Sarah’s Health Notes: diabetes and the low carb diet
How much will two slices of wholemeal bread increase your blood sugar? That may sound like a trick question but it’s not. In fact, there’s the equivalent of six teaspoons of table sugar in those two slices of ‘good for you’ bread. Likewise, a 150g serving of boiled rice has the equivalent of ten teaspoons of sugar, with nine teaspoons in a serving of potatoes.
While many people nowadays know that the fine white sparkly stuff is bad for our health – ‘pure, white and deadly,’ as pioneering ‘70s nutritionist Dr. John Yudkin put it – most are unaware that all carbohydrates are in fact sugars. And sugars raise blood glucose (sugar) levels, which can cause a multitude of ill health conditions including weight gain with all its attendant problems such as type 2 diabetes, cancer and heart disease. Most recently, obesity has been identified as one of the key factors in patients suffering serious complications and death from COVID-19.
Carbs come in two forms: ‘simple’, like table sugar, and ‘complex’, like bread, cakes, pastries, breakfast cereals and also starchy vegetables. Complex carbs such as whole grain products and root vegetables such as potatoes and parsnips take longer to break down and are more slowly absorbed than refined white carbs. But that doesn't mean they don't have an effect on blood sugar.
Merseyside GP Dr. David Unwin had a lightbulb moment about carbs in 2012 when a patient with long-term type 2 diabetes (the type that affects 90% of diabetes patients) completely reversed her condition with a low carb diet, based on information she found on the web. ‘I had been prescribing her drugs for years without any change,’ he admits. ‘Now she had lost three stone, looked marvellous and achieved drug free remission without my help.’ It was, he says, his ‘first epiphany about the potential of reversing type 2 diabetes through following a low carb diet’.
One thing that struck Dr Unwin was how furious his patient was that he hadn’t explained that bread, potatoes, breakfast cereals and pasta were all forms of sugar. He was also struck by the truth that, as a doctor, he was unhappy. ‘Giving my diabetic patients drugs for life never made them feel much better whereas offering them the alternative of a low carb diet did.’
It’s useful here to explain what carbs and insulin do in Type 2 diabetes.
• Type 2 diabetes is a condition where there is too much sugar in your blood. Normally, the role of the hormone insulin, which is made by the pancreas, is to allow cells to absorb and use glucose (sugar) and to regulate the amount of sugar in the blood. But in type 2 diabetes, insulin doesn’t work properly.
• When you eat sugar, the pancreas sends out insulin as a chemical messenger to tell the sugar/carbs where to go. Normally, it would go to all the cells in the body to be converted into energy. But if the cells are full because people have consumed so many sugars/carbs, the excess is stored as fat round the belly or in the liver.
• This leads to a pre-diabetic condition called insulin resistance, where the body’s cells take less notice of (in other words, resist) signals from the insulin.
• So… the pancreas goes into overdrive producing more insulin to try to stabilise blood sugar levels. But it can’t keep up the supply of extra insulin to compensate for the cells’ increasing resistance and blood glucose (sugar) levels shoot up. Unless the situation is put back into balance by diet or medication, the result is type 2 diabetes.
With the support of his wife (a consultant psychologist), and his practise nurse, Dr. Unwin started Low Carb Diet groups at Norwood Surgery every Monday evening. ‘It was such fun, and the results have been amazing.’ One of his simple mottos for patients is to ‘swap white, eat green’.
Over the last seven years in Dr. Unwin’s small practice of 9,000 patients, virtually half (49.7%) of those with Type 2 diabetes who follow a low carb diet are now in remission; that’s 82 patients from a total of 165.
Although mainstream medical opinion in this country is still somewhat resistant to offering patients the choice of drugs for life or trying a low carb diet, the situation is changing. The received wisdom used to be that carbohydrates should be the dietary mainstay for people with type 2 diabetes, with blood sugar levels balanced by drugs and, if that didn't work, insulin injections. The concept of a low carb diet was unthinkable; proponents were medical heretics. Although, given the effect of carbs on blood sugar levels, it seems illogical to say that people with type 2-diabetes should not limit their intake.
Now a significant number of doctors in the UK accept that drugs are not the answer for every patient and a low carb diet can help a significant number. ‘We need to identify the true cause of the illness and for 95% of people with type 2-diabetes that’s 20 years of consuming too many sugars, in my opinion,’ says Dr. Unwin. Interestingly, both the American and Canadian Diabetic Associations have recently both come out in support of a low carb diet, he says.
With a huge increase in diagnoses of type 2 diabetes (now about four million in the UK) and much earlier age of onset (from an average age of 40 two decades ago, children are now being diagnosed), the £1 billion drug bill is clearly not good value. Dr. Unwin’s practice, which serves 9,000 patients, now saves £50,000 annually on diabetes drugs, because of offering the low carb diet option. Sadly, not a penny of that goes to the practice, as the Treasury keeps it all. ‘So GPs are not incentivised to make those savings,’ comments Dr. Unwin.
The dramatic increase in obesity is accepted as the biggest risk factor for type 2-diabetes, with three in five adults in England now overweight or obese. For people with type 2 diabetes who want to explore the potential of a low carb diet, Dr. Unwin says it’s important to do this in consultation with your doctor. ‘A major dietary shift should always be discussed with your prescribing doctor,’ he states.
In collaboration with other doctors, Dr. Unwin has written a guide for the Royal College of General Practitioners (free to members) and also a review for the British Journal of General Practice (open access here).
