My experience with a low carbohydrate diet.

I was diagnosed type 2 diabetic about 12 years ago when I was 61. My Dr warned me of the consequences of uncontrolled diabetes & referred me to the local hospital for a basic course. There I was told to base my diet around whole grain carbohydrates & general follow a low sugar; low fat; low salt diet & maintain an active lifestyle. That diet was basically as recommended by Diabetes UK. I was also told that diabetes was progressive, & I would progress from diet to tablets to insulin, while suffering health deterioration.

My principle diabetes symptom was a numb sensation in my right thigh, which my Dr thought was diabetic neuropathy. At diagnosis, my HbA1c was 8.7, cholesterol 7.6 & weight 13 st 7 lb (86 Kg)

On diagnosis in November 2000, the Dr. told me all the complications could expect – foot amputation, blindness, stroke, heart attack, etc, & helpfully computed my heart attack probability as 25% within 10 years. She also advised me of the NHS help available. I went to the one-day course at West Middlesex Hospital for talks by nurse, dietitian, pharmacist & podiatrist. At first control by diet & exercise was recommended, before use of sugar control drugs is considered. I was assured that however good my control, diabetes was progressive through medication & insulin.

I was in a state of shock for some months, & was careful to comply with the advice. I was already playing tennis & getting plenty of exercise, & was have been health conscious all my adult life. I included cholesterol reducing margarine & oat bran to help reduce cholesterol.

I got on well at first, & after two years I felt I had diabetes under control. My HbA1c was 6.5, cholesterol 5.4 & weight 12 st 5 lb. (78.5 Kg.) My heart attack risk dropped to 15%. I was very happy with Diabetes UK diet recommendations which I understood as:Low sugar, low fat/oil, low salt ;

30-40% in the diet of carbohydrates, particularly multigrain bread, basmati rice, pasta;Plenty of vegetables & fruit.

I recommended the D UK diet in a radio phone-in in 2003. However, the condition progressed slowly, as predicted. After about 4 years I started taking metformin & then they wanted to reduce my cholesterol below 4.0 so I was given simvastatin. Simvastatin caused serious muscle pain & I have been unable to take any cholesterol medication.

Complications began to set in: chronic tiredness, muscle pain & the beginning of retina damage.

In April 2008 muscle pain was so serious I feared becoming disabled. It could take 5 minutes to get out of bed. Stairs were a struggle. My active life seemed to be over. My HbA1c was considered acceptable at 6.7. My overnight BG averaged about 7.

At that time I joined the http://www.diabetes.co.uk/ forum. Thousands of people with diabetes ask questions, note news items & contribute from experience. Many contributors had found from experience that a low carbohydrate diet was very beneficial. I had nothing to lose, so immediately cut right down on carbs. My overnight BG dropped to an average less than 6. Within 3 months I was playing tennis again & I was completely out of pain. My weight dropped to about 12 st (76 Kg.)

I have continued a low carb diet ever since. Four years on, I am well & active, playing tennis & table tennis at club standard. I have cooperated with several heart/diabetes research projects, including a long term Imperial College's SABRE & Ealing Hospital's LOLIPOP. There is no indication from these projects that my low carb diet is causing any adverse effects.

One blood measurement that my Dr is watching is kidney function, which is completely stable since before my change of diet.

What do I eat? Is it complicated or straightforward? Are there problems with eating out, or with friends?

Basically all I do is avoid the obvious carbs – bread, potato, rice, pasta. I have developed some special low-carb recipes. Also I make a bread/cake & a porridge based on ground almonds. I snack on cheese & nuts. My friends are used to me refusing biscuits & cakes & savouries. Sweet dishes include jelly flavoured with NAS squash & topped with yoghurt or cream.This chart shows a breakfast experiment:

Roughly the same weight showed striking differences in composition & performance. My almond porridge sustains me until lunch - & on occasions when I play tennis during the morning while consuming only water. After the 1 hour spike up to 7.4, my BG stayed at about 5.5.

The Tesco fruit/fibre cereal gave a massive spike to 14.3 & by 11 o'clock had dropped to 4.1 & I was beginning to feel shaky. Happily at that point my reserves came into use & raised the BG to 4.7.

A further point of interest is that the Tesco data is for a suggested amount of 30 g, with 125 ml milk. That provides only 183 kcals, or 10% of the daily requirement - which does not amount to a substantial or even adequate breakfast.

A very serious question for D UK is raised by their booklet “Eating well with Type 2 Diabetes” where they assert: Why is carbohydrate important?

All carbohydrate is converted into glucose and will have an impact on blood glucose levels. As this is the case, some people with diabetes wonder if it would be better not to have any carbohydrate in their diet to keep their glucose levels under control. This is not recommended as:

• glucose from carbohydrate is essential to the body, especially the brain

• high fibre carbohydrates, such as wholegrains and fruit, also play an important role in the health of the gut

• some carbohydrates may help you to feel fuller for longer after eating.

How much do I need?

The actual amount of carbohydrate that the body needs varies depending on your age, weight and activity levels, but it should make up about half of what you eat and drink. For good health most of this should be from starchy carbohydrate, fruits and some dairy foods, with no more than one fifth of your total carbohydrate to come from added sugar or table sugar.

These assertions by D UK appear to be totally without foundation. I have reported the benefits to me of low carbohydrate diet & asked for research references. All I get is “if it works for you, keep it up, but we cannot change our diet recommendations.”

I came across the July/August 2003 “Balance”, which had an article "investigating the truth behind a low carb diet."

I won't bore you with warnings of the dangers of "breakdown of vital muscle & body tissues" or "increased risk of heart disease, cancers & bowel disorders" or "the risk of kidney disease." Such a diet may be "suitable ... with medical supervision & with guidance from a state-registered dietitian."

A key paragraph is: "Research into the long-term effects of low-carb diets is now required. And in response to this, Diabetes UK is funding such research."

Eight years on we have the 2011 D UK “Position Statement” where we read:

"More research is needed to assess the effectiveness of varying degrees of low-carbohydrate diet on weight, glycaemic control, hypertension and lipid profile in people with Type 2 diabetes as well as to investigate the long term effects of these diets."

I can't wait for yet more long term studies - I've too much to lose. I followed their "healthy diet" for 7 years & was crippled by the complications. My low-carb diet started in May 2008. The complications disappeared in 3 months. Four years on I am well & active. There is no hint of any adverse effects in my experience, nor in the SABRE & LOLIPOP studies. My Drs are happy with my level of health & all my blood test results.

D uk state in their “Position Statement” on low carb diets, warn that “there is a lack of evidence related to long-term safety and benefit of following this diet.”

I know of two long term studies:

A 44 month Swedish study, (citation 13 in D UK Position Statement) which states:

“ the present high-carbohydrate dietary advice resulting in unnecessary hyperglycemia and insulin resistance seems difficult to support and for diabetes patients, current dietary recommendations seem to be a major part of their problem rather than being part of the solution. Carbohydrate restriction, however, reverses or neutralises all aspects of the metabolic syndrome.”

Mark Daly, Consultant diabetologist, the MacLeod Diabetes and Endocrine Centre, Exeter responded to my query:

“We have presented our results at 3 national and 1 international meetings. We found no serious adverse effects over 2 years but not everyone is as good at sticking to low carbohydrate diets as you.”

I challenge Diabetes uk to produce ANY evidence to (a) support their warnings of the dangers of low carbohydrate diets, & (b) to justify their recommendation for T1 & T2 diabetics that carbohydrate should make up about half of what you eat and drink.

A guest post by Ian Day