical of the Low Carb approach, you will approach it warily, not wholeheartedly. It is strange initially, and after half a century of the 'saturated fat is bad message', it's central to our thinking. That's why, I believe, proper support is essential and could make the difference. I don't understand why the GP practice in Southport who has changed the advice to their diabetic patients, actively promoting the low carb approach to those who find it acceptable, resulting in huge improvements in HbA1c and budget savings in medication. They must be getting something right. Why their practice has not been evaluated and rolled out nationwide mystifies me. I think the turning point will be the Tim Noakes trial in South Africa. Has anybody else been glued to it?

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This just shows that HCPs do not have to follow the guidelines in the UK.

NoCrbs4Me said:

This just shows that HCPs do not have to follow the guidelines in the UK.

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In this litigeous society, to ignore the guidlines raises the probability of legal action if anything goes wrong. It takes abrave practice manager to support 'outside the box' activities. As an Aeronautical designer I recognise the symptoms.

it is quite easy when on this forum to think that this site represents the big wide world outside. in fact diabetics represent a minority in the UK, and not all diabetics use this forum, and not all diabetics read or consider using any diet let alone an LC one to control their diabetes. We have access to this data, but we are quite a priviledged band, and small in number.

i remember when Atkins launched. They had similar issues to address, and had an uphill struggle to gain acceptance. But they had mainstream appeal (weight loss only) whereas we are looking for a special key to control bgl, something peculiar to our condition. We are just starting mainstream media beginning to pick up on LC, and we can advance things within the NHS by talking to our HCP's and by our examples. But its gonna be a hard fight worth winning.

Oldvatr said:

In this litigeous society, to ignore the guidlines raises the probability of legal action if anything goes wrong. It takes abrave practice manager to support 'outside the box' activities. As an Aeronautical designer I recognise the symptoms.

it is quite easy when on this forum to think that this site represents the big wide world outside. in fact diabetics represent a minority in the UK, and not all diabetics use this forum, and not all diabetics read or consider using any diet let alone an LC one to control their diabetes. We have access to this data, but we are quite a priviledged band, and small in number.

i remember when Atkins launched. They had similar issues to address, and had an uphill struggle to gain acceptance. But they had mainstream appeal (weight loss only) whereas we are looking for a special key to control bgl, something peculiar to our condition. We are just starting mainstream media beginning to pick up on LC, and we can advance things within the NHS by talking to our HCP's and by our examples. But its gonna be a hard fight worth winning.

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Perhaps someone should sue over the current bad advice.

NoCrbs4Me said:

Perhaps someone should sue over the current bad advice.

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But the defence would be : "We are just following the guidelines..."
AKA "I vos just following mine orders ...."

NoCrbs4Me said:

Perhaps someone should sue over the current bad advice.

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apre vous le deluge.

CollieBoy said:

But the defence would be : "We are just following the guidelines..."
AKA "I vos just following mine orders ...."

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It certainly isn't a defence if they don't .
I liaise with the healthcare ombudsman in Scotland . They ALWAYS check the current guidelines when people complain about their care . If the HCP has not followed the guidelines then they find against the health board ( most of the time anyway ). Also if someone has a claim then the powers at be look to see if current guidelines are followed .
Like it or not it's the way it is .

I was thinking we would sue the persons responsible for the guidelines. You wouldn't have a leg to stand on if you were suing an HCP for following the guidelines (perhaps literally as well as figuratively).

NoCrbs4Me said:

I was thinking we would sue the persons responsible for the guidelines. You wouldn't have a leg to stand on if you were suing an HCP for following the guidelines (perhaps literally as well as figuratively).

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Maybe a class action would succeed, but even Donald Trump might have difficulty paying the lawyers. You would have to PROVE negligence or intent, and that might be a tad difficult. As I pointed out, we are a small band of brothers with a vested interest fighting more powerful vested interests.

Oldvatr said:

Maybe a class action would succeed, but even Donald Trump might have difficulty paying the lawyers. You would have to PROVE negligence or intent, and that might be a tad difficult. As I pointed out, we are a small band of brothers with a vested interest fighting more powerful vested interests.

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The idea would not be to suing for damages, but to sue to get them to provide better dietary advice.