I am writing this after a gruelling weekend shift as an A&E doctor. Normally I am a naturally cheerful person but I came home feeling very down – an increasingly common feeling in my 23 years of working for the NHS.
It is impossible to provide good care when patients, as often happens, have to wait for hours in the emergency department for a bed, and there are dozens of patients in the corridor all day long.
But the worst part is that many of these confessions – perhaps a third – could have been avoided.
They result from elevated blood sugar levels and type 2 diabetes – and the complications that come with them, including strokes, heart attacks and cancer.
Coincidentally, just before my last shift started, I read a recently published research article that at first glance had nothing to do with my work.
The title (‘Initial findings from the NHS type 2 diabetes pathway to remission programme: a prospective evaluation of implementation in practice’) attracted little attention.
But this study, published in The Lancet Diabetes & Endocrinology, showed remarkable data from real diabetes patients (i.e., outside of a research setting) showing how their health could be improved in just three months by following a low-calorie, low-carb diet of shakes and soups.
You are what you eat, so eat the right foods to stay in top shape
Indeed, over the past decade, a new theory has emerged about the prevention and treatment of type 2 diabetes that has made me question everything I thought I knew about it.
Studies – including this new research – now show that compared to patients with type 2 diabetes who receive standard care (i.e., medications to control blood sugar levels, along with advice on diet and exercise), patients who follow a calorie-restricted, low-carb diet can lose an average of 10-15kg (22-33lb) – which they can then keep off. Half even manage to reverse their type 2 diabetes, so that they no longer need medication.
In fact, five years later, they have half as many diabetes-related complications.
Yet in medical school I was taught that the way to treat obesity and type 2 diabetes was to eat less fat and take medication for the rest of my life – an approach that has clearly failed for millions of people.
So many people could have benefited from this new lifestyle-first advice and avoided diabetes and the complications that come with it, which often lead to emergency room visits.
One of my patients last week was a 78-year-old woman with type 2 diabetes, high blood pressure, heart failure, angina, osteoarthritis, and depression.
She was so typical of the patients I treat. Chronically ill, she bounced between outpatient clinics and GP appointments, and was hospitalised every few months for a flare-up of one of her chronic conditions.
This time she had increasing pain in her left leg. When I examined her, it felt cold and every movement caused agony. She had an ischaemic limb – a vascular emergency caused by a blockage in the blood flow to the limbs. This can sometimes be treated with surgery to restore blood flow, but a scan showed that my patient’s diabetes had damaged the blood vessels so badly that they could not be opened.
There was no other option: she urgently needed an amputation.
As I moved on to my next patient, I couldn’t help but think about her plight: her precious independence was being taken away from her.
Over the years, traditional medical care had essentially failed her. For although all the clinical boxes had been ‘ticked’ and she was following the accepted best medication regimen, the underlying cause of her problems – a high-carbohydrate diet that was exacerbating her obesity and diabetes – had been encouraged rather than addressed.
And, tragically, this woman’s plight is mirrored in hospitals across the country. Obesity and diabetes rates have skyrocketed – as has disease, disability and illness as a result – and our NHS can’t cope.
But this is not a cry for more resources. More money may be a temporary palliative, but I have come to realize that until we address the underlying causes of the disease, no amount of additional funding will satisfactorily cure this flood of diseases.
Professor Rob Galloway says up to a third of the patients he sees in the emergency department each night could have avoided hospital by changing their diet and lifestyle
But this latest research shows that we can climb out of this valley without having to prescribe even more drugs that do not improve quality of life.
Lifestyle changes and a switch to a low-carb diet can help address the root cause of ill health, not just the consequences.
So why is it so effective? Once eaten, sugars and carbohydrates (which are broken down into sugars) are removed from the blood by insulin and stored as energy in the liver. The problem is that modern diets are full of ultra-processed, addictive, high-carb foods and, with our constant snacking, blood sugar levels are always high, leading to more insulin release.
Insulin is a hormone that tells the body to convert the carbohydrates we eat into fat. The result? Obesity.
And the more insulin is produced, the more resistant the body becomes to its role of removing sugar from the blood. So blood sugar levels stay high, and this leads to type 2 diabetes. The key here is that complications can arise as soon as your insulin levels start to rise – years before you are diagnosed with diabetes.
Rates of obesity and diabetes have skyrocketed, but cutting carbs can put you on the right track to a fit future
It is true that some people have a higher genetic risk of type 2 diabetes, but even then it can often be reversed with dietary changes.
In the battle to keep producing more insulin, many type 2 patients end up with daily insulin injections. One side effect, however, is occasional low blood sugar – hence the advice to eat carbs and snack regularly. But all this leads to even higher insulin levels, making us even fatter. It’s a catastrophic, vicious cycle.
But now we do it in a different way.
I recently visited a GP practice, Mythe Medical Practice in Tewkesbury, Gloucestershire. I had heard that they were testing a new approach for patients with type 2 diabetes, similar to the one used in the recent study.
The plan was set up by GPs Dr Caroline Butler and Dr Simon Fearn, who offered patients with type 2 diabetes (or at risk because they were overweight) a three-month course of sustainable lifestyle changes. As well as avoiding ultra-processed and high-carb foods, they advocate a diet of vegetables, dairy, eggs, nuts and low-sugar fruits such as berries – and stress the importance of exercise, cutting down on alcohol, managing stress and getting a good night’s sleep.
The approach has transformed patients’ lives. I spoke to one, Sharron Wilson, 71, who was feeling depressed when she first saw Dr Fearn. She is 5ft 6in tall and weighed 220lb (more than 16st), and her obesity had led to knee arthritis, high blood pressure and type 2 diabetes that were so poorly controlled that even four insulin injections a day weren’t working.
The traditional model of care would have seen her depression as a chemical imbalance and prescribed antidepressants. But Dr. Fearn suspected her condition was a response to her poor health. Instead of a medical prescription, he prescribed the lifestyle course.
A trial at a medical practice in Tewkesbury, Gloucestershire, for patients with type 2 diabetes, recommended a diet of vegetables, dairy, eggs, nuts and fruit, low in sugar, as well as exercise. One participant lost 2st in six weeks and her depression lifted.
Sharron lost over 15kg (over 2st) in six weeks and her blood pressure improved so much that she needed half the amount of her previous tablets. Her cholesterol levels have improved and so has her diabetes, going from four insulin shots a day to just one.
She told me, ‘I’ve tried diets all my life, but I was so hungry that they all failed.
“This is different. I have a new mindset and feel empowered to make changes, which is easy because I’m not hungry anymore. Not only have I lost weight, I feel like a different person, with more energy, and I no longer feel down.”
Sharron could have become another patient in my corridor. Instead, as long as she continues with this new approach, she has years of healthy life ahead of her and will not be a burden to the NHS.
Dr. Butler and Dr. Fearn’s patients also used a free website and app (lowcarbfreshwell.com) that you can use to improve your own health. Consult your doctor before making any major changes.
Addressing the underlying causes of disease in this way is the only sustainable, viable solution to improving people’s health and reversing the tide of ill health that the band-aids I apply in the emergency room no longer seem to help.
@drrobgalloway