We welcomed Marie Rouse, Advanced Nurse Practitioner and Diabetes Specialist Nurse from Firs House Surgery. Marie explained exactly what diabetes is and the different types. Type 2 diabetes is the most common form, where the body’s cells stop responding to insulin or the beta cells of the pancreas are unable to produce sufficient amounts of insulin. The talk focused on Type 2 diabetes, the most common form which affects around 90% of those with diabetes.
A copy of the talk can be downloaded here:
Next followed some statistics to put the rest of the talk into perspective. In the county there are 40,000 people over 17 recorded with diabetes. Since 1996 the number of people diagnosed has doubled. About 1 in 15 with diabetes have not been diagnosed. The costs of managing and treating diabetes is over £8.8B per year, 10% of the NHS budget, and is forecast to rise to £16.9B by 2035.
On a more personal level, compared to the general population you are 48% more likely to be admitted to hospital with a heart problem, and 25% more with a stroke. Poorly controlled Type 2 diabetes reduces life expectancy, on average at the moment by 10 years!
There has been a dramatic change in the way Type 2 diabetes is treated over the past 10 or so years. Traditionally the approach has been to manage the patient’s health with increasing strength medication, ending with insulin injections. Dietary advice was to lose weight by eating more healthily. However, the Eatwell Guide, prepared in 2016 and still in use today within the NHS, advises that meals should be based around carbohydrates such as potatoes, bread, rice and pasta and that these should make up a third of the food eaten. But the body only needs around 1 teaspoon of sugar per day. The recommended 100 gram of starch in each meal will be converted in the body to 20 teaspoons of sugar! The Eatwell Guide was composed by a committee since exposed as mainly having vested interests with processed food, fast food etc.
By comparison scientific studies have shown that carbohydrates are part of the problem. In particular Dr Jason Fung in his book “The Diabetes Code” published in 2018 states “you can’t use drugs to cure a dietary disease”. Diabetes is caused by our body’s insulin resistance to long-term overconsumption of carbohydrates. The natural way to reverse the disease is to reduce consumption.
Carbohydrates is the collective name for sugars and starches. Starches include bread, pasta, rice, potatoes and are rapidly digested into blood glucose. Therefore the way to tackle diabetes is to eliminate as much as possible sugary sweet foods and drinks and to reduce consumption of carbohydrate.
Low carbohydrate diets are those with less than 130 grams/day. The recommended way to achieve this is to minimise consumption of the starchy foods mentioned above, but also root vegetables, tropical fruits, smoothies and fruit juices etc. To replace these foods you should eat more eggs, non-processed meats and fish, full-fat dairy, nuts, seeds and pulses. Marie particularly recommended the Freshwell Low Carb Project by Dr Kim Andrews, who has published a 4 week meal plan, online at https://lowcarbfreshwell.co.uk/blog/ .
Low carb diets are hard for vegans and vegetarians who already miss a major food group. It also breaks with tradition and some lifestyles (Marie cited lorry drivers) can find it tricky to adopt. At first you might feel light-headed, get mild headaches and suffer from constipation. If you are on any medication apart from Metformin you should review these before commencing the lifestyle changes.
Several were concerned about being advised to eat full-fat foods and dairy, having been advised all their lives to minimise intake of fats. In particular fats have been blamed for clogging arteries and leading to heart disease. This is now considered completely wrong, and in fact low-carb healthy fat diets mainly lead to improved health.
Marie recommends using a Glucometer, a low-cost blood glucose measuring meter which uses test strips to indicate the current blood glucose levels. This is a different measurement to the HbA1c blood test, which measures an average of blood glucose levels over around 3 months. The glucometer is therefore useful to test the effects of your individual blood glucose response from eating various foods. You take a test before you eat, then check again an hour or so later. The rise should be no more than one unit, more than that and you have identified a food or quantity to avoid! Unfortunately, the issue of glucometers is limited on the NHS, but they can be bought for £10-20 from pharmacies, supermarkets and of course the internet. The consumables – tests strips – cost extra and where the suppliers make their profit.
Marie illustrated the amount of blood glucose in various foods such as cereals and fruit with infographics developed by Dr David Unwin. These slides are included in the copy of the talk. Also shown were some HbA1c charts showing the effects on several patients of moving to a low-carb lifestyle.
Marie then answered questions from the floor. One concerned zero calorie drinks such as Coke Zero. These contain sweeteners which prolong addiction to ‘sweetness’ and make the lifestyle transition to low-carb harder, so are best avoided.