In the UK, the Dr David Unwin, A general practitioner (GP) noticed that people with type 2 diabetes (T2D) reported great results on a low carbohydrate diet (http://www.diabetes.co.uk/forum/threads/low-carb-success-stories.3763/) Yet this was not the standard advice: Diabetes UK recommends 5 – 14 servings of starchy food per day.
Clinical studies also show that a lower carbohydrate diet is beneficial for people with T2D.
Dr Unwin decided to trial a low carbohydrate diet for his patients with raised HbA1c (>42mmol/mol [60%]) He set up a support group and individual education sessions for patients interested in taking this on. 18 patients with T2D and pre-diabetes took part and were followed and supported for 8 months.
The tests carried out included cholesterol profile, blood pressure (BP), liver function tests for fatty liver, renal function and HbA1c (a measurement of blood sugar).
Here are the results (mean+ standard deviation)
All 18 participants lost weight and had improved HbA1c, and none had higher cholesterol. The majority reported improved energy and wellbeing, and many began exercising.
The authors were struck by the energy and enthusiasm as patients took control of their lives instead of waiting patiently for doctors and nurses to ‘solve’ their problems.
After a few meetings, members of the group were trying to help each other, often making sensible suggestions.
Repeatedly, patients would step on the scales expecting not to have lost weight, only to find that they had lost several kilograms; they were surprised by this as they had not felt hungry on the low carbohydrate diet but it had nevertheless worked. For some, carbohydrates appeared to be addictive and increase appetite, so that as they gave up carbohydrates they felt much less hungry. All patients reported increases in energy levels. An unexpected result of the diet was that two of the partners, the practice manager, the deputy practice manager and both practice nurses all went on the diet and remain on it.
The 47% improvement in serum GGT was another unexpected finding. The patients with the highest initial levels seemed to improve the most, but on average there was a drop of approximately 35 U/L. For years, patients with raised GGTs had told us they didn’t drink alcohol.
Now that the role of carbohydrate in excess of requirements, especially the fructose component, is better understood in the genesis of fatty liver, it is clear that excess carbohydrates can be a cause of fatty liver.
Seven patients were able to come off medication: metformin (one completely and two have halved their dose), perindopril and lacidipine, as BP control improved so much. Additionally, metoclopramide, omeprazole and lanzoprazole were discontinued, as symptoms of acid reflux improved.
Based on our work so far we can understand the reasons for the internet enthusiasm for a low carbohydrate diet; the majority of patients lose weight rapidly and fairly easily; predictably the HbA1c levels are not far behind. Cholesterol levels, liver enzymes and BP levels all improved. This approach is simple to implement and much appreciated by people with diabetes.
Here is the diet sheet of instructions given to patients:
So what should I eat to control my weight?
Patient diet sheet.
Reduce starchy carbs a lot (remember they are just concentrated sugar). If possible cut out the ‘White Stuff’ like bread, pasta, rice – though porridge, new potatoes and oat cakes in moderation may be fine. Sugar – cut it out altogether, although it will be in the blueberries, strawberries and raspberries you are allowed to eat freely. Cakes and biscuits are a mixture of sugar and starch that make it almost impossible to avoid food cravings; they just make you hungrier!!
All green veg/salads are fine – eat as much as you can. So that you still eat a good big dinner try substituting veg such as broccoli, courgettes or green beans for your mash, pasta or rice – still covering them with your gravy, Bolognese or curry! Tip: try home-made soup – it can be taken to work for lunch and microwaved. Mushrooms, tomatoes, and onions can be included in this.
Fruit is trickier; some have too much sugar in and can set those carb cravings off. All berries are great and can be eaten freely; blueberries, raspberries, strawberries, apples and pears too, but not tropical fruits like bananas, oranges, grapes, mangoes or pineapples.
Proteins such as in meat, eggs, fish – particularly oily fish such as salmon, mackerel or tuna are fine and can be eaten freely. Plain full fat yoghurt makes a good breakfast with the berries. Processed meats such as bacon, ham, sausages or salami are not as healthy and should only be eaten in moderation.
Fats (yes, fats can be fine in moderation): olive oil is very useful, butter may be tastier than margarine and could be better for you! Coconut oil is great for stir fries. Four essential vitamins A, D, E and K are only found in some fats or oils. Please avoid margarine, corn oil and vegetable oil. Beware ‘low fat’ foods. They often have sugar or sweeteners added to make them palatable. Full fat mayonnaise and pesto are definitely on!!
Cheese: in moderation – it’s a very calorific mixture of fat, and protein.
Snacks: avoid. But un-salted nuts such as almonds or walnuts are great to stave off hunger. The occasional treat of strong dark chocolate 70% or more in small quantity is allowed.
EATING LOTS OF VEG WITH PROTEIN AND FATS LEAVES YOU PROPERLY FULL IN A WAY THAT LASTS
Finally, about sweeteners and what to drink – sweeteners have been proven to tease your brain into being even more hungry making weight loss almost impossible – drink tea, coffee, and water or herb teas. I’m afraid alcoholic drinks are full of carbohydrate – for example, beer is almost ‘liquid toast’ hence the beer belly!! Perhaps the odd glass of red wine wouldn’t be too bad if it doesn’t make you get hungry afterwards – or just plain water with a slice of lemon.
Where to get more info?
A book – ‘Escape the diet trap’ by Dr John Briffa (2013).6 Well researched and easy to read.
Internet – Google ‘about.com low carb diet’ for loads more info and recipes, or look into the closely related PALEO DIET; also Google ‘diabetes.co.uk forum low carb’ for contact, recipes and hints.
BEFORE YOU START get an accurate weight and measure your waist, re-weigh and measure once a week to see how you are doing and ask for help if problems or little progress is being made – GO ON DO IT!!!
Link to post: High fat low carb diet for diabetes: A GP’s tale By Dr David Unwin
Full study PDF here: Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes and pre-diabetes, experience from one general practice