Dr Kesar Sadhra is a general practitioner with an interest in type 2 diabetes. His practice, Manor Park Medical Centre in Slough, has a 90% South Asian patient population. Dr Sadhra analysed the diets of his diabetic patients and came to the logical conclusion that carbohydrates were the main offender. Since then, Dr Sadhra has been implementing low carbohydrate diets for diabetes control with great success over the past ten years. This talk was given at the Public Health Collaboration conference 2017 in Manchester.

Dr Sadhra works towards four main goals with his low-carbohydrate interventions: lowering HbA1c readings, lowering weight, improving lipid profiles and reducing medication costs. These all fall under his overarching aim of putting type 2 diabetes in remission. One of Dr Sadhra’s patients lowered her HbA1c by 116 mmol/mol, the third largest drop in HbA1c for a type 2 diabetic in the world, in four months. Besides this single success story, Manor Park Medical Centre is one of the overall top performers in diabetes control, whilst simultaneously being the lowest spender on diabetes medication.

Dr Sadhra notes a number of difficulties in introducing a low-carbohydrate lifestyle to his patients. Firstly, his advice often conflicts with what patients have been told by dieticians, the Diabetes Centre and national guidelines, leaving them feeling confused. To work around this, Dr Sadhra recommends offering a trial period for the interventio, demonstrating the benefits of the intervention visually and offering personal help and support in order to build trust. Follow-up appointments should be tailored to the individual in order to maintain motivation and compliance.

Patients may also oppose the intervention because they do not like change; elderly people especially tend to be set in their ways. In this case, Dr Sadhra suggests that improving the scientific literacy of the patients will help them to understand why these lifestyle changes would benefit them, and so, will make them more responsive. To this end, he uses visual educational tools, both in individual and community settings, to teach people how their bodies respond to different foods. Working in a South Asian community, Dr Sadhra also stresses the importance of taking culture into account when recommending dietary interventions.

Theoretically, it is all well and good to tell a diabetic to give up carbohydrates in order to improve their blood sugar control. In reality, many people simply cannot bring themselves to give up the foods they are so used to eating. In many cases, low-carb alternatives to popular foods can help soften the blow. For example, cauliflower rice is a favourable substitute for white or brown rice. Bread and chapattis can be made using flour with a lower glycaemic index, such as Fiberflour, and whilst these still cause in increase in blood sugar, it is modest compared to normal white and brown breads.

Dr Sadhra summarised all what he has learned from analysing all of his patient data into some key findings. Firstly and most importantly, restricting dietary carbohydrate whilst ensuring the presence of protein, fibre and healthy fats in each meal greatly improves blood sugar control. Secondly, carbohydrates in evening meals were found to sustain high blood sugar levels for longer than at breakfast, and so, less starchy evening meals were advised. Thirdly, light exercise, such as walking, after a meal reduced the length of the blood sugar spike, bringing it back down more quickly.

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