Why is the dietary advice given to diabetics so often so woefully inadequate?

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I’m not really one for anecdotes, but feel compelled to share one with you. In my practice on Monday I saw a small boy, whose parents were seeking nutritional advice. Less than three weeks ago their son had been diagnosed with type 1 diabetes, which for him right now necessitates him having insulin injected 2-3 times a day.

Once he had been diagnosed and stabilised on insulin, this boys parents were duly dispatched to the hospital dietician for advice about what to feed him. The advice they got was depressingly predictable: that they should not worry too much about sugar and that he should eat plenty of starchy carbohydrates. The parents has duly obliged by feeding him a diet replete with bread, pasta, rice, rice cakes and breakfast cereals.

Anyone that takes any interest in nutritional at all will likely know that these are foods that, generally speaking, cause considerable surges in blood sugar ” precisely what should be avoided in individuals who have diabetes. Oh, and to cap it all, the dietician recommended that the boy have a bedtime snack of Hob Nob biscuits.

Not surprisingly, his parents were having difficulty controlling their son’s blood sugar on this dietary regime. Blood sugar levels, they noted through finger prick testing, were prone to both highs and lows. After the Hob Nobs, for instance, blood sugar levels would skyrocket to 20 (ideally, blood sugar levels should not rise above about 6 or 7).

Obviously, I felt compelled to set the record straight about what to this boy’s parents should feed their son if they want to stabilise his blood sugar levels and minimise his insulin requirements. This means keeping a much tighter reign not just on sugary foods (like biscuits), but also many of the starchy carbohydrates his parents had been encouraged to ply him with. I recommend that such changes are made gradually and that appropriate reduction in medication (e.g. insulin) be made concurrently.

A couple of years ago, I gave written advice to this effect in a newspaper. I got a very stern letter from a doctor telling me that I was endangering the diabetic concern because diabetics ‘need carbohydrate’.

Well, I dispute this notion that diabetics need carbohydrates. The reality is that carbohydrate (sugar) can be made in the body from other fuels including protein. And anyway, a diet largely devoid of starchy carbs and foods with added sugar need not be particularly low in carbohydrate. Vegetables are essentially carb, are they not, as is fruit. Beans and lentils are also a decent source of carbohydrate. The difference is, these foods are generally slower sugar releasing and more nutritious than the crappy carbs so often touted for all, including diabetics.

Some doctors and dieticians seem to think that carbohydrate control is pointless: why not let them eat what they like and let them jack up a bit more insulin if need be? No doubt this rationale is music to ears of the food companies that make the rubbish foods so often advocated. And I expect the manufacturers of insulin are suitably delighted too.

However, the less carb a diabetic eats, the less their need for medication (including insulin), and the less likely they are to suffer from the side effects of excess insulin. And the better their blood sugar control is likely to be too. That means less likelihood of diabetic complications such as kidney disease, nerve damage and blindness. Can we really afford to take such a laissez faire approach to carb consumption, when it likely has important implications for health and an individual’s chances of survival?

To my mind, the fact that health professionals can and do advise diabetics to eat foods that are known to disrupt blood sugar levels is a testament to the guile and persuasiveness of the food industry. It also says something about the professionals who not only ignore the science, but seem unwilling to exercise any common sense either.

However, it seems not all health professionals are similarly ‘blinded’. About 3 years ago, when the Atkins’ diet was all the rage here in the UK, I spoke on Channel 4 News in broad support of the diet. They pitted me against a dietician from a London teaching hospital who trotted out the same old line about the high fat nature of such a diet being bad for people (despite a singular paucity of evidence to this effect). However, when the cameras were no longer rolling she told me that a diabetologist where she worked advocated the Atkins’ diet for his patients. She went on to tell me that, despite his enthusiasm for low-carb eating, the doctor concerned was unwilling to publicly support this nutritional approach. One can only guess as to why. Did he think his peers would think him a crank? Would funding for his research suddenly dry up? Would drug companies no longer invite him to attend or speak at conferences about diabetes and its management?

Whatever the reason, this story reminds me of how much medical practice is influenced by factors such as herd mentality, politics, commercial considerations and fear for one’s ‘reputation’ ” all things that shouldn’t, in my view, be arbiters in the care and advice we offer our patients.

Because I am not really one for mincing my words, I had some strong ones for the parents of the diabetic boy with regard to the advice he had received. My reaction is partly borne out of frustration at how misguided nutritional advice for diabetics often is. This is not just a political issue: lives are at stake after all.

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