Ian Lake, GP and Type 1 Diabetic
A low-carbohydrate high-fat diet has revolutionized my medical practice.
The NHS, Diabetes UK, and NICE, recommend the DAFNE protocol for the treatment of diabetes. "DAFNE is a way of managing Type 1 diabetes and provides people with the skills necessary to estimate the carbohydrate in each meal and to inject the right dose of insulin."
The protocol has evolved out of practice. It's not science based. There were multiple objectives, to control blood glucose, to reduce the fat in the diet because heart disease is a risk for diabetics, and to allow diabetics to eat like everyone else. It was made possible be the discovery of insulin, and that certainly saved lives. The problem is that using DAFNE, over time diabetes gets worse not better. I was a good example of that. It's plain enough to every GP, that the protocol doesn't work very well.
Sadly, because researchers are afraid to put people on a high fat diet, they keep up the pretence that the lowest number of carbohydrates a diabetic should eat is 30% of total energy. The call that a low-carbohydrate diet. The effect of a very-low-carbohydrate diet is seldom tested.
Because of this failure, people are going online seeking solutions. It's not hard to find that protocols that work. That simple fact is quickly making the recommendations of the NHS and NICE irrelevant. About three years ago (2013) I stumbled on LCHF diets in that way.
I've discovered that as a type one diabetic, on a very-low-carbohydrate diet, if I get the amount of insulin I inject right, I don't need to eat any carbohydrates at all. If the amount of fat in the diet is high and the carbohydrates are low, my blood sugars are very stable, minimizing the amount of insulin I need. I now use 30% of the insulin I used to use.
Wriggle Room for UK GP's
According to the NHS, UK GP's are now permitted to recommend a diet based on patient preferences. That's enough wriggle room for our practice to HELP many diabetic patients discover a better diet. We don't want to be vulnerable to attack, by the NHS, by NICE, or by other GP's. We don't expect to face court action like Dr Tim Noakes in South Africa. What we do is patient led.
However, we have found Dr Richard Bernstein's book "Diabetes Solution" is inspirational. Bernstein has had type one diabetes for 60 years and is complication free. He eats less than 30gm of carbohydrate every day, and has done so for more than 40 years. (Who says that low carbohydrate must be unsafe and is unproven over a long time? Only people who have never tried it.)
I'm not the only diabetic in our practice. My own success with a LCHF diet encouraged others to try it. That gave us confidence to help or patients move in this direction if that's what they want. Most GP's don't have enough experience of LCHF and ketogenic diets, to feel confident about that.
"A Diabetes Protocol that Works"
Good Science on Our Side
From the journal "Diabetology and Metabolic Syndrome."
Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit. 2012 by Jørgen Vesti Nielsen, Caroline Gando, Eva Joensson and Carina Paulsson
Findings Altogether 48 persons with diabetes duration of at least 12 years, and for some as long as 36 years, attended the course. HbA1c was greater than 6.1% (Mono-S; DCCT = 7.1%). Mean HbA1c for all attendees at start, was 7.6% plus or minus 1.0%. After 3 months HbA1c was 6.3 plus or minus 0.7%; and after 4 years, 6.9 plus or minus 1.0%. The figures get worse because of the 50% drop-out rate. But they are still amazingly good.
In the group of 23 (48%) adherent persons mean HbA1c at start, was 7.7 plus or minus 1.0%, After 3 months HbA1c was 6.4 plus or minus 0.9%; and after 4 years, 6.4 plus or minus 0.8%. They quickly became "normal" and stayed that way for 4 years.
The number of non-adherent persons was 25 (52%). HbA1c in this group at start, was 7.5 plus or minus 1.1%. After 3 months HbA1c was 6.5 plus or minus 0.8%; and after 4 years, 7.4 plus or minus 0.9%. They stuck it out for at least three months, but eventually went back to the old diet.
Conclusion Attending an educational course on dietary carbohydrate reduction and corresponding insulin reduction in type 1 diabetes gave lasting improvement. About half of the individuals adhered to the program after 4 years. The method may be useful in informed and motivated persons with type 1 diabetes.
I wish Public Health England, would read this study and act on the information it provides. I would hope in the future that type one diabetics would be encouraged to adopt a ketogenic diet from the time of their early diagnosis. I also hope that people with type two diabetes are encouraged to switch the a ketogenic diet quickly, all at once. Then you get a clear transition and very quick benefits.