Diabetes Forum UK

Of course one of the main concerns of a newly-diagnosed diabetic is food.  What can and can't I eat?  What should and shouldn't I eat?  As previously discussed, many people start off with "avoid sugar" but of course there is more to it than that.

Dietary advice in the UK stems from the British Dietetic Association - the professional body of dietitians, in conjunction with the Department of Health.  Since this is the official source, most other sources of advice (doctors, nurses, Diabetes UK etc) follow the guidance given out by these two bodies.  After all they are the experts.

When looking at diet, the content of food can be broadly summarised as: Carbohydrates, fat, protein, fibre, vitamins and minerals.

Now there is no denying that much of the advice is good to follow, making sure that we are taking in enough vitamins and minerals and so on.  The sources for these are generally unprocessed fruit & vegetables, so that tends to be a main focus.  This also tends to cover our needs for fibre.

The problem with the official advice lies with protein, fat and carbohydrates (carbs).  These are the 3 elements which have an effect on the blood glucose, to varying degrees.  Carbohydrates raise the blood glucose level and controlling the blood glucose level is the main concern for a diabetic.  Fats slow down the effects of carbohydrates on the blood glucose although how much of a difference they make is up for debate.  Protein does not have that much effect on blood glucose except under certain circumstances.

The official dietary advice for diabetics regarding these three is exactly the same as for non-diabetics - "base your meals on starchy carbohydrates"   This makes no allowance for the fact that carbohydrates raise your blood glucose.  Furthermore, the advice is to eat as little fat as possible and not overdo the protein.

If you are thinking "that will just push my blood glucose up too high" you're right.  So why do they recommend a diet which seems completely contrary to all common sense?

The simple answer is that they are terrified of fat.  This seemed to start in earnest in the early 50s with the publication of a report which claimed to prove that in countries where the population ate less fat, there was less heart disease.  Almost overnight most of the western dietary organisations and governments seem to have changed their policy based on the idea that fat is evil.

It sounds pretty convincing until you take a look at this report in more detail and discover that it appears the report's author threw away all the numbers he didnt want to see.  The report is the "Seven Countries" study and when you realise that he started out with data from 22 countries, you get an idea of how much got thrown away to come up with the "fat is evil" conclusion.

Studies since then have been very weak with the most convincing ones showing improvements in heart health from reducing fat a little bit while keeping everything else the same.  However, studies where the carbohydrates are reduced instead and even increase the fat intake considerably, show far better results.

We have all been conditioned over the years to think of fat as evil, but the more you look at it in detail (not just a report's conclusion), the less it seems to be true.  In the meantime this leads our official dietary advisors to tell us to load up on the very things that push our blood glucose up

So we need to look at things in a different way.  What can we eat without pushing our blood glucose up?  Well the simple answer to that is to try eating different things and see what happens to the blood glucose.  Then learn from that process to work out what foods and in what quantities we can eat without affecting the blood glucose too much.  Since we know that fat slows down the effects of carbohydrates on the blood glucose and ignore the "fat is evil" message, we can see the effects of increasing and decreasing fat on our blood glucose as well.  

Over time we build up a picture of what works for us.  Everyone is slightly different in the way that their body reacts to food and although we can get a rough idea of what works for everyone most of the time, things might be a little different for each one of us.

What happens when people give this a serious try is as follows:
1)  Their blood glucose is lower and easier to control.
2)  Their risk of complications fall considerably.
3)  Their cholesterol improves, reducing their risks of heart disease even if they are eating more of the "evil" fat
4)  They end up eating things they like rather than what some book says they should eat.
5)  They usually lose weight despite increasing their calories if they are overweight (see myth #3).
6)  They feel better generally day to day because their blood glucose is more stable and not being "spiked" by carbohydrate-heavy meals.

I should also mention protein.  It has been found that people with kidney problems should avoid protein.  Since people with diabetes are prone to get kidney problems, advice has sprung up that diabetics should avoid protein.  However, there is no danger from eating protein until the kidney problems actually start, so there is no reason for most people to avoid protein in order to protect their kidneys.  As it happens protein has been found to reduce hunger so it makes you feel fuller for longer and if you are trying not to overeat, thats a useful bonus.

So when we are diagnosed we are all looking for easy answers and the dietary advice is right there from all the official sources.  It may be a little more effort, but trying things out for yourself and learning from the process is far more effective.

So the final question has to be "if we know this works, why do they keep giving us the wrong advice?".  There are various theories on this and certainly the research has been done, but some biased research has been done as well.  Studies into "low carb" diets place the goalposts in very different places.  The standard official advice is to eat 230g of carbohydrate per day.  Some "low carb" studies test as much as 210g of carbohydrate per day.  Others go as low as 50g of carbohydrate per day.  So the results from these studies are bound to be very different and the conclusions they reach are also very different.

So if you have been conditioned to believe that fat is evil and look at research, you are far more likely to focus on the studies with 210g of carbohydrate per day, which will favour your position.  You will ignore the study on 48000 canadian women over 8 years on a low fat diet who had no improvement in heart disease risk and many others.  So the argument continues to rage on.

In the meantime, the only way to be sure is to try things out for yourself, learn from the results and find a diet which suits you.  Your dietitian/doctor/nurse may not like it, but its not their body they're playing with.

And someday they may actually try it for themselves, instead of just repeating what their book says.

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

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Not a week goes by without me seeing someone claim to have a cure for diabetes.  Its odd because considering there are 2 million diabetics in the UK, you would have thought it would have made the news.

Except of course that it hasn't made the news because its nonsense. There are a number of tricks which are used to make this sort of thing believable but we can see through those.

1)  Its in a book by someone selling the product.  If something is in a book, it tends to be more believable until you realise that someone can write anything in a book, whether its true or not.  Its not as if anyone checks before its published.  So although we tend to think that books are a source of knowledge, we have to remember that books can just as easily be full of lies, half-truths and misunderstandings

2)  They give a reference to a scientific study.  If there's a scientific study that says cinnamon cures diabetes, it must be true, right?  No.  For starters, there is one and its wrong.  The problem is that studies start off small, find some point of interest which is worthy of further study and what follows is bigger and more rigorous studies to see if there's anything in it.

Cinnamon is a good example.  An initial study seemed to be quite promising for its effects on diabetes, until some more detailed studies were done and found that it actually has no effect.  

There's various reasons for this including the placebo effect where if people genuinely believe they are getting some wonder drug, they will think they are better than they are.  Or things may actually improve since the human mind is a wonderful thing.  So in order to test properly you have to give half the people the product and give the other half something harmless but tell them its the same thing and see if there's a difference between the two.  Crucially the people doing the study shouldn't know which is which either, in case that skews the result.  This is roughly what's referred to as a double-blind study since neither the researchers nor the subjects know who got what until the results are collated.

It was when double-blind studies started being done on cinnamon (or cassia) that it emerged there was no effect.

But that doesn't stop people from seizing on the original small study, claiming all kinds of wonderful things and selling wonder products.  Whether or not they intend to deceive you (or are deceiving themselves) they refer to the first small indicator study as absolute proof that their product works.

Now some of these people may just be conning you, using the study as an excuse.  Others may just not know what they are doing and have thought that 2+2 = 22.  But whether they are dishonest or not, both types are wrong.

3)  "They don't want you to know".  The conspiracy theory con.  They may tell you that there is this cure, which all the scientists know about, but the medical community is suppressing it so that they can make money out of selling you drugs instead of curing you.  

All kinds of claims are made for conspiracies in relation to diabetes and if all of them were to be believed then there is a conspiracy between every doctor in the world, all the drugs companies, all the government health advisors, all the food companies, sweetener manufacturers, the masons, the CIA, the FBI, MI6, Prince Philip, Elvis and the aliens who kidnapped him.

The message is simple.  What they are trying to hint at is "they won't let me tell you about the wonderful things this product can do".  There's a reason for that.  There are laws preventing them from making unproven claims about products.  So they can't claim that this wonder pill cures cancer without actually proving first that it cures cancer.  So the reason they are being silenced is that they don't actually have any evidence that it works.  If there was any evidence they would use it and be able to make the claim.

So this is all a "the big boys are picking on me" con.

4)  Its a natural remedy thats been used for hundreds of years in some developing country such as Peru - China is a favourite.  This is often used in conjunction with the "big boys are picking on me" line.

It may have been used for centuries somewhere.  That doesn't mean it works.  For centuries leeches were used in Britain as a treatment for almost everything.  They didn't actually work on anything, despite lots of claims that they did.

Basically, we know better now.

Plus, the research done by pharmaceuticals companies has to start somewhere and its generally with a herbal remedy.  Take metformin as an example.  Its a chemical found inside a particular south american plant.  They analysed it and worked out which chemical actually had any effect from the couple of hundred chemicals in the plant.  Now they just produce the bit that actually does some good and don't give you the other 200 chemicals, in pill form.  This was over 30 years ago.

Now what are the chances that this guy tripped over a wonder drug which the pharmaceuticals companies (with their massive research budgets) missed?



At the end of the day, if this guy's theory or pill actually worked, he would not be selling 58 copies of a book online or spamming you with special offers for his wonder pill.  He would be off in Stockholm claiming his Nobel Prize.

Except for me of course, I have these chinese pills which will make you lose weight, cure diabetes, make you fantastically attractive and wealthy.  I tested them on myself and here's my study's conclusion... well I would tell you but the big boys are trying to silence me.  But if you send $5000 to my nigerian bank account in used, non-sequential notes I'll send you a copy of my book ;)

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I've written about this before, but I can't do a series on diabetes myths without mentioning calories since they may be the biggest con and/or misconception in nutrition.

We are regularly told by health authorities, food manufacturers and the media that we need to eat a calorie controlled diet.  But why?

A calorie is a measure of energy and your body uses energy not only for movement - jogging, swimming, poking the remote control, raising your pint glass etc - but for keeping your body's automatic systems going.  So your brain uses energy all the time, your heart uses energy to keep pumping and so on.  So yes we do need a certain amount of energy for the body to keep going.  If we take in more energy than we use up, it gets stored in the form of fat and we put on weight.

So far so good.  So whats the problem?

The problem is that calories in food are measured by putting a certain amount of food into a calorimeter, setting fire to it and then measuring how much energy is given off.  Does your body set fire to food?  Mine doesn't.

The body simply does not use energy in that way.  All the parts of your body are made up of a collection of cells, which use energy in the form of glucose.  Its similar to the way in which the cooker in your kitchen may use fuel in the form of electricity or gas or wood or coal.  The fuel that your body runs on is glucose.

And it doesn't set fire to it.

As discussed in myth #2, the body makes most of this glucose from carbohydrates - because its easier to make it from carbohydrates than it is to make it from fat or protein.  But when they set fire to food in a calorimeter, it doesnt take into account whether its burning carbohydrates, fat or protein.

Protein is used mainly by the body for building and repairing itself.  Since thats what the body mainly uses it for, its unlikely to get turned into glucose.  Some sources suggest that as little as 10% of the calories in protein get converted to glucose in a human on a "normal" diet.  The rest is used for repair and building.

So when you set fire to a steak, all the protein in it burns and gives off energy - but thats not what the body does with protein so the number of calories from burning a steak bears no resemblance to what the body really does with it.

Its a similar story with fat.  The body can make glucose out of fat, but its harder than making it out of carbohydrates.  They are on safer ground here though since if the body already has enough glucose from carbohydrates, it will convert the excess glucose to fat and store it as fat.  But there's still a difference.

If the body does not have all the glucose it needs from carbohydrates, it will convert fat to glucose.  But this is much harder to do, so it  "costs" energy to make glucose out of fat.  So some of those calories get lost.  Some sources suggest that as little as 30% of the calories get converted to glucose in a "normal" diet.

When looking at the classic "calorie controlled diet", people avoid fat because there's more calories worth of energy in fat when you set fire to it.  These are usually foods with more protein in them as well - meat, cheese etc.  But if most of the calories in protein and fat are never used for energy, then even though they have more calories in them to start with, they don't all "count".

But the calories in carbohydrates do count.

So a calorie controlled diet drives you towards a diet which has more carbohydrates in it, less fat and less protein.  But you're likely to wind up eating more effective calories than before.  This is bad enough for non-diabetics, but for diabetics its positively insane because more carbohydrates means higher blood glucose.  Because its harder for the body to make glucose out of protein and fat, it takes longer.  So your blood glucose rises slower and either your pancreas or your injected insulin (if you use it) has more of a chance to keep up.

So unless there is a furnace in your stomach and your body actually DOES set fire to food, then counting those calories is likely to lead you down entirely the wrong path and have you pushing your blood glucose much higher than it needs to be.

On the other hand if it does then you are about to become immensely rich because you will be the first species on the planet which uses energy in the same way that they measure it.

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

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I remember at one point when I was a kid my mother saying "if you eat too many sweets you'll be diabetic" or something along those lines.  Its one of those "everyone knows" things which isn't actually true.  These days, more people are aware that its not true, but there is a general perception among the public that diabetes is all about sugar, so just have a cappuccino without the sugar, right?  Maybe I'll only have half this skinny muffin cos its probably got some sugar in it.

The situation is not helped by people talking about "blood sugar" rather than "blood glucose".  When you mention sugar, people have all kinds of preconceptions but if people started talking about "blood glucose" more often then people would not make the same assumptions they currently do about the word "sugar".

The way that most people think about sugar has nothing to do with diabetes.

We all eat or drink sugar in one form or another all the time, but that does not translate into having a lot of sugar in your blood.  In fact, since people think of sugar as being the white stuff in a bowl, there is NO sugar in your blood.  What we do have in our blood is glucose and the vast majority of it is not eaten in the form of glucose - the body makes it from other food substances.

So where does this glucose come from that appears in our blood?  A tiny proportion of it will come directly from the food we eat in the form of glucose.  Take cereal bars for example - all those lovely "healthy" ingredients are held together with glucose syrup.  But taking a look at the ingredients of most of the food we eat, theres nowhere near enough glucose to account for how much we have sloshing around our bloodstream - and the body needs that glucose so where does it come from?

Normally, the body will make glucose from carbohydrates.  Confusion arises here because "sugar" is a carbohydrate.  So is glucose.  The sugars are a small family of chemical compounds (everything is a chemical - even water) but this family of sugars is part of a wider family - carbohydrates.  What surprises most people is that most of the carbohydrates in a "normal healthy diet" do not come from sugars at all, but from starches - in the form of bread, potatoes, pasta, rice and products made with white flour.

So most of your blood "sugar" had nothing to do with sugar in the first place.  Your body made it out of potatoes etc.

There is another misconception about sugars in that its generally considered that in a diabetic, sugar will raise your blood glucose faster than anything else.  This is not true either, but thats a separate, more complex topic - Glycemic Index (see myth #7).

So although we all grow up "knowing" that diabetes is all about sugar, its not actually true.  Its about all carbohydates.  Just that one bit of information makes all the difference when looking at how to manage diabetes.  

So going back to our cappuccino, the biggest problem isn't the spoonful of sugar you were going to put into it.  Its the carbohydrates in the milk - or even all that flour which went into making that nice low fat "skinny" muffin.  

The sugar has only a walk-on bit-part in this particular drama.....

....he just gets top billing because he's the most famous.

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