Type 2 Diabetes – A Dietary Disaster – A Dietary Solution
As a medical student in the 50s and 60s the teaching was that fats (ALL FATS) were bad for us and caused raised cholesterol, hypertension and cardiovascular disease and should be avoided. We were told that our calories should be obtained mainly from carbohydrates. This advice resulted in an increased intake of carbohydrates. The food industry was able to provide the carbohydrates profitably and with an increased shelf life as a result of processing, largely by means of saturated fats.
The increase in consumption of carbohydrates has resulted in both the obesity crisis and in the rise in the incidence of Type 2 diabetes. While carbohydrates are a ready source of energy (calories) most of it is highly refined with very little nutritional value (empty carbs) and much of the attraction of these foods, especially for children, is the high sugar content, sugar being one of the most highly processed but nutritionally deficient carbohydrates. (“not addictive but irresistible”).
In The News
There have been lots of headlines newspaper reports on how people’s diabetes was cured by low carb diets. You may have seen them:
In May 2013 The Guardian published:
Type 2 diabetes and the diet that cured me
“After receiving a shock diagnosis of type 2 diabetes, I followed an extremely low-calorie eating plan and saw my blood sugar levels rapidly return to normal. The idea of Taylor’s diet is to use up the fat that is clogging up the pancreas and preventing it from creating insulin, until normal glucose levels return. With my GP’s blessing and a home glucose-testing kit, I began my experiment. The diet was strict: three litres of water a day, three 200-calorie food supplements (soups and shakes) and 200 calories of green vegetables. Thanks to my doctor’s dietary guidance, and running three times a week, I had already lost a stone. Yet my glucose levels were still above 6mmol/L (millimols per litre), the upper limit for a healthy person without diabetes. According to Taylor, I had to lose a sixth of my pre-diagnosis bodyweight.”
In March 2017 The Express wrote:
Diet ‘reverses diabetes in just 10 weeks’, claims new study
“TYPE 2 diabetes can be reversed in 10 weeks with a high-fat and low carbohydrate diet tailored to the patient, claims a study. The research, the first of its kind, could pave the way for an overhaul in the management of the condition which is linked to obesity and affects almost three million people in the UK. Most diabetics are advised to eat a balanced diet, including carbohydrates. However, scientists, who carried out the study on 238 patients, found that restricting carbohydrates and increasing fat led to dramatic improvements. Half the patients saw their condition reversed after just 10 weeks and were able to reduce or stop taking diabetes drugs. Eighty nine per cent of those in the study, who had been reliant on insulin due to the severity of their disease, were able to dramatically reduce or stop taking it.”
In December 2017 The Daily Mail reported:
A cure for diabetes: Crash diet can REVERSE Type 2 in three months
“A crash diet lasting just three months can reverse Type 2 diabetes, a landmark study has shown. Nearly half the people who underwent the diet saw their condition go into remission — providing the strongest evidence yet that diabetes can be eradicated by simply losing weight. The patients had struggled with their condition for up to six years, using drugs to control their blood sugar levels. But a year after starting the 850-calorie-a-day diet, 75 per cent were drug free and 46 per cent had seen their blood sugar drop so far they were no longer considered diabetic. Some 86 per cent of people who lost more than 15kg (2st 5lb) went into remission, along with 57 per cent of those who lost 10kg (1st 8lb) to 15kg, and 34 per cent of those who lost 5kg (11lb) to 10kg.”
So is this true? Can a low carb diet resulting in weight loss reverse diabetes?
NHS Choices looked at the information reported and assessed the trial/study many newspaper reports were based on and concluded:
“The trial, looks promising trial and suggests an intensive calorie-restriction programme, followed by reintroduction of a more normal diet and steps to keep weight off, can lead to weight loss and remission of type 2 diabetes”. They further said that “this was a well-designed trial that had many strengths, such as analysing all participants in their assigned group regardless of whether they completed the study (although very few were lost to follow-up) and ensuring they included enough participants to be able to reliably detect differences between them. The nature of the intervention meant it wasn’t possible for people to be unaware of group assignment but, because weight and HbA1c are objective measures, the risk of bias was minimised”.
However they highlighted some points to be aware of:
- Most people in the trial were obese, with an average BMI of 35. Therefore intensive weight loss and calorie restriction may not be appropriate for everyone with diabetes.
- The participants had raised HbA1c, but with an average around 7.5% their blood glucose control wasn’t as bad as it could be. People who had started taking insulin were excluded. Therefore discontinuing all medication and managing diabetes by weight loss alone likely wouldn’t be appropriate for everyone.
- Intensive calorie restriction and energy balance is something that would need to be carefully monitored by a health practitioner, especially if you have type 2 diabetes.
- Only one person had serious adverse effects related to the intervention however further investigation would be needed to be sure that these, and other side effects, don’t occur more regularly in larger groups.
- Participants were followed up at the 12-month mark but would need to be further tracked to see how their diabetes and weight were progressing over the coming years.
- The participants were predominantly white, therefore it’s unclear whether this approach would be suitable for other groups – for example, for people from an Asian background, who have a higher risk of diabetes.
NHS Choices concluded that this type of intervention showed promise, but further research would be needed. They further went onto say that for now, if you have type 2 diabetes, you shouldn’t undertake any treatment changes or intensive weight loss without medical support.”
The Low Carbohydrate High Fat Eating Regime
From the research above and NHS Choices comments its clear that a low-calorie diet may help reverse type 2 diabetes. Low carbohydrate, high fat can be beneficial both in reducing Insulin Resistance and therefore Type 2 diabetes and also in allowing us to obtain most of our calories from fat rather than from carbohydrates. While saturated fats are harmful and should be avoided, unsaturated fats are essential and are required in moderation. So what would this type of diet look like?
Below is an overview of the types of foods that should be avoided and those which should be included:
Food To Be Avoided
- All processed food, which contains a large amount of saturated fats.
- Carbohydrates especially sugars (empty carbs).
Food To Be Included
- Coconut oil
- Green vegetables in moderation (fruit and vegetables are good for you, but they contain carbohydrates)
Healthy Eating Guide
An excellent guide to healthy eating the low carbohydrate high fat way is given by Prof. Noakes in his book The Lore of Nutrition.
I am an advocate of the low carbohydrate high fat regime proposed by Professor Noakes, but feel that I can improve on his suggested regime in that while Prof. Noakes obtains his fruit and vegetable antioxidants largely from berries (to avoid unnecessary carbohydrates which a wider range of fruit and vegetables would provide), I add dried powders (the nutritional essence) of fruit, vegetables and berries, to my diet, in order to obtain a comprehensive range of antioxidants without significant carbohydrates.
The medical fraternity are beginning to appreciate that the previous recommendation of an increased intake of carbohydrates at the expense of healthy fats is contributing to the obesity and diabetic epidemic with the consequent rise in the incidence of ill health which is crippling the health services particularly of Western countries.
The answer is to revert to healthy eating habits as outlined above and to avoid processed food, carbohydrates especially sugars and saturated fat.