Something has been chewing away at my thinking for a year or so now: My consultants response when I asked why Low Carb eating is not rolled out as standard advice to every diabetic (both types) was “it’s too hard – we can’t expect patients to change their diet this much”. Does this imply that it is “known” in the medical establishment that cutting out carbohydrates is the solution ? I am starting to think I might be some kind of conspiracy nut job, and I keep winding myself up over this.
Recently Gary Taubes wrote a book called “The case against Sugar”, this has opened up debate and controversy. In a Journal called Cato Unbound an essay by Dr Yoni Freedhoff criticises Taubes’ assertion that sugar is at fault for rising obesity and diabetes. Part of Freedhoff’s argument is that sugar reduction is “too much” because a diet without sugar: if embraced, may lead to calls for extremes of action that even if enacted, aren’t likely to be enjoyable enough to be sustainable for most. Enjoyable! What?! Is this a medical Doctor arguing that even if this diet change is the solution it shouldn’t be enacted because it’s not enjoyable. Surely that’s the patients choice? Not the Doctors; who does he think he is? Calm down Neil…
Gary Taubes’ response is of course brilliant and gets to the nub of things:
Dr. Freedhoff is concerned with the advice he should give his patients to maximize their health, which includes maximizing their happiness. I’m concerned with identifying the causes of the epidemics such that we know what has to be done to stop them. If sugar is the ultimate cause of obesity and diabetes, however, which is at least a viable hypothesis, then I can’t agree with Dr. Freedhoff that his advice to his obese and diabetic patients should not include making this fact abundantly clear.
This is why I often evoke cigarettes as a comparison. Because, based on solid evidence, we are confident that smoking causes lung cancer, we do not advise smokers to smoke in moderation or to worry that non-smoking will make them unhappy. (It certainly will, at least in the short run. I can personally vouch for that.) We don’t assume that if we tell them that cigarettes cause lung cancer, this will reduce the likelihood that they’ll quit, because changing their behaviour for their own good may be an unrealistic luxury for them. We give them the knowledge and we let them decide. We don’t say, “what’s the smallest amount needed to be happy?” as Dr. Freedhoff suggests about dietary indulgences. We counsel, as Dr. Freedhoff also does, “not smoking.”
Ahh, as usual Gary has hit the nail on the head: Its’ my body, its my health, in what universe is it ok for Dr Freedhoff or my consultant to say its;’ “too hard”, or “its too much” ? Are they hoarding health knowledge for themselves and their own loved ones? I don’t think that’s the case, but I do think science and discussion cannot be held back because its unpalatable to the public.
Within a day of reading Gary Taubes response to Dr Freedhoff I attended a Diabetic Help Group run in an adjacent town. I went because I thought it may give some pointers regarding setting up a group in my own town.
An NHS dietician was giving a talk, it’s been nearly 2 years since the hospital told me to see one of their dieticians so I was eager to hear what the current advice was. It was well attended with approx. 25 diabetic sufferers (3 type 1’s the rest were type 2’s). Right off the bat the dietician started talking about carbohydrate reduction as the solution. She asked if anyone in the room was restricting carbs rather than calories, myself and 2 others put our hands up (the other two were type 2’s with dramatically reduced blood sugars). As she proceeded to talk about low GI foods and restricting carbs I could see jaws were dropping around the room. These were patients told to” base meals and snacks around starchy foods and healthy whole grain carbohydrates”.
She had some great questions for us :
Fruit? Spikes up blood sugar one of the other low carbers said.
Picture of a jacket potato on the screen… What about eating one of these… “It’s candyfloss” I answered.
Whats faster to act on your blood sugar… Wholemeal bread or a mars bar? “The Bread!” The room was shocked at this one.
It went on like this for a while, excess insulin wasn’t discussed as the problem for diabetes, the dietician said diabetes stems from obesity – I don’t think that is correct, but hey, the advice was the best I had heard so far from anyone in the NHS.
Toward the end I asked her a question :
“During all your treatments of diabetics, have you ever had any patient improve their blood sugar through any kind of treatment NOT involving carbohydrate restriction”…. A long pause. “No”… “except bariatric surgery patients”. I didn’t say anything (I was too slow), but bariatric patients are of course restricted in everything, including carbs.
Afterwards I explained that 2 of us are looking to set up our own self help group and would she come along and talk at it – she agreed.
Ref https://www.cato-unbound.org/2017/01/13/yoni-freedhoff/unintended-consequences-special-interests-sugar-view-clinical-trenches
