The DCUK view: Doctor in the House, week one

By Kurt Wood
25th November 2015
In Depth
 
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On November 19, the BBC broadcast Doctor in the House, in which Dr. Rangan Chatterjee goes to stay with a family for a few months. The families all have a range of health problems, and while there, Dr. Chatterjee rebuilds their lifestyle. The first episode featured a man with type 2 diabetes.

The program’s reception was mixed. Many praised Dr. Chatterjee’s dietary advice for the man with type 2 diabetes – cutting out refined carbohydrates, in particular – but other commentators were less positive. The Association of UK Dietitians (BDA) criticised Dr. Chatterjee’s changes, labelling them “potentially dangerous.”

At Diabetes.co.uk, we support the low-carbohydrate diet. It won’t work for everyone, but we believe – and research shows – that lowering carbohydrate intake aids weight loss and reduces blood glucose levels, blood pressure and cholesterol. (A list of references is provided at the end of the article.) However, much of the advice given by Dr. Chatterjee is, if not incorrect, at least unhelpfully vague.

Like most television programs that focus on improving a family’s diet, Doctor in the House contained a scene in which of all of the bad foods eaten by the family are collected into a large pile in the centre of a room, and the enormity of that pile shocks us all into understanding. By the time Dr. Chatterjee has finished telling the family what not to eat, viewers might be left wondering what they can eat.

Dr. Chatterjee advises the family to lower their intake of refined carbohydrates, and we wholeheartedly support that – it’s great to see a doctor encouraging people to make those changes. He also recommends that the family completely removes fizzy drinks from their diets – including “no added sugar” versions – which we also agree with.

Then, Dr. Chatterjee advises the family not to eat dairy, and this is where the advice becomes vague. It isn’t specified whether this refers to “low-fat” versions of dairy, which we would recommend cutting out of one’s diet altogether. Low-fat dairy is often stuffed with sugar to compensate for the lack of fat. But presumably – seeing as it isn’t specified – Dr. Chatterjee’s advice to cut out dairy applies to full-fat, unprocessed versions too. Without carbs or healthy fats, where is the family supposed to get their calories from?

Critics of the low-carb diet have cited a lack of evidence for its benefits, but they are incorrect. Hundreds of studies have found the low-carb diet to offer a wide range of benefits to people with diabetes, particularly type 2 diabetes. The time-restricted fasting recommended by Dr. Chatterjee, however, has been less well-researched, and this too has irked critics of the show.

True, there have been several studies that have shown that time-restricted feeding – restricted to a 10 or 12 hour window – prevents metabolic disease, but these studies have been conducted primarily on mice. The advice to restrict feeding to a specific window of time should be offered tentatively.

Therein lies the problem with the Doctor in the House: it is never explained to the viewer exactly what the family’s new diet consists of, or the context of Dr. Chatterjee’s recommendations. Anyone watching the program for dietary advice, and taking Dr. Chatterjee’s recommendations at face value, could be putting themselves in an unsafe position. The BDA, which described itself as “alarmed by some of the advice provided by the doctor,” explained why Dr. Chatterjee’s advice is poorly presented. According to Dr. Duane Mellor, PhD, and registered dietitian:

“This advice is potentially dangerous with possible adverse side effects. Not only is there limited evidence around carbohydrate elimination and time-restricted eating for those with diabetes, but cutting out food groups and fasting could lead to nutrition problems including nutrient deficiencies and adversely affect their blood sugar control, particularly in individuals taking certain medications or insulin.

“Whilst reducing refined carbohydrates and sugar intake is definitely a positive, many of the other recommendations lack evidence from scientific research base. People living with diabetes watching the programme are advised to stick with their current treatment and discuss any changes with their diabetes team, which can include a consultant or GP, dietitian and Diabetes Nurse.”

Note that Dr. Mellor does not disagree with the recommendation of a low-carb diet.

The problems with Doctor in the House are as much problems with editing and the need to provide a narrative as they are flawed science. None of the advice offered by Dr. Chatterjee is inherently wrong – although avoiding dairy on a low-carb diet is difficult to understand – but put together, and without sufficient explanation that following such a drastic diet is potentially unsuitable without professional supervision, Doctor in the House provides a distorted view of type 2 diabetes management. Clearly, it works for the family – the man with type 2 diabetes lowers his HbA1c levels by two per cent, from nine per cent (74.9mmol/mol) to 7 per cent (53mmol/mol) – but it isn’t made clear that this is a drastic regimen.

Despite the program’s many flaws, we fully support its recommendation of a low-carb diet, and we commend Dr. Chatterjee for being one of the few doctors brave enough to stand by it.

On World Diabetes Day (November 14), Diabetes.co.uk launched the Low-Carb Program, a structured educational tool that offers a step-by-step guide to following a low-carb diet. The program’s structure was designed with the support of several leading experts. Learn more at diabetes.co.uk/lowcarb.

Image source: BBC.

What do you think?

References