I am a type one diabetic. As a GP I've felt qualified to control my own diabetes for 25 years. I controlled my blood sugars and I exercised a lot. But the side effects of my disease came anyway, fogginess of thought and vision. Heart palpitations, and more frequent hypo incidents.

About Dr. Lake

Dr. Ian Lake is a GP in Cheltenham, Gloucestershire. He has had a long term interest in preventive medicine and even set up a weight management research project in primary care in collaboration with TescoDiets. This was because of a lack of dietary advice in the NHS. The project used practice nurse weight management expertise combined with TescoDiets online nutrition support. It produced results comparable with all of the best current commercial providers, and was commissioned by the local PCT cluster. The project won the GP Awards Clinical Team of the Year, Nutrition award in 2012.

However, this was less that a triumph. If this was very good, it's still a failure. Patients were still sick and getting sicker. Including Dr lake himself.

Dr. Lake is strongly influenced by Richard Bernstein's Diabetes Solution book , and subsequently the approach by Robert Lustig, Tim Noakes, Eric Westman, Nina Teicholz, and many others in the field.

In the past year he has adopted a ketogenic diet to great benefit and is keen to promote to all patients who are vulnerable to carbohydrates.

Ian Lake, GP and Type 1 Diabetic

A low-carbohydrate high-fat diet has revolutionized my medical practice.

Dr Ian Lake 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.

Ketogenic Diet Resource

The main author of these two books has a very useful web site, The Ketogenic Diet Resource.

Restore Your Health with a Ketogenic Diet
Ketogenic diets allow you to eat real foods in the form of natural fats and protein (meat, fish, poultry) but severely restrict the amount of carbohydrates (sugars and starches) you are allowed each day.

These are electronic books, in PDF format. At about US$15 each, the one I purchased cost me NZ$22.00. Very satisfactory to read on your screen. I printed mine because I wanted to be able to show other people.

The book I have has a technical section at the back, explaining medical terms, and giving references for about 140 scientific papers.

There is also a good section on ketogenic foods and cooking. There is a list of places to get ketogenic recipes, including the The Ketogenic Diet Resource.

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.