- A low-carb meal can mean that a patient’s blood sugar only rises by six per cent
- Brian Parsons, from Skipton, North Yorkshire, had a low reading on the diet
- Patients lost an average 10 lb over two years, opposed to 6 lb on a low-fat diet
For more than 30 years, the official advice to people with diabetes has been to ensure starchy carbo-hydrates, such as pasta, rice and potatoes, feature heavily in every meal while fats should be kept to a minimum.
But is it right? Not according to the increasing number of patients and doctors leading a grassroots rebellion against the standard advice.
They argue for a low-carb approach, claiming it can be more effective for weight loss and blood sugar control.
‘The low-carb diet has several beneficial effects on type 2 diabetes,’ says Dr Clare Bailey, a GP in Buckinghamshire, and wife of TV doctor Michael Mosley.
A low-carb diet could help people fight off diabetes. Patients with type 2 diabetes also found the Atkins-style diet could help stop big rises in their blood sugar (file photo)
‘If it were a drug, companies would be running large trials to get it licensed.’
She and others want a low-carb diet to be offered to patients as another option, rather than the ‘high carbs for all’ advice.
The low-carb approach is a variation on the low-carb, high-protein Atkins diet, which was popular in the Nineties. Overweight people who had type 2 diabetes found that as well as shedding pounds, it stopped big rises in their blood sugar.
Keeping blood sugar under control is vital as it helps reduce the risk of diabetes complications such as heart disease and damage to the blood vessels (which can lead to ulcers and even amputation).
Around 80 per cent of the £20 billion the NHS spends on diabetes care goes on treating complications, says Diabetes UK.
Low-carb fans claim this diet is better for people with type 2 diabetes because they can’t handle glucose effectively. Since all carbohydrates, from refined flour to wholegrains and fresh vegetables, turn to glucose when digested, it makes sense to eat fewer of them.
Word spread about the benefits of the low-carb approach and diabetes.co.uk, a website support group, claims it has details of more than 100,000 people who have tried the low-carb diet.
Carbohydrates can increase blood sugar levels by 15 per cent, but low-carb meals can mean sugar rises by only six per cent.
Many have successfully used it to lose weight and control their blood sugar — and they report they have had their medicine doses reduced by their doctors.
Some of the 100,000 have been measuring their blood sugar levels with cheap DIY devices to see how their bodies respond to a typical low-fat meal, as recommended by the NHS Diabetes Prevention Programme.
After an hour they report blood sugar can rise by 15 per cent, yet a low-carb meal rarely raises it more than 6 per cent. ‘Seeing a diet making a difference in this way is motivating,’ says Dr Bailey.(Health Records, Personal Health Record)
This is not a scientific study, but the low-carb approach is soon to be tested in Bermuda where 13 per cent of the population have type 2 diabetes — three times the proportion in the UK.
The trial with 300 diabetics will be run by Dr David Cavan, a UK expert and previously director of policy and programmes at the International Diabetes Federation. There have been a number of smaller studies of the low-carbohydrate diet.
One, run by leading dietitian Trudy Deakin who has a special interest in diabetes, involved ten type 2 patients who had been on medication for the condition for at least five years.
At the beginning of the trial, they were tested for HbA1c, a more sophisticated measure of blood sugar that reveals how high it’s been on average over the previous month.
A reading of more than 47 means you have diabetes.(Health Records, Personal Health Record)
During the six-week trial, based on a programme developed for the NHS by Ms Deakin, the patients followed a low-carb diet.
Nine had significant improvements in their HbA1c readings — one patient’s levels dropped from 85 to 45 (no longer diabetic).
Former headmaster Brian Parsons, 65, from Skipton, North Yorkshire, went from 68 to 47 (borderline).
‘I was diagnosed with type 2 six years ago and told to eat lots of bread, pasta and rice,’ he says.
Brian Parsons, 65, from Skipton, North Yorkshire, went from a blood sugar reading of 68 to 47 (borderline). He said: ‘I tell everyone about the low-carb diet’ (file photo)
‘I did this religiously, but my weight went up as did my blood sugar. My doctor kept increasing the dose of my drugs — Metformin and Glimepiride. He told me it would soon be time for insulin.’ When a friend mentioned the low-carb alternative, Brian was keen to try it.(Health Records, Personal Health Record)
‘The result was amazing,’ he says. ‘As well as the drop in the blood sugar marker, I lost a stone in six weeks and cut my medicine.
‘I tell everyone about the low-carb diet. My teenage daughter says I’m becoming a bore, but I don’t mind. My wife says she finds me attractive again.’
Meanwhile, one of Dr Bailey’s patients had more spectacular results — her HbA1c reading of 128 dropped to a healthy 33 after four months. She also lost 14 kg (over 2 st).
‘I first heard about the low-carb theory when Michael was making a TV programme about the 5:2 diet,’ says Dr Bailey. ‘It was the opposite of all I’d been taught about diabetes and diet so I was sceptical.’(Health Records, Personal Health Record)
Dr Bailey first heard about the low-carb diet for diabetes patients when her husband Michael Moseley was making a TV programme about the 5:2 diet (file photo)
But after a friend improved on the diet, she became a convert and is one of more than 150 GPs on a Facebook group where professionals swap data and tips about the low- carb approach.
‘The official position is curious,’ she says. ‘We spend a fortune on drugs to allow patients to eat sugar rather than on ways to reverse diabetes.’
Richard Feinman, a professor of cell biology at the State University of New York and a world expert on carbohydrate biochemistry, published a paper in the journal Nutrition in 2015 on why low carbs for diabetes makes sense.(Health Records, Personal Health Record)
‘A high-carb diet inevitably pushes up blood sugar,’ he told Good Health. ‘Raised blood sugar is the major symptom of diabetes. Why would you recommend that diet when a low-carb diet brings blood sugar down?’
In a small high-versus-low-carb trial published in the journal PLOS One in 2014, the low-carb group saw their blood glucose levels drop and 44 per cent were able to reduce their medication; just 11 per cent of the high-carb group cut their medication. In March, researchers at London Metropolitan University announced findings of a review of studies comparing trials of high and low-carb diet conducted since 2001.
They concluded the low-carb approach is safe and effective and while the high-carb approach did have benefits, they were greater on low carbs.
Patients lost an average 4.7 kg (10 lb) over two years, compared with 2.9 kg (6 lb) on a low-fat diet. The researchers say both approaches should be available.
NICE, which advises the NHS on cost effectivness, is updating the guidelines on preventing and treating diabetes. (Health Records, Personal Health Record)
Patients lost an average 10 lb over two years, compared with 6 lb on a low-fat diet. NICE is updating the guidelines on preventing and treating diabetes (file photo)
But at a recent meeting about the update, there was no mention of the low-carb diet as an option.
The official EatWell Guide, a graphic produced by Public Health England that shows how much of various types of food you should eat to stay healthy, continues to show that ideally carbohydrates should make up half an average meal.
Adiet based on The Eatwell Guide is suitable for people with diabetes, says Professor Louis Levy, head of nutrition science at Public Health England.
‘Evidence suggests choosing a diet with the right combination of foods can help to maintain blood sugar levels.
‘This means choosing carbos that release sugars slowly, such as wholegrain bread and pasta.’
But the failure to consider a low-carb approach as an option is confusing for patients, says Dr Bailey. ‘We get paid for sending patients to get official diabetes advice,’ she says.
‘But when patients, who have had great benefit from following a low-carb approach, attend one of these clinics they come back confused because they’ve been told to eat lots of starchy carbs.’