I am new to diabetes and trying to absorb so much information. I had been told a long time ago I was borderline diabetic however, symptoms before Christmas made me feel that it was now getting serious. Long story short--- a blood test showed my readings were off the scale.
I am trying to bring the levels down through diet but at the moment it is all guesswork. Should I be doing low carb or counting calories? Or do I need high protein and low fat?
I also know I need to include fiber.
Due to other health issues the medication I am on causes weight gain and it affects mobility. This means I am unable to walk very far.
Thanks for taking the time to read this. Have a lovely Sunday
If anyone has any suggestions that would be useful to me I would be so grateful
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NitasNan
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Dr Michael Mosely has some good information on this, and I believe the NHS are taking some inspiration from him, by providing a calorie restricted diet to help reverse diabetes (T2). The diet works by getting patients to restrict caloric intake to 800 calories a day for a period of 6-8 weeks.
If the diet doesn't sound right for you, we can still learn from it. If you can only eat 800 calories a day, you tend to up the veg intake because veg are very low calorie for their size. They also provide lots of fibre.
The diet also restricts quick carbs, so you should try to limit them as well - cut back on rice, pasta, bread, sugar, and if you have to eat them, replace them with brown rice and brown pasta. This should help limit the impact of insulin spikes in your body, and bring the diabetes under control.
Many thanks for your reply. I have gone back to the wholemeal bread, brown rice etc. However, I`m not sure I could cope with just 800 calories per day.
When I see my GP in a couple of weeks time I also need to know what my blood readings are and how I can check them. At the moment he just says they are "off the scale" and I am a walking time bomb !!!
I couldn't manage on 800 cals per day either as that would affect another health condition I have (though it seems to have had some positive effects for those who can tolerate it) I have found this website very informative and supportive since I found I was prediabetic.
To see what your eating is high, mid or low GI just browse these - as you will see they vary but if there is a common factor to your diet it will stand out.
I would note on what you have said - what you have gone back to eating is high carb.
Wholemeal bread is med. / brown rice is the same or higher than white long grain.
Some carbs. are good to keep the gut healthy but limit the amount.
I have never worried about calories , a good low carb. diet will keep that in check anyway providing your metabolism can still create energy and you burn it but dont store it as fat.
Can you get a blood glucose meter ?
Just beware that until you have 90 days of diet change the blood tests will be different to your readings - but still a lowering amount even if its wrong is still an indication that your doing something right.
I have an underactive thyroid that does not help with weight loss. As for a blood glucose meter, I was going to check with my GP about getting one.
As my symptoms started before Christmas and it took until January to get an appointment and have a blood test done I am pleased to say I have shifted a little weight. Maybe it`s due to the Metformin.
My next blood test is on Tuesday and then I have to wait and wait for an appointment with the GP.
In the meantime, it`s good to know there is somewhere to go for help and support
There is no need to torture yourself with 800 calories/day diet. That requires medical supervision. There is better option as detailed below.
Do you mean you do not know your blood sugar level? That is surprising! Why did your practice not give you the blood test results? You should phone them and ask. Anyway, regarding the diet, you should follow LCHF/KETO diet -
NO GPS please. G: grains; P: Potatoes; S: Sugar. That means no bread( white or wholemeal), pasta etc.
Vegetables: Both cooked and salad. Choose vegetables with low carb contents. Most of the vegetables that grow above ground are suitable as they have low carb.
SNACKS/SIDE DISH: Full fat cheese, Greek yoghurt, Full fat sour cream/fresh cream, Nuts e.g. Walnuts, Pecan, Almond.
Eat till you are full. Do not follow traditional three meal a day plan. Eat only when you are hungry. Normally people following this diet plan cannot eat more than two meals a day.
EXPECTED RESULTS: From the first meal itself your post-meal blood sugar level will drop. Within three months your HbA1c will show significant improvement. In your case it should come down to non-diabetic range.
Post your blood sugar numbers here when you get them. Wish you all the best.
Many thanks for your reply. I don`t know why I was not given blood results. I do have another blood test being done tomorrow and when the results are back I have to see my GP. As he has prescribed Metformin for me he wants me to have been taking it for a couple of months to see if this is helping. I have lost some weight by looking at labels for nutrition values and using diabetic recipes I have found online.
Once I have the new results I will get back to you.
The short answer here is that diabetes is a disorder of carbohydrate metabolism: you have essentially lost your ability to extract energy from carbohydrates, so it is pointless eating them (to the extent that they can be avoided - all foods contain some carbs).
Your backup energy pathway is fat. Under normal circumstances both the carbohydrate and fat pathways operate together (although typically with one dominating at any given moment), but in your case you're going to be dependent on fat until you recover some carbohydrate-processing ability.
Don't worry too much: diabetes T2 is at least partially reversible, in most cases, and eating a fat-based diet doesn't involve weird or unpleasant meals. In fact most of what you'll put on your plate will be good, natural, wholesome food that we've been told for decades is bad for us (hence, unfortunately, a tsunami of new diabetes cases).
You might want to join the LCHF group, where you'll find a lot of discussion about food rather than macronutrients. For example, have a look at this:
Do you think that's the sort of meal you'd be happy eating? If so, you're on the road to recovery. It's a pity most doctors still refuse to acknowledge how simple this is to treat; even in those few cases where a low-carb, fat-based diet doesn't put diabetes into remission, it does at least prevent the damaging swings in blood sugar which ultimately end in neuropathy, blindness, amputations, and other fun stuff.
I intended to ask myGP about local support. However, due to not knowing when I shall get an appointment your advice means that hopefully I can get started soon.
Hi not to long ago I was diagnosed with diabetes also. My numbers where off the charts too. I feel overwhelmed by this. SOOO much information to absorb, bad doctors who don't care. I've gotten my numbers down without anyone's help. I go every 3 months for blood test, so far so good. I have found it's a combination of different things, mostly it's the Carbs, complex carbs are best. Google diabetic diet's, that's been a big help. Have you seen a Endocrinologist? (Diabetic Specialist). I'm considered obese, losing weight is difficult because I'm also 64, that works against me too.
Thanks for your reply. It is good to know that there are other people who seem confused by all the information needed to get diabetes under control. I am 71 and have struggled with my weight all my life. An underactive thyroid does not help. Plus, medication for another problem causes weight gain.
People have been kind enough to respond and I am sifting through their advice. It would appear that diet advice differs quite a lot. Therefore, I shall have to see what suits me and hopefully works.
My daughter has seen an Endocrinologist although she is not diabetic. When I see my GP next I shall mention it to him.
Why would your daughter see that kind of doctor if she doesn't have diabetes? May I ask if you're female? The reason I'm asking is because I found a diabetes support site called diabetes sisters. Check it out,
Your welcome, I thought that kind of doctor was Only for diabetes? I have a brother who has diabetes, he's difficult to speak to from past history with him. I want to speak to someone who's had it for several years.
Your endocrine system comprises the main glands which secrete hormones, the pancreas is only one of these glands, therefore an Endocrinologist can specialise in more than diabetes, hope this helps 😀
I am sifting through several diabetic recipes and trying to find low carb ones that I know I will eat. I really don`t think I can cope with the 800 cal diet and I`m not sure about cutting out carbs completely. If I attempt these I think I shall be setting myself up for failure.
It's actually impossible to "cut out carbs". Most foods have some carbs in them. However, long before doctors has access to all the powerful drugs they currently abuse - at the expense of their patients - diabetes was successfully treated with a low-carb high-fat diets.
As someone mentioned above, you don't need to do the 800kCal/day thing. It works for the same reason a standard eat-to-satiety low-carb protocol works: it reduces carbs to a level that allows your pancreas to adapt away from its current malfunctioning position.
The US-based "Virta" program charges a lot of money for walking you through something you can easily do yourself. However, the interesting thing about them is that they publish their results: 60% complete remission, and 94% of patents who either reduce or eliminate their medications.
Please give LCHF a try before you decide it won't work. The fear of giving up carbs is far worse than the reality. "I can't possibly give up carbs" is a common refrain, but it's not difficult at all. Where most people go wrong is failing to replace those carbs with fat. If you cut out carbs and replace them with nothing at all (or, just as bad, replace them with protein) you're basically running on fumes: you will feel terrible and give up (as you should, because if you kept on like that you'd die). Bacon is not off the menu: the idea that saturated fat is bad for you has been disproven again and again over the past 15 years or so, but doctors are still so fixated upon it that they're denying diabetics lifesaving treatment.
Your misgivings are understandable in the face of mainstream advice, but here's the decision you face:
1) Allow your diabetes to progress to its inevitable conclusion, which is very ugly indeed.
2) Try dropping the carbs and embracing fat for a few weeks and see how you get on. I've been doing this for 15 years and my heart hasn't imploded yet. In fact I'm fitter and leaner than about 95% of men in my age group.
If you want join the community go to "my Hub" at the top of this page, click on that, then the drop down menu will say "browse communities "
With a blue + sign, click on this, type "LCHF" in the search box which comes up, the LCHF forum will then appear and you click on "follow", you have then joined and will be able to see all the posts and reply or ask questions. ( these are instructions which work for my iPad it may look different on a computer or phone)
It is good that you are eating whole foods. The more you do that the more your diabetes risk will reduce. There are people who have responded that blame the carbs. That is poor advice in my opinion. There are very many people removing diabetes from their lives forever by following a whole food plant based diet, naturally rich in carbs. These kind of diets mean you do not need to count calories.
The UK's diabetes society has a page on veganism and diabetes diabetes.org.uk/guide-to-di... with some useful recipes. However veganism is primarily about abstaining from animal products for ethical reasons. A whole food plant based diet is a kind of vegan lifestyle that is about maximising health outcomes over the long term. It is about steady weight loss with no-downsides.
Here is another article by the Physicians Committee for Responsible Medicine about reversing diabetes pcrm.org/health-topics/diab... with lots of helpful resources to proven methods.
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If I can just finish off with a comment to clear up the discrepancy between HCLF vs HFLC. There is a question mark around high-fat diets that, whilst (especially Keto) they can lead to rapid weight loss in the short term with associated benefits including diabetic, but they also have potential downsides in the long term. In fact finding good long term studies supporting high-fat is a real challenge.
I have swapped from white bread, rice etc to wholemeal. Plus, I am making notes of sugar content in foods. I used to have sweeteners in coffee but have cut these out as I have read they are not good for you.
Thanks, but so confused about diabetes the article link you sent me, there is information out there that will contradict that one? I have found that there is No consistent information out there? Even those saying that diabetes is reversible? My daughter works in a hospital with doctors and they say it's Not? I feel like giving Up? I keep trying different things turns out that's Not Right? Who do you believe?
I know your question was to Concerned, hope you don't mind me answering. There is a lot of conflicting information, try not to panic. Many people with prediabetes and some with type 2 diabetes can "reverse" this with lifestyle change. This means they can get their blood sugars back in the normal range by one or a combination of losing weight, eating foods which don't spike your blood sugar, and excercise. This doesn't mean they are " cured" which is why some doctors say it can't be reversed, it means they are able to keep their blood sugars in the normal range if they continue with what they are doing but if they go back to being obese, sedentary and eating junk food the diabetes will come right back, so they are "managing" their condition rather than curing it. For a few people it appears to be genetic and they can do all the right things and still become diabetic.
The standard advice from the NHS still advocates a fairly high carb diet though they advise the less processed carbs. Not all doctors agree though and some would advise low carb or at least lower than the governments "eatwell plate" . This is where the NHS diabetes prevention programme is coming from, tagging Hidden as he can tell you more about it ( I think he might work for them? Sorry if I've got that wrong!) unfortunately it's not available in my area though it is in the neighbouring county!
The doctors who give the mainstream advice aren't trying to confuse you, they are giving you what they believe to be good advice. But bear in mind new scientific knowledge takes a long time to become mainstream advice, ( scientists knew smoking caused lung cancer for many many years before this became mainstream knowledge amongst the medical community)
I was diagnosed pre-diabetic about 6 weeks ago. I was advised to avoid sugar and "white" carbs, lose some weight and get re-tested in six months to see if I can bring my fasting blood sugars down to normal levels. I'm doing that but I've taken it a step further and reduced all starchy carbs, probably not as low as some people would but a lot lower than previously. I'm also looking at buying a glucose meter so I can test my blood to see if any of the foods I eat regularly spike my blood sugar. If when I have my re-test things are no better or worse I'll know it wasn't just lifestyle related then I can adjust what I'm doing (probably go very low carb) . If my results are positive I'll know to keep on doing what I'm doing now. I'm a pragmatic person and this is a plan which makes sense to me.
Let us know how you get on with your experiment, Fran! The blood glucose meter is a good plan because the results of what you're doing won't show up on your HbA1c test for several months. However, unless you're very unlucky, you should see a marked improvement in your glucose response, bodyweight, and general well-being. Since you're referencing the diabetes.co.uk site, you've probably heard of Dr David Unwin: he's reliably getting about 50% remission with his diabetic patients simply by giving them some dietary advice. Bearing in mind the limited time GPs get to spend with patients, that's pretty impressive.
Don't forget: plenty of fat to replace those carbs
There are low fat cohorts like in Linda Loma that have been followed for many years, not to mention the blue zones. Whereas the high far consuming Inuit have a very low life expectancy.
You seem rather confused about the causes of type 2 diabetes and the role of glucose. T2 diabetes is caused by insulin resistance, and the high blood sugar levels measured is a symptom rather than a cause. Thats why low fat diets work, by reducing the fat, insulin resistance improves and the blood sugar drops as its naturally metabolised.
And why do you suppose insulin resistance develops in the first place?
Insulin resistance is not a malfunction. It's the means by which your body's organs signal back to the pancreas, and to each other, that the glucose-control loop parameters need adjustment. It has absolutely nothing to do with fat. If your body's organs didn't have a mechanism to reject glucose, nothing would work properly. Diabetes is not merely extreme insulin resistance: it's a condition where no adaptation is even theoretically possible given the rate at which dietary glucose is entering the bloodstream. Your body is being asked to solve a set of equations that have no solution.
Low fat diets do not work. For anything. There is not one single documented instance of diabetes being corrected by removing only dietary fat; in fact diabetes T2 often comes as a complete surprise because people think they're already "doing everything right" with their low-fat, carb-based diets.
>>> There is not one single documented instance of diabetes being corrected by removing only dietary fat
This feels like a strawperson argument. I'm not sure anyone has ever suggested a diet that is *exactly* the same as someones previous diet but without the fat.
And yet as far back as 1976 (and probably earlier) studies were demonstrating that a high carb diet could treat T2 diabetes
As for your statement that fat has nothing to do with it, there are studies such as this one suggesting that saturated fact specifically has an effect on insulin resistance ncbi.nlm.nih.gov/pubmed/126...
>> I'm not sure anyone has ever suggested a diet that is *exactly* the same as someones previous diet but without the fat.
Yes, I know. Clearly, then, diabetes has nothing to do with fat per se, does it?
I realise there are multifactorial interventions for diabetes which reduce both carbs and fat (and protein, in the case of ultra-low-calorie treatments). In my view these are all completely pointless, since they deliver results in the same ballpark (50-60% complete remission) as eat-to-satiety low-carb high-fat. In other words, they reduce fat and/or protein without any sensible theoretical basis.
>> a high carb diet could treat T2 diabetes
So what's the intervention? The modern American diet already is 75% carbs and 20-odd grams of fiber.
If I were to present a diabetic Filipino (Filipinos eat mostly rice, rice and more rice) to those researchers, what would they tell him? Carry on eating exactly what you're eating and your diabetes will be cured? At best, these guys seem to be not entirely clear why their diet works (assuming they're telling the truth - their results appear to have never been replicated).
>> there are studies such as this one suggesting that saturated fact specifically has an effect on insulin resistance
I'm aware of these studies that show a transient increase in liver insulin resistance in response to fat. I can't figure out what they're intending to measure in that particular experiment, or why, but there are better some ones, so the effect does seem to be real.
The thing is, this result is meaningless outside of the context of the body's response in other respects. People eating low-carb high-fat diets show incredibly stable blood sugar regulation: therefore, whatever is going on here must be an appropriate adaptation. Insulin resistance is not in itself a pathological state: it only becomes so when the pancreas responds to generalised insulin resistance by upregulating insulin secretion, organs become more insulin resistant, pancreas makes more insulin .. etc. And that only happens when the rate of glucose infusion persistently exceeds the aggregate capacity of your body's organs to deal with it.
Just to be clear here: I'm not saying "all carbs are bad". Obviously, people with normal metabolic function can use carbs for energy, up to a point. I'm saying they're bad for diabetics. I genuinely don't understand why people think this is contentious. Telling diabetics to eat lots of carbs is a bit like putting gasoline in a diesel engine and expecting it to work properly.
"...were fed weight maintaining American Diabetic Association diets contining 43% of calories as carbohydrate for 1 week and then were fed 75% carbohydrate diets with 15 g of crude dietary fiber for approximately 2 weeks."
> The modern American diet already is 75% carbs and 20-odd grams of fiber.
Seriously? Do you have studies to support that? I'd also be interested to see total calories.
> (assuming they're telling the truth - their results appear to have never been replicated).
So now you are suggesting that the researchers are not telling the truth. That's a nice way of being able to ignore any evidence that contradicts your pet theory.
First you claim there is no evidence, now when evidence emerges you say it might not be true.
> I'm saying they're bad for diabetics. I genuinely don't understand why people think this is contentious.
Because its not supported by the evidence. If carbs were inherently bad for diabetics there would not be studies demonstrating reversal with a high carb diet.
>> To save you the trouble of reading the article.
I read the article. My point was that they're prescribing exactly what the average American is eating today (at least, if you assume that the nutritionist's habit of boiling everything down to carbs/fats/proteins has any validity).
>> Do you have studies to support that?
Why do you keep asking for "studies"? Calculate it out yourself from the USDA guidelines, or Google it. It's been done any number of times. Zoe Harcombe did the calculation for the UK guidelines and found it's somewhere between 70 and 80% carbs.
>> I'd also be interested to see total calories.
Are you implying that the cause revolves around calories? I won't disagree, but I will say it's not quite that simple.
>> So now you are suggesting that the researchers are not telling the truth. That's a nice way of being able to ignore any evidence that contradicts your pet theory.
No, I was giving them the benefit of the doubt. However, the fact that nobody seems to have replicated their result since 1976 suggests we should treat that paper with a healthy dose of suspicion.
Apart from anything else, you haven't answered my question: what is the intervention, exactly, if the patient presents with an existing diet of 75% carbs?
>> Because its not supported by the evidence.
What "evidence" do you want here? A diabetic cannot derive energy from carbohydrates, or at best can do so only with serious risks to his health. It's what diabetes means.
>> If carbs were inherently bad for diabetics there would not be studies demonstrating reversal with a high carb diet.
Your link doesn't demonstrate any such thing. It suggests merely that the official advice for diabetics is disastrous and that pretty much anything else is an improvement (which I'd agree with). My main problem with that abstract is that "vegetarian and vegan diets" is a phrase that covers a vast range of possible eating habits; to assert that they're all equally healthy is daft.
> Why do you keep asking for "studies"? Calculate it out yourself from the USDA guidelines, or Google it. It's been done any number of times. Zoe Harcombe did the calculation for the UK guidelines and found it's somewhere between 70 and 80% carbs.
So you are conflating 'guidelines' with reality. Just because the guidelines are for 70/80% carbs and 20% fibre doesn't mean the population is actually following them. And I suspect given the scale of obesity they are not. That's why I was asking for studies of what they actually ate.
> Are you implying that the cause revolves around calories? I won't disagree, but I will say it's not quite that simple.
I would agree with your agreement. Its not quite that simple true, but obesity is strongly associated with T2 diabetes, and total calories strongly associated with obesity.
> Apart from anything else, you haven't answered my question: what is the intervention, exactly, if the patient presents with an existing diet of 75% carbs?
Are you talking about in the study I referenced? That was a controlled study with the conditions being a) "43% of calories as carbohydrate for 1 week" and b) "75% carbohydrate diets with 15 g of crude dietary fiber". So why are you asking about the intervention?
> My main problem with that abstract is that "vegetarian and vegan diets" is a phrase that covers a vast range of possible eating habits; to assert that they're all equally healthy is daft.
I am not asserting that they are all equally healthy, and I don't believe the study is doing that either. These studies use specific diets, and would guess that for convenience in the title they are choosing to refer to them as vegan and vegetarian.
The context here is your original claim that "There is not one single documented instance of diabetes being corrected by removing only dietary fat". Now I agree that the way you have phrased it and your use of the word "only" offers a degree of wiggle room, but I believe the Barnard study demonstrates such correction using a low fat high carb diet.
> A diabetic cannot derive energy from carbohydrates, or at best can do so only with serious risks to his health. It's what diabetes means.
So how do you explain the studies that show diabetes reversal with a high carb diet? At the very least that suggests your definition of diabetes is over-simplistic.
>> Just because the guidelines are for 70/80% carbs and 20% fibre doesn't mean the population is actually following them.
Then the question arises: why do the authorities even bother issuing these guidelines if they know nobody follows them?
Let us assume that some people follow the guidelines. I would wager that many on the NHS Weight Loss forum do; their daily meals fit closely with the guidelines. Yet they are overweight, they cannot lose weight (even though they follow the recommendations to the letter), and some of them are diabetic or prediabetic. They can't all be just unlucky.
>> So why are you asking about the intervention?
You appeared to be suggesting that a diet of the type described in that study could cure diabetes. If that study doesn't illustrate your point, do you have one that does (preferably from the modern era)?
>> I believe the Barnard study demonstrates such correction using a low fat high carb diet.
Is there some hard data on this? What's his remission and/or failure rate? What is his diet, exactly? I have attempted to find something on Google, but unlike (say) David Unwin, who publishes his results in detail, Barnard seems to be a bit coy about the numbers. All I can find is this presentation:
Which on slide 44 shows only a trivial difference as against the ADA diet. This is (apparently) only just statistically-significant, at P=0.03. Everyone is still definitively diabetic (HbA1c>6.5%). So I'm not sure how that represents a triumph for veganism.
Incidentally, I've watched Barnard's videos and he makes the most outrageously silly claims (such as that 'fat clogs up your cells') which have no basis in known biochemistry. Frankly, this is crystal-healing and colon-cleansing territory. If he's prepared to go on video spouting that sort of nonsense, it does tend to make me doubt the veracity of anything else he says.
>> So how do you explain the studies that show diabetes reversal with a high carb diet?
Well, so far you haven't shown me such a study, but I'd be prepared to consider the possibility.
Still, if I take your claim at face value, the most likely explanation would be low GI - that is, glucose is presented to the system at a low power rate. Any diet that allows your endocrine system to find a mathematical solution to the problem being presented to it should, in theory, result in reversal. Eventually. However, given the nature of diabetes, this doesn't strike me as an efficient approach, and the only reason for choosing it over better methods would be pure ideology.
> Then the question arises: why do the authorities even bother issuing these guidelines if they know nobody follows them?
I can't answer for the authorities. But i would note that a lot of people still smoke despite the advice not to (and I don't think anyone would suggest that they stop issuing that advice because of this). More seriously, this does raise a valid point as to the extent of whether concerns about adherence affect (and should affect dietary advice) but that's a whole other topic.
The NHS dietary advice is slightly different between the weight loss and general cases. The weight loss forum by definition is going to contain people who have struggled with weight and food for one reason or another, but i doubt that many of these people having been following the NHS advice "to the letter".
>> So why are you asking about the intervention?
The study from 1976 I quoted showed that increasing carbs in the diet could improve insulin sensitivity to the extent that insulin meds could be discontinued. I'm not sure what happened to the participants after the study which was admittedly of short duration, so we probably should hesitate to say they were cured. But that demonstration alone casts doubt on your claim that people with T2 diabetes should necessarily reduce carbs.
I intentionally quoted an old study to make the point that this finding isn't new.
Unwin seems to use a Ketogenic diet and its not clear how long he expects his subjects to stay on that, or what the longer term effects will be.
> Any diet that allows your endocrine system to find a mathematical solution to the problem being presented to it should, in theory, result in reversal. Eventually. However, given the nature of diabetes, this doesn't strike me as an efficient approach, and the only reason for choosing it over better methods would be pure ideology.
The 1976 study I quote showed an improvement to insulin sensitivity within a few weeks, which is a lot less than "eventually". So far, i've not seen any studies that compare a ketogenic diet (which i assume is the one you are advocating but apologies if i am mistaken) directly against a plant based one. But if they both work, it may come down to personal preference.
>> But i would note that a lot of people still smoke despite the advice not to
And a lot of people don't. Smoking rates have dropped precipitously since the government began a concerted assault upon it.
>> i doubt that many of these people having been following the NHS advice "to the letter".
They try to. But they can't, because it's nutritionally-deficient. They get into terrible trouble and then blame themselves. As you said, though .. different conversation.
>> Barnard does here
Those are the same figures I referred to earlier. That paper does not demonstrate reversal of diabetes with a vegan diet. Every single one of the subjects is still as diabetic as they were when they started. In the slide I mentioned, Barnard uses the old trick of shifting the X-axis upwards so that the change looks bigger than it is. In fact HbA1c changes by a trivial amount at 74 days, in both the control and vegan diet.
>> Unwin seems to use a Ketogenic diet and its not clear how long he expects his subjects to stay on that, or what the longer term effects will be.
Note the size of the effect, and the p-values, compared to Barnard's paper.
In fact Unwin is very much sitting on the fence - he doesn't go full-blown keto or LCHF. That's why I'm quoting him. Remember he's an NHS employee and he can't flat-out say that NICE guidelines are wrong. The paper describes his diet, and like many in his position, he places more emphasis (in print at least) on protein rather than fat, because to contradict NHS orthodoxy on fat means losing your job.
He expects them to stay on this forever. The long-term effect is that they will no longer be diabetic (for all practical purposes at least).
Various organisations which use proper LCHF for diabetes treatment achieve complete remission rates (HbA1c normal with no drugs) of 60%+, and drastic improvement (some low-dose drug support) in 90%+ of cases.
The acronym NICE, incidentally, always makes me laugh. C.S.Lewis used that name in his Cosmic Trilogy for a shadowy, quasi-governmental secret society whose aim was the subjugation of the entire natural world under the banner of "science". Considering how many members of the UK government are drawn from Oxbridge, you'd think somebody would have spotted that. Perhaps they did, but nobody has any sense of irony.
I understood insulin resistance was improved by reducing excess body fat rather than reducing dietary fat? Still trying to sort through the fine detail 😀
Yes, it seems the best thing for an overweight T2 diabetic to do is to lose the excess weight - and it probably doesn't matter much how.
There's a good article here on how patients who achieved weight loss either through surgery or a low calories (800 per day) also reversed their T2 diabetes
diabetes.org.uk/guide-to-di... says avoid refined foods, avoid red and processed meat, eat fruit and veg, beans are a great substitute for meat generally.
Got a bit sidetracked on Dr. Aseem Malhotra’s presentation. Some absolutely fearsome stats in that one - tens of billions of pounds being wasted on diabetes management, 50% of NHS staff overweight or obese. I'm just really pleased that these people are finally being given a platform to speak from instead of being sidelined and vilified. Maybe something will finally change.
This is how I feel, that one size does not fit all. I am really grateful to all the people who have responded to my post. It has given me a lot to think about, also links to helpful sites for information.
I shall work my way through the information and then hopefully have a better idea of the way forward for me.
Im reading Reversing Diabetes by Dr Neal Barnard. He is an MD and a Phychiatrist and has written many other books and numerous Scientific Reports. He has a website called Physician Committee for Responsible Medicine. pcrm.org/about-us/staff/nea...
When a theory conflicts with reality there are a couple of options. One is to modify the theory, another is to deny reality. There are studies that show diabetes reversal with high carb diet. Maybe there were some mysterious stakeholders that faked those studies. But a better approach is a more sophisticated understanding of diabetes than concentrating solely on the carbohydrate in the food.
The positioning statement on low-carb link that you provided incudes the statement, verbatim, "However, this call for low-carb diets as a default for people with diabetes is based on opinions rather than robust science."
Personally I would want to support my dietary choices with more than just "opinions" when science is available.
Don't get me wrong, people many who have followed low-carb have had success with diabetes. Similarly many people who have followed high-carb have had success with diabetes. So wherein lies the difference, that is the question.
Is it rates of success? Is it easy of maintenance? Is it cost? Is it long term health outcomes? Is it side-effects? Is it ease of adoption?
>> Is it rates of success? Is it easy of maintenance? Is it cost? Is it long term health outcomes? Is it side-effects? Is it ease of adoption?'
It's all of those.
As for your quote, the people at diabetes.org.uk are weasels. They're more concerned with keeping their cushy jobs than helping diabetic people, which is ... monstrous. I don't have any kind words for people who would abuse their position of authority to cause diabetics harm and distress.
>> Similarly many people who have followed high-carb have had success with diabetes.
So where are they? Show us some evidence that a high-carb vegan diet delivers a better result than the best-available option (ie., is LCHF).
I already pointed out (above) that Barnard's paper shows NO cure for diabetes with his high-carb vegan protocol. ALL his patients were still diabetic on day 74, with only a ~5% drop in HbA1c. His diet was slightly better than the official advice, which makes virtually no difference ... but that's hardly surprising since the official advice is "eat what everybody else eats".
Here is a further summary by Kaiser Permanante on the health benefits of a whole food plant based lifestyle thepermanentejournal.org/is.... In its conclusion it states, "A plant-based diet is not an all-or-nothing program, but a way of life that is tailored to each individual. It may be especially beneficial for those with obesity, Type 2 diabetes, high blood pressure, lipid disorders, or cardiovascular disease."
TAD, if you don't think the UK diabetes society is up to much, then perhaps you want to also rubbish the American Diabetes Association who advocate, "Carbohydrate intake from whole grains, vegetables, fruits, legumes, and dairy products, with an emphasis on foods higher in fiber and lower in glycemic load, should be advised over other sources, especially those containing sugars."
This is part of their 2017 Standards of Medical Care in Diabetes, where the ADA maintains that a plant-based eating pattern is an effective option for type 2 diabetes management.
(Personally I don't agree with their recommendation for dairy, but hey-ho the rest sounds good to me.)
By coincidence, I was just reading an account of an American POW who was held at Clark, Philippines by the Japanese during WW2. They were given almost exclusively white rice, in portions which a dietician might today call "calorie controlled". It may well be the case that they were at minimal risk of diabetes and obesity. But they sure got beriberi.
Your second link quotes Barnard again, so let's be clear about this: Barnard did not cure diabetes with his diet. Not one patient.
The Anderson study is hard to comment on because insulin is contraindicated in Type 2 diabetes - I have no idea why doctors are keen to prescribe it because T2 does not involve a lack of insulin output; in fact insulin is invariably maxed out.
"A 2014 review and meta-analysis of controlled clinical trials of vegetarian diets in the treatment of type 2 diabetes found a significant reduction in hemoglobin A1c of −0.39 points compared to control diets" - this is completely consistent with Barnard's result, i.e., a miniscule effect with no practical value.
As for Kempner, he apparently achieved his result by psychologically and physically abusing his patients - who found his diet intolerable and eventually refused to eat (a phenomenon a psychologist would recognise as "learned helplessness"). Under those circumstances, it's not entirely surprising they lost weight.
Which brings us to the Newcastle Diet, which feeds diabetics a daily 800kCal shake full of carbs and chemicals (the precise formula is a commercial secret, but a few details have been leaked). It has a success rate of about 40% (ie., lower than the worst-case rate achieved by David Unwin with nothing more than a once-a-month counselling session). The reason it's (somewhat) successful is pretty simple: it's low-carb, albeit low-everything-else into the bargain.
It seems to me that medicine isn't medicine unless it involves draconian punishment. 'Twas ever thus. The most popular witchdoctors in "less civilised" parts of the world are those who put on the best show. LCHF is massively unpopular among the medical profession, it seems to me, because it works without putting patients through purgatory. That annoys them no end.
I'm starting to think this thread should be locked... We've gone away from the original purpose, which is to help clear up NitasNan's confusion over what diet is best for diabetes - we're probably just causing more confusion by this point!
NitasNan, if it's something you can afford to do, I would recommend seeing a nutritionist to help work out what works best for you. You can use this tool to help find someone operating in your area: bant.org.uk/bant/jsp/practi...
I am starting to think I have caused World War 111
I am so grateful that people want to help but, I am getting more and more confused with all the conflicting advice.
Today I have had my second blood test and I now have to arrange for a GP appointment to discuss the results. I hope to get an appointment for sometime next week ( it`s a slow process at my surgery)
Once I know where I am on my journey I shall get back and update everyone.
In the meantime, thank you all again. I am now going to relax and enjoy this lovely sunny day.
oh, it's not a row (if you're referring to the conversation between me and benwl). It's more like that hair-splitting debate that happens down the pub a couple of hours before closing time. It's just a bit of a ritual here.
He's wrong, by the way. Just so we get that bit clear.
Debate is fine and healthy, I just worry it's a bit overwhelming for newcomers, who are starting out, and not used to the site! There's lots of great info here, so we do want people to come back
I have a feeling I shall go for low carb. I can`t cut them out totally. I just hope that my blood test today shows an improvement on my last one. Maybe then my GP won`t be telling me " It`s all in your mind " !!!
I should perhaps leave well alone, but I'll just add: don't decide what you can't do until you try it. You might surprise yourself.
And if you do go low-carb, it's absolutely crucial that you add fat. A low-carb low-fat diet is incredibly dangerous. In fact this is why there are so many popular pundits telling us all that we shouldn't do low-carb; according to the experts, fat is haram, so the only possible low-carb diet is a high-protein one. Which doesn't work.
It is an expert opinion. In the hierarchy of evidence based medicine experts come pretty well at the bottom of the table. Below experts are anecdotes for example. Peer reviewed research, meta-analyses etc are for more valuable.
no, andy, results are what's valuable. Especially if you were once diabetic and now you are not. We're talking about applied medicine here, real people in fear of their lives, not theoretical abstractions.
You do understand that the meta-analysis that you quoted shows that veganism does virtually nothing for diabetics? I realise you have powerful emotional reasons for believing that fat is bad for you, but are you seriously going to swear that black is white when the evidence is right there in front of you?
Making religious objections to things that cure people is unconscionable. That's why I called DiabetesUK "weasels". I can think of far more appropriate (but probably unprintable) words for people who are happy to see others die rather than admit they're wrong. They're just lucky they were born into such a forgiving (and superstitious) era. A few centuries ago they probably would have been thrown to the lions.
Even if "50% of my diabetic patients are getting better" is merely expert opinion, that's a definite step up from "none of my patients are getting better, but at least they're vegans".
I'll maybe post the results from Barnard's study as a separate post. You're entitled to eat in whatever way you choose, of course, but the official obsession with giving diabetics carbohydrates really freaks me out; it's homeopathy, woo-woo. We might as well be putting leeches on them and drilling holes in their skulls for all the good it does.
T2D is no longer some obscure condition that only happens to the idle rich. It's important that people understand the physiology so we can put a lid on this.
You make it sound as if no one has ever reversed t2d using a WFPB lifestyle whilst quite the opposite is true. I could paste case after case after...
I know you believe low carb is some kind of new kid on the block that deserves greater publicity, but whilst I agree it can deliver short term results these can be at the expense of other chronic health issues in the future.
>> You make it sound as if no one has ever reversed t2d using a WFPB lifestyle
Your own link demonstrates that this is so: nobody has ever reversed diabetes by this method. On the average, there is some very small effect. It absolutely isn't "reversal".
If you have something better, then let's see it. I'm quite prepared to believe that a tiny number of people have achieved the desired result by pure luck. However, as you may be aware, all medical studies compare a proposed treatment against the current best practice. LCHF consistently shows 50-60% remission (depending on exactly what you do, who you do it to, and how you determine "remission"). The "Newcastle Diet" achieves about 40%. I want to see a WFPB study that betters or equals that.
I "believe" that diabetics are diabetic. I'm genuinely baffled that you think this is heresy.
That's one anecdote, andy. I don't dismiss it as meaningless - I believe he's telling the truth - but where are all the other people who tried it and failed? Because Barnard's own numbers suggest there must be a lot of them.
Low carb is not a new kid on the block: carbohydrate restriction was the standard treatment for diabetes before the discovery of insulin.
To quote from the Open Access document:
“Currently in the literature there are four methods to place T2DM into remission: bariatric surgery [6], extended fasting [7], a very low-calorie diet using a mealreplacement formula [8], and low-carbohydrate diets [9,10]. Low-fat, plant-based protocols have been suggested as first line therapy for diabetes management, but the most intensive protocol failed to achieve remission of T2DM over 74 weeks, as hemoglobin A1c (HbA1c) reduction was 8.1 to 7.6 [11]. Low-carbohydrate diets are therapeutic interventions that clinicians can use to help patients discontinue medications for hyperglycemia and achieve remission of T2DM [9,10]. For patients, this approach may be less extreme, safer, and more acceptable than bariatric surgery, extended fasting, and a very low-calorie meal replacement.“
Whilst low carb was used to treat diabetes back as far as the late 1700s, the modern low carb is a twist on the Atkins diet which became mainstream from 1989. But let's take it back as far as 1967, when Irwin Stillman published The Doctor's Quick Weight Loss Diet. which was popular in the US.
The low carb diet can be traced back to 1863 and William Bant, giving rise to the term “Banting”. It seems to have provoked the same amount of disapproval then as it does now.
I think his name was actually Banting. As far as I can tell, people were somewhat less triggered by it in those days, simply because fat was an ordinary and accepted part of cooking, and sugar and sweets were known to make you fat. Remember, cooking oils literally didn't exist: lard and dripping were the only available options, unless you actually lived in the Mediterranean or Middle East.
By all accounts, the Banting diet was pretty popular and remained so for many years ... although I've no doubt some people just objected on general principle.
Apparently the medical profession objected to it, describing it as dangerous and spreading the rumour that he had died because of it, (whilst he was still alive). It’s the kind of diet that would have deprived them of lucrative income! Obesity was a real problem, although obviously only for the well off.
"Low carb" in reality means "high fat, high protien"
In those times you NEEDED fat because the average diet had so little. I remember growing up as a child and the meat was shared so that my Dad got the lions share. All the fat was saved, at every meal, without exception.
In my childhood we didn't have margarine, we hardly ever had butter. We saved all the dripping from the carcass and that was the fat we had on our bread. In my childhood we were lucky if we had a rabbit to eat, despite the plethora of bones.
This is not to paint a glossy coat on fat being brilliant. Today's society is very different. In today's society we are saturated with fat, fat, fat. Almost anywhere in the world you can go and buy enough meat to fill a freezer in one trip - and not worry about the financial consequences. For almost no money at all you can go into McD's anywhere in the world and feed a family on cheap high-protein high-fat meals.
So please tell me how a low-carb diet of the 1800s bears ANY resemblence to what the average low-carber eats today. It was a name, that's for sure. But it bears no relationship to the spin that Atkins put on low-carb.
You seem determined to paint low-carb as something that it isn't, andy. Low-carb "in reality" means a plant-based diet, not unlike yours. Lots of non-starchy vegetables, plus some meat, eggs, and dairy. Protein is typically <1g/kg/day (ie., the same as anybody else), for the simple reason that appetite drives protein consumption. Too much is just unpleasant.
Modern low-carb actually looks a lot like the standard diet from the 1800s. Funnily enough, I've just been researching exactly this, and I found a webpage on the subject with some example meals:
I have to say, this looks like the sort of food a very rich person would eat. But notice the amount of fat and protein at breakfast ... as opposed to a bowl of sugar and carbs. Broadly speaking, these people were eating meat and vegetables, with a modest amount of pastry and bread - which, incidentally, LCHFers don't avoid entirely. We just don't eat it all the time, every day, as a staple source of energy.
As for "today's society ... saturated with fat, fat, fat" ... well, yes and no. The low-fat message is now carved on people's hearts. People feel guilt if they eat something with fat in it. But then there's this:
We're eating vast quantities of vegetable oils - a product which simply wasn't available when you were a lad. LCHFers avoid these in favour of historically-accepted fats: animal fat, butter, cheese, and cold-pressed oils like olive, coconut and palm oil.
I wholeheartedly agree with you about the sheer quantity of food on offer at ridiculously low prices ... much of it being "food" only in the loosest sense of the word. It's wrong. It has terrible effects up and down the supply chain; on the consumer, and on the farmer. This is largely a result of misguided government policies for agriculture, and farmers' sullen compliance with bad laws. In a former age they would have been banging on the doors of parliament waving pitchforks.
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Shocked
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Meal ideas/options with limitations
