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   Web Issue 3149 May 16 2008   
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Are diabetics suffering for no reason?
STEPHEN NAYSMITH, Society EditorApril 08 2008

John Gibson's leg had been ulcerated, swollen and inflamed for weeks. "It looked like a damson from my toes to my knee," the 61-year-old recalls. His specialist suggested it would have to be amputated. "He whipped out a camera and photographed it. I said, Is this going to be the last time you see it?' and he said, It might be.'"

But when he next visited, Gibson explains as he sits at home in Mauchline, Ayrshire, the specialist was astonished to see that the leg had healed. "He asked me, Where's the ulcer?'" The former army nurse explained that his diabetes was now being managed on a special low-carbohydrate diet, recommended by his GP. "The specialist told me, Oh, we don't believe in that.'"

Indeed, most NHS doctors and dieticians are far from convinced by the way Gibson manages his diabetes. But Gibson's GP, Dr Katharine Morrison, is one of a vocal minority who contend that the orthodox advice given to type one and type two diabetes patients is not only unhelpful but might be counterproductive.

She believes that eliminating or at the very least strictly controlling carbohydrates is the only way diabetes patients can properly control their blood glucose levels. Unless they do this, she says, they remain at risk of the serious complications that can go hand in hand with the illness, including potential loss of limbs, blindness and kidney failure.

Lifestyle change is the first line of treatment for diabetes, type two in particular, with weight loss the main goal. Yet for decades, the standard advice has been that diabetics should cut out sugars and fats and replace them with a diet that is high in carbohydrates. The overall philosophy has been that diabetics should not be deprived of the pleasure of a normal diet.

Morrison disagrees - and she argues that the experiences of her own patients demonstrate that, by following a more restricted diet, patients can avoid the relatively large fluctuations in blood glucose that many accept as near-normal.

So do the experiences of her own son. Steven Morrison, 15, was diagnosed as a type one diabetic four years ago and follows a regime of low-carbohydrate meals, blood glucose monitoring and insulin injections after every meal.

Whether the close personal involvement with diabetes makes Morrison's position more or less credible depends on your own viewpoint. She certainly has a vested interest in being right; she is also passionate about her cause. The low-carb alternative is "patently obvious", she says. "The simple fact is, I will potentially save many more people's eyesight and limbs and even lives by promoting this approach than I will by being a GP."

She will promote low-carb diets at the International Forum on Quality and Safety in Health Care later this month in Paris, and she has devised an online training tool in the techniques for diabetics. It is based on the work of Dr Richard K Bernstein, himself a diabetic, who devised a diet for sufferers with the goal of controlling blood glucose. Since the publication of his book Dr Bernstein's Diabetes Solution in 1997, he has gained an international following. Morrison says that, at a recent forum held by Diabetes UK in Edinburgh, 70% of patients present said they wanted to know more about the low-carb diet.

"If you are swayed more by real people than by statistics, let me introduce you to some," she adds, backing up her points with success stories. But science doesn't move ahead by individual accounts - surely solid research and statistics have to back up clinical case studies? Morrison insists her approach is supported by such evidence.

What if she is right? Are thousands of diabetic patients suffering unnecessarily because official advice is leading them to suffer more and earlier complications, and putting type two diabetics at greater risk of needing to use insulin?

Diabetes UK continues to recommend that diabetic people follow the same balanced diet recommended for the rest of the population. Low in fat, sugar and salt, with plenty of fruit and vegetables, meals can contain some starchy foods such as bread, potatoes, cereals, pasta and rice. Carbohydrates with a lower glycaemic index - those that break down slowly - are better as they don't affect blood glucose as much, a spokesman for Diabetes UK said.

Stephen Fyfe, spokesman for the charity in Scotland, says research on the effects of low-carb diets has been limited in scope and duration. "Until the long-term effects prove the effectiveness and safety of low- carbohydrate diets, Diabetes UK does not recommend them."

However, the ground may be shifting. Diabetes UK and the International Diabetes Federation have commissioned research on the long-term effects, and Fyfe adds: "We may alter our recommendations to patients based on those findings."

The body responsible for making recommendations to doctors, the Scottish Intercollegiate Guidelines Network (Sign), has since 2001 been advising that diabetics be told to replace sugars and fats with carbohydrates. However, the entire Sign policy on diabetes is currently under review, and a spokesman said this process would take in the latest thinking and research.

Three factors are still hindering wider take-up of the low-carb message, Morrison believes. The first is a reluctance by the medical profession to concede possible mistakes. Secondly, drug companies and food manufacturers have a vested interest in promoting the high-carb option, she argues. A whole industry depends on medicating diabetics and providing them with specialist foods, which Morrison believes low-carb diets will eliminate.

But the third is also a significant hurdle: the low-carb regime is onerous for patients. In a recent briefing that she sent to her own health board, Ayrshire and Arran, Morrison admits that even her own patients have mixed reactions.

These range from the resistant - she quotes one type one patient who said: "I would rather die than give up my porridge in the morning" - to the indignant. "Look at these blood sugars - they are normal! Why wasn't I told about this years ago?" she says one patient told her.

The Herald contacted several Scottish diabetes specialists, each of whom was reluctant to comment on the diet advice given to patients. Perhaps this is because the issue remains so controversial. Across the Atlantic, the debate continues to rage, too. The American Diabetes Association has tentatively moved towards recommending low carbs, but diabetes specialist Hope Warshaw says many study subjects are unable to stick with Bernstein-style diets. "Diabetes lasts the rest of your life. You need to find an eating plan that you can follow for that long as well."

Young people in particular may find it difficult to avoid carbohydrates in a culture where the norm is to eat prepared food and fast food. But Steven Morrison is unperturbed. "It may be easier for me as I've never known anything else. I think it's harder for people who have to change what they've been doing for years," he says.


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Posted by: JC on 7:57pm Mon 7 Apr 08
Sugars are carbohydrates- most advice is to reduce the intake of these but a lot of diabetics lack the self control to do that.
Posted by: aldo69, Glasgow on 7:47am Tue 8 Apr 08
A lot of people lack the self control to do that.

Its hard enough reducing carbohydrate intake without also having to worry about whether you are going to start acting like Basil Fawlty in an important business meeting or on the bus home
Posted by: sharkey, UK on 9:10am Tue 8 Apr 08
Where can we get more information regarding this Theseis; I'm an elderly Diabetic and with nothing to loose at my age I would like to try it, but how?
Posted by: Katharine Morrison, Mauchline on 10:27am Tue 8 Apr 08
Hi,

You can get the information you need online. In addition I will answer any queries here until the thread is closed.

www.dsovle.com

You can get this by googling "solve diabetes now"

This site contains the full "HOW TO" course which covers the management of weight, metabolic syndrome, type two and insulin dependent diabetes.

There are also useful slide shows and downloads of research papers. The second last module gives a very good summary for insulin users.

The doses of insulin and drugs such as gliclazide drop dramatically on low carb diets so you need to read all about how to do things to avoid hypoglycaemia.

www.lowcarbdiets.abo
ut.com

This site is run by Laura Dolson via the New York Times. It has a very helpful low carb food pyramid and tips to help you over the first few weeks.

www.diabetes-normals
ugars.com

This is Dr Bernstein's site. If you join the forum you will get support, advice and scientific information that will greatly help your low carb transition. I have explained in depth what is correct and what is not on the current SIGN guidelines here.

www.nmsociety.org

This site is where a lot of scientific papers are accessable. I think diabetics need to be at least as well informed as the doctor who treats them and this will get you up to speed.

There are a range of low carb dietary options for diabetics ranging from strict to fairly liberal. I think that all diabetics need to have an informed choice. You certainly have nothing to lose by exploring your options. You may even be able to reverse certain diabetic complications. This is unheard of with the high carb/low fat approach. In addition once you are stablised hypoglycaemia is greatly reduced with the low carb approach.

Posted by: Katharine Morrison, Mauchline on 2:55pm Tue 8 Apr 08
This is the URL of an important paper which discusses the rationale for restricted carbohydrate diets in metabolic syndrome and diabetes.

http://www.nutrition
andmetabolism.com/co
ntent/5/1/9
Posted by: ms1960, Glasgow on 5:05pm Tue 8 Apr 08
This is a fascinating article. I was diagnosed Type 2 18 months ago, I'm 47 and of average weight. Got sugars well under control for a year until the last couple of months where they have become very unpredictable and too high. By coincidence I stopped smoking - finally - 16 weeks ago.

The GP's answer has been to double my gliclazide to 80mg per day. And it's not really helping!

I haven't tried low carb. My question to Dr Morrison is: does it work for everyone, or only certain types of patients?
Posted by: kevinm, Connecticut, USA on 5:11pm Tue 8 Apr 08
I have been low-carbing happily for six years after gaining a great deal of weight on low-fat, and there is nothing "onerous" about low-carb whatsoever. All of my blood lipid and fasting glucose profiles are very improved. No, I have never started acting like "Basil Fawlty", unless you think losing your limbs and independence is somehow a better outcome? I have more energy and mental clarity and sleep better as well, which are no small benefits. The nutrition and metabolism article mentioned above, endorsed by a growing body of independent experts, lays the research-based argument out - low carb reverses ALL known sypmtoms of metabolic syndrome easily and simply, including dramatic reduction of triglycerides, without need for exercise. This information is being repressed by the medical system for all the reasons mentioned above. Science has made no progress in explaining the modern medical crisis, and will not do so until it recognizes these as metabolism-based. You owe it to yourself to take your health back into your own hands.

Here are some more links for further medical information:

http://rjr10036.type
pad.com/askdrvernon/ (Dr. Mary Vernon)
http://www.proteinpo
wer.com (Drs. Michael and Mary Dan Eades)
http://www.diabetes-
normalsugars.com (Dr. Richard Bernstein)
http://weightoftheev
idence.blogspot.com (Regina Wilshire)
http://livinlavidalo
carb.blogspot.com (Jimmy Moore)
http://drbass.com/ro
sedale2.html (Dr. Ron Rosedale on Insulin)
http://www.second-op
inions.co.uk/taubes.
html ("The Soft Science of Dietary Fat" - Gary Taubes)

http://www.amazon.co
m/Good-Calories-Bad-
Gary-Taubes/dp/14000
40787/ref=pd_bbs_sr_
1?ie=UTF8&s=books&qi
d=1203358056&sr=8-1 (Good Calories, Bad Calories, recent book by Gary Taubes laying out a great deal of research info supporting low-carb.)
Posted by: ms1960, Glasgow on 5:31pm Tue 8 Apr 08
Thanks Kevin I'll look these up. I do exercise (gym mainly) several times a week and been on gliclazide for more than a year. But I am on a high carb diet (starts with porridge every day!) and must admit I know absolutely nothing about low-carb.
Posted by: Katharine Morrison, Mauchline on 6:04pm Tue 8 Apr 08
Low carbing is suitable for everyone. Some people find it easier or more difficult than others.

For me it was easy. I went on Atkins five years ago to lose weight. I did lose weight but very very slowly. What I got rapidly was elimination of my irritable bowel symptoms, elimination of post lunch slump and much improved muscle and nails. I am on 35-80g of carb a day. A lot of people like me take to low carbing like a duck to water and this is enhanced if you have a wheat intolerance as I now realise I have.

Others find it more difficult. If you are vegetarian but eat eggs and soya products you can often manage the low carb diet fairly well. If you follow a vegan diet I don't think it would be possible, but I would welcome comments from anyone in this situation who has managed this.

More often people are pretty well addicted to carbohydrates and find it as hard a habit to break as smoking. It's hard to find someone who comforts eats on steak and broccoli but easy to find people who comfort eat on crisps, biscuits or items like mashed potato.

Because you eat hardly any processed food on a low carb diet you need to plan your meals ahead of time. Shopping is more frequent because you use a lot of fresh ingredients like fish, meat, vegetables and low glycaemic fruits. I like Steven to have the choice of low carb baking so he doesn't miss these items from his diet. He can eat low carb versions of chocolate cake, choc chip peanut butter cookies, key lime pie, lemon pie, vanilla cheesecake and a variety of muffins with only small amounts of insulin to cover them because you don't need to cover fat with insulin only the carb and the protein.

You need to be motivated to spend the time in the shops and in the kitchen and to make packed lunches for some days.

No matter how much more time you will need to spend on successfully low carbing it is useful to think ahead of how much more difficult and unpleasant life is with diabetic complications. Visual distortion, constant pain, dialysis, wheelchairs. Currently most diabetics never get the option to avoid complications completely or to reverse at least some of the problems they have. I aim to change this.

Kevin, thank you very much for your links. It would be great if our helpful links could be sorted out by the Herald staff so they could provide a direct link to the sites.
Posted by: ozbuc, Lakewood CA on 8:55pm Tue 8 Apr 08
I have been low carbing for about 6 months now and am very happy with the results. My A1C is down LDL is also down and HDL is normal. I am one happy camper.
Posted by: nonegiven, US on 9:42pm Tue 8 Apr 08
You have a typo, your site is dsolve.com



I recommend the site:
bloodsugar101.com as well as the new book available there, "Blood Sugar 101 What They Don't Tell You About Diabetes" By Jenny Ruhl
and:
http://www.alt-suppo
rt-diabetes.org/Newl
yDiagnosed.htm
Also:
the latest edition of "Dr Bernstein's Diabetes Solution: Complete Guide to Achieving Normal Blood Sugars" by Richard K Bernstein M.D.
http://www.amazon.co
.uk/Dr-Bernsteins-Di
abetes-Solution-Achi
eving/dp/0316167169/
ref=pd_bbs_sr_1?ie=U
TF8&s=books&qid=1207
685789&sr=8-1
and
Atkins Diabetes Revolution: Control Your Carbs to Prevent and Manage Type 2 Diabetes by Mary C. Vernon M.D. & Jacqueline A Eberstein R.N.
http://www.amazon.co
.uk/Atkins-Diabetes-
Revolution-Control-P
ractice/dp/000716482
3/ref=sr_1_1?ie=UTF8
&s=books&qid=1207686
310&sr=1-1
Posted by: Ivan C, NYC, USA on 10:28pm Tue 8 Apr 08
Keep up the great work, Dr. Morrison! Your information on Dsolve is very helpful to me and I'm sure many others.
Thank you!
Posted by: Jo, USA on 12:54am Wed 9 Apr 08
Following are shortened versions of Dr Morrison's links:

http://tinyurl.com/2
r3zv2 Laura Dolson's site
http://tinyurl.com/4
zlpcg Dr Bernstein's site
http://tinyurl.com/3
r8ku8 NMS Society
http://tinyurl.com/4
yx83g Netrition & Metabolism article

Posted by: phishery, Highlands Ranch, CO, USA on 4:00am Wed 9 Apr 08
This is a fanastic article Dr. Morrison--keep up the good fight. As a reference I have had tremendous success in achieving much tighter control over my blood sugars by moderating my carb intake. It has become a much less frustrating experience trying to constantly chase blood sugars and in fact testing my blood sugar is far easier and less frequent then trying to maintain good blood sugars while on a high carb diet.

Congrats again. And as mentioned above the linke to dsolve is mistyped it should be http://www.dsolve.co
m
Posted by: gdebussy, USA--Washington State on 7:15am Wed 9 Apr 08
I am responding to what Hope Warshaw implied, that doing a Bernstein-type is unsustaintable for the rest of one's life. I've been doing very low carb since May, 1999, first as the Dr. Atkins diet, and then the past 7+ years as Dr. Bernstein's diet. My elderly, insulin dependent Type 2 mother has been doing Dr. Bernstein's diet since April, 2000. even though I do not have diabetes, I plan to eat low carb for the rest of my life. This way of eating is quite sustainable, and very effective for managing pre-diabetes and diabetes.

I am very sad that people are not even told about using low carb for managing diabetes. I am very sad that people are unnecessarily condemned to heart disease, stroke, dementia, amputations, dialysis and blindness, because they haven't been allowed the chance see what a Dr. Bernstein-type diet can do for them. Diabetics can achieve and maintain non-diabetic normal blood sugars. My mother is proof enough for me.

I noticed the web site for Dr. Bernstein that some have posted is not the current URL. It is

www.diabetes-book.co
m

Anyone that wants to really learn how to control diabetes, go to Dr. Bernstein's web site, and while you are there, join the forum.
Posted by: hermit104, Scotland on 8:02am Wed 9 Apr 08
Brilliant article - I wish my doctor agreed. She lectures me on returning to "healthy eating" which at best gave me an average fasting blood glucose over three months of 16 mmols/l, whereas with low carb and the same tablets it is averaging below 7. Non-diabetic levels are around 4 - 7 - I know which I prefer!

Now how do we convince the rest of the medical profession and Diabetes UK?
Posted by: Katharine Morrison, Mauchline on 1:50pm Wed 9 Apr 08
That is a very good question Hermit.

There is a conference for the health professionals who look after diabetic patients in Edinburgh on the 7th October this year.

http://www.diabetesi
nscotlandconference.
co.uk/

I will submit an abstract for presentation at this conference. Whether it is accepted or not will be interesting.

There is a terrible culture of fear, blame, denial and avoidance at all levels of the NHS. One way of dealing with this sort of working environment is to fit in with whatever is fashionable at the time. It is extraordinarily hard to acheive change no matter how beneficial the changes will be or how detrimental the currrent situation is. The way group dynamics work means that the larger the group the less intelligently it functions. The NHS is a very big group of people indeed.

Steven's hbaic is currently 5.3% and the average for his age on a recent European study was 9.8%. There has been no improvement in hbaic levels for over 20 years despite the changes in monitoring and insulin therapies. A study recently reported in the BMJ showed that 40% of children or adolescents will have microalbuminuria which is a marker for renal damage within ten years of diagnosis. In addition renal disease accelerates much faster in youngsters than people who develop diabetes later in life. The only thing that makes a difference is very strict glycaemic control, yet young people and their parents get no opportunity to learn about the low carb option at NHS clinics.

Jorgen Vestig Neilsen found a 20 fold reduction in hypoglycaemic events once type one diabetics had stabilised their insulin on a 70-90 g of carb a day eating plan.

Low carbing reduces or eliminates the features of metabolic syndrome which is a cluster of markers for cardiovascular disease.

Low carbing reduces the doses of insulin and other drugs needed and sometimes allows a person to stop insulin or their drugs for diabetes altogether.

There is a human cost and an economic cost to diabetes which we must face together. If patients wait for health professionals to act as a group on their behalf it could be too late to prevent that hypoglycaemic induced car crash, that amputation, that heart attack, that stroke, the onset of progressive renal failure, or that retinal bleed that will determine their personal future.

The good thing about the internet is that like minded individuals who want to give diabetic patients and carers a choice over their dietary and educational options are able to provide support, education and advice directly.

Posted by: F16, Glasgow on 7:20pm Wed 9 Apr 08
This is a great article and discussion. And thanks for all the links.

I have been diabetic (type 1) for 10 years and am miserable. I have put on 5 stones, never have any get-up-and-go, have horrid mood swings, and my energy levels are zero. I was told that consuming complex carbs was the way forward but it didn't work for me. Then I was introduced to the DAFNE thing (eat what you want and adjust your insulin) but that didn't make me feel healthier either. I came across Bernstein 2 years ago and thought I'd found the answer to my problems but my diabetic specialist (I see a different doctor every time once a year - woopee) told me he was a quack and his ideas were unfounded nonsense. My GP was a little more positive but told me to be careful if going down the Bernstein route. I didn't follow Bernstein as I believed the experts I spoke to must know more than I do. The result is that I am very unhealthy (in body and mind) and feel like throwing the towel in and eating whatever the hell I like.

This article has given me some hope. I look forward to reading the information on all the links - and I'll look out Bernstein's book and his cookbook.

Low carbs it is from now on. It has to be. Nothing else has worked so far.

Thank you Katharine Morrison.
Posted by: Anna, California, USA on 7:40pm Wed 9 Apr 08
I second the recommendation to review the info on www.bloodsugar101.co
m. The info is well-researched (based on peer reviewed research), is very up-to-date (maybe even more current than your doctor), and is explained in a clear and organized manner.

In 1998, at age 36, I was diagnosed with gestational diabetes during my only pregnancy. A whole food, low carb diet was the best way for me to keep my blood sugar in tight control without insulin or medictions (much tighter control than suggested for non-pregnant diabetics). The ADA recommended "exchange" diet gave me higher blood glucose readings than my regular non-LC diet, which I find hilarious). With a LC diet the last third of my pregnancy I gave birth to a healthy average-sized baby. I gained a a very healthy amount of weight, with just a few pounds to lose after the birth (which was burned off with 6 months of breast-feeding). If a whole foods LC way of eating (not processed foods) is healthy for a pregnancy, then it's reasonable to assume it is healthy for everyone for life.

A few years after my pregnancy when I was back on my regular higher carb way of eating, I began to gain some weight (about 5 pounds of year) so I again followed a LC diet to lose the weight (20 pounds). Experimentation taught me that including sugars and starches in my diet put on weight. My husband joined me in LC and he lost about 35 pounds.

Later, when I reviewed the info at www.bloodsugar101.co
m I realized that I probably still had an underlying glucose metabolism problem, but because my LC diet was effectively treating it, my doctors had failed to effectively screen for impaired glucose metabolism, despite my history and risk factors. If I had been heavier, perhaps they might have investigated it sooner or more aggressively, but because LC kept my weight in a normal range, I had to push and insist on a Glucose Tolerance Test, which was abnormal (prediabetic). I have no doubt that if I hadn't been on a LC diet for several years, I would have progressed to T2 diabetes already (many common high-carb foods will give me diabetic glucose test readings).

Low carb diets are not so hard to stick to, if one is informed and motivated to stay healthy (certainly having a healthy baby is good motivation, too). Using a glucose meter to experiment with foods makes it much easier, too, because it is easier to determine exactly where one stands.

One of the keys is having good low carb cookbooks for inspiration (especially ones that emphasize real foods instead of manufactured fake "low carb versions" of high carb foods. I think I have a better diet now, with more fresh, home-cooked foods and less processed junk foods. I eat more veggies than many vegetarians, I'll wager. I also eat a lot more natural fats than I used to, because that's what I burn for energy, instead of carbs. It's like running on premium fuel instead of cheap gas.

Research is finally coming out showing that natural, unprocessed fats are not only not harmful, they are healthy. Despite the claims that long-term effects of LC diets are not known, one only needs to look back to the pre-agriculture ages. Humans were naturally eating diets lower in sugars and starches (especially grains), because concentrated carbs were not available everywhere, all year. There is little reason to attribute younger ages of mortality in stone-ages with stone-age diets (more likely due to injuries, infection, and lack of modern medical treatment now take for granted. Even in America and Europe, life expectancy was still at stone-age levels until the last 100 years or so. Throughout the ages, there were plenty of people who lived very long lives (70s, 80s, and longer). There is no evidence that stone-age diets prevented achieving such longevity.




Posted by: F16, Glasgow on 8:03pm Wed 9 Apr 08
Wow... I've been on most of the links and am feeling overwhelmed by the amount of information and advice.

Other than the Bersnstein book can anyone recommend a simple guide for idiots like me?

I'll also go through the DSOLVE site and follow their advice.

Also, what foods are low in carbs? Unfortunately it is only processed junk that has the food guide on the side of the pack, if only carrots etc had the same...
Posted by: Dallee, NY, USA on 8:41pm Wed 9 Apr 08
It steadily amazes me that a low carbohydrate (i.e., no or limited baked goods, starches, beans, grains and fruit) is labeled "controversial," because it was once the best way to approach diabetes.

As was recently observed: "The dietary recommendation for diabetes in a prominent internal medicine textbook from 1923 was 75% fat, 17% protein, 6% alcohol and only 2% carbohydrate. The recommended total daily energy intake was 1,795 Calories per day."
The link is Article URL http://www.nutrition
andmetabolism.com/co
ntent/5/1/10

Is the answer for a diabetic to limit the number of carbohydrates ingested to 30? That's a good starting point, but diabetes seems to be remarkably complex because there are so many variations in metabolic systems and how they can go awry. Some can go higher, but it still goes back to the basic concept that all diabetics have a flawed ability to use the glucose which comes from carbohydrates and the "extra" unused glucose floating around the body will be deposited as fat (if you're lucky) and/or lead to one or more of those diabetic legion of health problems (if you're not so lucky).

One of the best answers is frequent blood glucose testing by individual blood glucose meters, which will immediately tell you if you have too much glucose in your blood. Anyone whose life is touched by diabetes should support ready access to diabetes testing strips. Quarterly testing (A1C testing) doesn't allow fine-tuning of a diabetic's specific conditions.

On food choices, Dr. Bernstein's recommendations are on line and can be read at no cost here:
http://www.diabetes-
book.com/book/chapte
r10_4.shtml

As to my experience, once I was diagnosed with diabetes, I immediately tried the "healthy diabetic" recommendations and found that supposedly healthy grains (oatmeal, whole grain bread) and fruits (watermelon) raised by readings to more than DOUBLE the level where damage occurs. I quickly found the Bernstein book and have lost 50 pounds and resolved a number of related medical issues. The trade-off is more than worthwhile.

The only caution I would give is that, if you are on insulin, go low-carb gradually -- also take a look at the DSolve website, do some research, use your meter consistently, and consider staying in touch with your doctor because your need for insulin could swiftly decrease and you need to be prepared for those adjustments.

And, I think Dr. Morrison is remarkable and that the Herald has done a great public service by covering this subject. Could more be in the offing? It would be very welcome.

Hope this information helps.

Dallee
Posted by: Katharine Morrison, Mauchline on 10:06pm Wed 9 Apr 08
Hello again,

Dear F16 don't despair. Join the "Bernies" at Dr Bernstein's Diabetes Forum where we can have a good old blether about how to sort out your difficulties.

You are hinting that your glycaemic control has not been as good as you would have liked. Even though this is the case many complications can be reversed with normalisation of blood sugars over an extended time. Your mood could well be due to blood sugar swings and this can be sorted out quite quickly.

A typical day for me is:

smoked trout with scrambled eggs made with butter and double cream. tomato. (7g)

Chicken caesar salad. (no croutons) (10g)

Steak fahitas. Steak, seasoning, fried in macadamia nut oil, with shallots, peppers, avocados, sour cream, salsa. (15g)

A lump of smelly cheese eg Brie de Meaux.
A cox's orange pippin. (20g)

2 glasses of dry red wine. (10g)

Milk in tea all day (10g)

Daily total: 72g carb.


This is why I have had no trouble sticking to a low carb diet for 5 years. I love it !

I do appreciate that this is a lot more expensive than breakfast cereal and toast, soup and sandwiches and pasta and tomato sauce.

There is a considerable amount of information on Dr Bernstein's site and on Dana Carpender's "Hold the Toast" site on how to low carb on a budget.

A wonderful site for low carb recipies is :

www.carblite.com

Since I made their roast chicken in butter, garlic, shallots and thyme, I have not made it any other way.


Anna, well done with your pregnancies. In the BMJ last week there was a commentary on how miserable the outlook for pregnant diabetic women and their babies is. Again, they have hope for the technical solution - insulin pumps - as if that is really going to solve things. Dr Lois Jovanovick is a type one diabetic herself. She works at the Sansum Research Centre in Santa Barbara CA and looks after pregnant women who have type one and gestational diabetes. As she has a large Hispanic population she has more than her share of diabetic mums. She aims to give these women normal blood sugars and she manages them with what I describe as the liberal end of the low carb spectrum: a limit of 30g of carb for each meal and optional snacks of no more than 15g. In her lecture presentation at www.presentdiabetes.
com she has a photo of her last 50 mums and babies. Normal blood sugars and no complications. It would certainly be nice if NICE took notice.

Dallee, thank you very much for your support and reminder to everyone who uses insulin or sulphonylureas. The reduction in medication dosage that most people experience when transitioning to low carb is large and you need to plan things out very carefully with your doctor.

Posted by: pattidevans, Cornwall, UK on 10:48pm Wed 9 Apr 08
I am almost in tears that at LAST someone in the medical profession in the UK has realised that low carbing works! I realised this with the help of enlightened diabetics some 4 or 5 years ago, since when my Hba1c has not been above 5.7 (this is as a LADA on insulin). Initially I followed the NHS dietitian's advice, had an Hba1c of 7.8 and gained nearly 2 stone.

I have since been a moderator in http://www.diabetes-
insight.info and launched a diabetic advice forum at www.diabetes-support
.org.uk
I hear people come in who are newly diagnosed, confused and determined to follow the "starch with every meal" regime.

The other seasoned members of both forums try to explain how this isn't a good idea... there is resistance. Recently I have felt totally disempowered by the medical profession who advise "eat a healthy diet high in starches and T2s don't need to test because we will do Hba1c's on them". Excuse me?????

I have known without a doubt, for a long time now, that curbing the carbs and "eating to your meter" is the way to go. It seems to me to be so simple and such an easy way to limit the damage for the future which in turn will limit the cost to the NHS... Just exactly WHY are most of the medical profession so short sighted?

Dr Katharine you are a beacon of hope! I would be honoured if you would visit either of our forums and post a message!
Posted by: pattidevans, Cornwall, UK on 10:54pm Wed 9 Apr 08
PS I have a great diet! I love my food, I am a gourmet cook and my husband never feels the lack of "carbs". We eat much much better than any of our colleagues in our respective offices. OK, I do cook from scratch most days, but I can cook and freeze for those days I am working late. Anyone needs recipes.... contact me!
Posted by: Katharine Morrison, Mauchline on 7:52am Thu 10 Apr 08
Hi Patti,

I will meet you online. I didn't know there was a UK low carbing diabetics group !

Keep up the good work.
Posted by: aldo69, Glasgow on 11:59am Thu 10 Apr 08
kevinm wrote:
I have been low-carbing happily for six years after gaining a great deal of weight on low-fat, and there is nothing "onerous" about low-carb whatsoever. All of my blood lipid and fasting glucose profiles are very improved. No, I have never started acting like "Basil Fawlty", unless you think losing your limbs and independence is somehow a better outcome? I have more energy and mental clarity and sleep better as well, which are no small benefits. The nutrition and metabolism article mentioned above, endorsed by a growing body of independent experts, lays the research-based argument out - low carb reverses ALL known sypmtoms of metabolic syndrome easily and simply, including dramatic reduction of triglycerides, without need for exercise. This information is being repressed by the medical system for all the reasons mentioned above. Science has made no progress in explaining the modern medical crisis, and will not do so until it recognizes these as metabolism-based. You owe it to yourself to take your health back into your own hands. Here are some more links for further medical information: http://rjr10036.type pad.com/askdrvernon/ (Dr. Mary Vernon) http://www.proteinpo wer.com (Drs. Michael and Mary Dan Eades) http://www.diabetes- normalsugars.com (Dr. Richard Bernstein) http://weightoftheev idence.blogspot.com (Regina Wilshire) http://livinlavidalo carb.blogspot.com (Jimmy Moore) http://drbass.com/ro sedale2.html (Dr. Ron Rosedale on Insulin) http://www.second-op inions.co.uk/taubes. html ("The Soft Science of Dietary Fat" - Gary Taubes) http://www.amazon.co m/Good-Calories-Bad- Gary-Taubes/dp/14000 40787/ref=pd_bbs_sr_ 1?ie=UTF8&s=books&qi d=1203358056&sr=8-1 (Good Calories, Bad Calories, recent book by Gary Taubes laying out a great deal of research info supporting low-carb.)
Thanks for all of the info kevin

As an IDD for 22 years with no complications and very good control, but having gained a fair bit of weight over that time, I am intrigued by these concepts and feel that I have almost become addicted (as one other poster commented) to eating too many carbohydrates.

My concerns, on a personal level, are around changing from the diet I have followed for so long and losing control of my blood glucose and having multiple hypos - a very serious consequence.

If you are IDD I am very surprised you have never acted like a 'Basil Fawlty' - have you never had a Hypo???

I give you the benefit of the doubt, but feel you may not be diabetic at all and perhaps just another US-based blogger who has landed here to brainwash us all with your views (we get them a lot - Scientology, Embryo research, abortion). These views on carbs may be valid, and I will look into them further for myself, however no-one who has had IDD should be under any mis-apprehension that this solution is the panacea to all of your problems.

Thanks for listening

Aldo

Posted by: Katharine Morrison, Mauchline on 2:29pm Thu 10 Apr 08
Hi Aldo,

Nielsen J V, Jönsson E, Ivarsson A. A low carbohydrate diet in type 1 diabetes: clinical experience - a brief report. Ups J Med Sci 2005;110:267-273

If you copy this paper into your google search box the paper should be easily found. It is also in the dsolve.com downloads section.

Dealing with unpredictable hypos is indeed a serious problem for insulin users. There are a lot of techniques you can use to minimise meal/insulin mis-matches to substantially decrease the frequency and severity of these. Reducing the amount of carb is the main technique but advanced insulin techniques that are not yet taught mainstream help too. I would say the most important of these is the "7 unit rule". You can read more in the insulin users section of the How to course at www.dsolve.com.
Posted by: F16, Glasgow on 4:26pm Thu 10 Apr 08
I'm for giving the low carb route a try as everything else has been poor for me. However I am worried about the 'side effects' of the low carb diet - constipation, not eating 5 fruit a day, etc. Also, the recipes use a lot of eggs and other ingredients which seem harmful to someone with high cholesterol (me!).

I'll look into it further but am feeling fairly positive so far. Here's hoping...
Posted by: Katharine Morrison, Mauchline on 6:19pm Thu 10 Apr 08
Hi F16,

There are many opinions written about low carb diets and as you read up on the science behind it you will be able to understand what is the truth, what is a half truth and what is an untruth.

You can have 5 portions of many different vegetables and several sorts of fruit a day even on the strict Bernstein diet, but these all tend to the low glycaemic types for optimal blood sugar control.

Many of us low carbers eat lots of foods that some consider to be unhealthy such as red meat, eggs and dairy produce. There has been a lot of research in this field and I think you will be surprised at how little evidence supports this "unhealthy" label considering the amount of print space and repetition that has been given to the "cholesterol/ saturated fat causes heart disease" hypothesis.

Dr Bernstein's site has some good articles about the fat/cholesterol research, particularly Gary Taubes and Dr Mary Enig's articles.

Dr Malcolm Kendrick, a General Practitioner and fellow Scot, has written an entertaining book, "The Great Cholesterol Con" which is a good primer. If you search you tube, there are several short films of him explaining what does and does not cause heart disease.

There is an entire food and drug industry which are making profits out of the cholesterol/saturate
d fat heart disease theory. It is in your interests to find out whether the theory stands up to scrutiny or not. Diabetics lives are made utterly miserable by microvascular complications such as blindness and painful neuropathy but it is more often heart attacks and strokes that kill them.

I will be interested to hear what you think about the causes of heart disease once you have had a good look at the information.

I'm glad you brought this subject up. We are all short of time and it is so easy just to accept things without looking deeper.
Posted by: F16, Glasgow on 7:03pm Thu 10 Apr 08
Thank you - I'll get hold of that book ASAP. And watch the YouTube films.

You really have turned my thinking totally around this week and I am more positive about my future than I have been in a decade. The diabetes has been controlling me, and it's time it was the other way around.

I now hope I have the courage to say "no thanks" to the dietary advice I have been getting from the specialists I see - advice which, whilst it may work for some, has not been good for me.

I have joined the forums (DSOLVE, Bernstein and another) and hope to improve my understanding and education through chats etc., with likeminded fellow 'sufferers'.

Many thanks.
Posted by: gdebussy, USA--Washington State on 7:11pm Thu 10 Apr 08
Aldo, I don't know if you are including me in your "perhaps just another US-based blogger who has landed here to brainwash us all with your views" category. I do not have a blog, nor is it my intent to brainwash you all with my view. I "landed" here because Dr. Morrison sent me the URL for the report. I have high regard and respect for Dr. Morrison. I support her because I know she is right in what she is doing. I wanted to respond because of Hope Warshaw's statement that a Dr. Bernstein-like diet is unsustainable. It is very sustainable, and this is from a person that hates to cook.

I truly believe in using low carb to manage diabetes, and I've used Dr. Bernstein's method for my elderly IDD type 2 mother for 8 years. I presume you are using IDD strictly in terms of Type 1. However, my mother is essentially a Type 1 now...makes absolutely no insulin of her own because of typical diabetes management protocols failure in the US. The causes may be different between the commonly accepted definition of Type 1 and Type 2s, but the effect is the same...my mother is totally dependent on insulin to survive. The added twist is that my mother has insulin resistance of the Type 2, but that also isn't so different because more and more Type 1s are acquiring insulin resistance because of the high insulin doses required to manage the effect of the high carb diet.

I follow the Laws of Small Numbers: Small input, small mistake; large input, large mistake. When one understands what this is, it means hypoglycemic incidents are greatly reduced. Here is the URL to Chapter Seven of Dr. Bernstein's book called The Laws of Small Numbers: http://www.diabetes-
book.com/book/chapte
r7.shtml

My mother uses NPH twice a day for basal insulin. The morning dose is about 6 units. Her bedtime dose is about 4-5 units. She uses Humalog for her fast acting. She requires about 5 units for breakfast; about 3-4 units for lunch, and about 3-4 units for supper. I know fairly closely how much blood glucose is generated by one gram of bioavailable carb...about 5 mg/dl. That's about .28 mmol. I also know that one unit of Humalog will lower her BG level about 20 mg/dl, or about 1.1 mmol. Because I am working with such small numbers, it is very easy to manage diabetes without hypo incidences. I'm not saying we never have hypo incidences, but I am saying these incidences are not dangerously low, as compared to what can happen to a diabetic using large amounts of insulin to try to cover large amounts of dietary carb.

Back in 1992, mom's doctor sent her a letter, which I have. Her A1c was 11.9, which at that time corresponded to an average blood sugar of 240. I have a copy of insulin instructions given to mom by her doctor: breakfast 25 units NPH, 15 units R, plus adjustment from sliding scale if BG was over 200, which it usually was. Lunch, mom was to use the sliding scale for Regular insulin, which resulted in even more Regular, around 10 units more, because her BG was high. Dinner's insulin was 10 units of NPH and 10 units of Regular, plus the sliding scale if blood sugar was over 200, which it often was. I have many of my mother's log books from over the years. I can tell you, her BGs averaged well over 200.

Finally, in April, 2000, I totally took over mom's diabetes management. Her A1c in June 2000 was 7.3; it was 7.0 in Aug; April 2001, it was 5.9; Nov 2001, 5.8; Feb 2002, 5.1; Dec 2002 4.8, all the A1c's since then have averaged around 4.5. I don't know about you, but what I've seen while managing mom's diabetes convinces me that low carb is the best way to manage diabetes.

Incidently, Dr. Bernstein is a Type 1, diagnosed at age 12. He is now in his 70s, and still working full time in his practice, he works out with weights, and pursues his hobbies. Also, he is the one that made it possible for us to have our home meters. He had to go outside of the US to accomplish it because when he tried to get the medical community here to endorse it, he was told that people wouldn't be interested in checking their BG at a home. How wrong, once again, was, and is, the US medical community! So, every time you use your BG meter, remember it was Dr. Bernstein that made it possible. ;-)

Posted by: gdebussy, USA--Washington State on 7:36pm Thu 10 Apr 08
I forgot to mention that Dr. Bernstein does free monthly teleseminars. http://www.diabetes9
11.net/askdrb/index.
php is where you can register to listen to the teleseminar online. You can also submit a question to Dr. Bernstein for that seminar, and hopefully, your question will be answered during the seminar.

April 30th is the next teleseminar. Because of the time difference, it happens while people in the UK are sleeping, but there is an mp3 made of each seminar and it's available for download for a few days after the seminar.
Posted by: yksin, Anchorage, Alaska on 10:12pm Thu 10 Apr 08
Great article & discussion. I'm a prediabetic with PCOS, began to overhaul my eating & exercise two years ago after my mother died of complications of Type 2 diabetes. With all that I've learned since, I'm convinced that her life could have been much longer, & of higher quality, were she not following the conventional advice of the American Diabetes Association about high carb/low fat diets. I'm going a different route -- greatly lowered carbs -- & I'm pretty sure that my health will go a different route too. Congratulations to Dr Katharine Morrison for the important efforts you are making to bring this vital information to the UK. And shame on the ADA & NHS & whomsoever else for however long they continue to promote high carb diets for diabetics that only make people sicker & sicker.