Solving the obesity and type 2 diabetes epidemic is one of today’s most important public health challenges.

The challenge

After a quarter of a million years of painstaking evolution, human beings ended up a healthy, well-nourished species with a long life expectancy. But in the last 30 years, things have gone horribly wrong. Epidemics of obesity and type 2 diabetes are causing reduced life-expectancy and putting a massive strain on our healthcare systems.

In the UK, obesity directly costs the NHS more than £6 billion per year, and the treatment of diabetes and its complications account for an estimated £14 billion a year—10% of the annual NHS budget! This is set to double over the next 20 years as the disease progresses within the population.

The roots of obesity and type 2 diabetes are firmly embedded in the food that we eat, with diet-related disease now contributing to more disease and death globally than physical inactivity, smoking and alcohol combined.

Why are we eating so many carbs?

Seeing as carbohydrates turn into glucose when digested, it makes complete sense that type 2 diabetes patients demonstrate profound carbohydrate intolerance. Refined and starchy carbohydrates are well known to increase blood glucose levels, requirements for medications and weight gain. Such carbohydrates can either be naturally found in food as sugar or starch—such as fruit, rice and potatoes—or could be artificially added, such as in refined cereals, chocolate bars and sweetened yoghurts.

The Eatwell Guide, a policy tool in the UK used to define government recommendations on eating healthily and achieving a balanced diet, currently advises the public to "base meals on potatoes, bread, rice, pasta or other starchy carbohydrates". It’s clear that—in an overweight population such as the UK—eating foods that promote insulin secretion is likely to increase the risk of worsening insulin resistance and hasten the onset of type 2 diabetes. Yet, recommending lots of carbohydrates with every meal does just that!

Disturbingly, both Diabetes UK and NHS websites prioritise the consumption of starchy carbohydrates for type 2 diabetics. This seems to be completely illogical and the opposite of what should be recommended in order to halt the ever-increasing rates of obesity and type 2 diabetes. Such diets likely lead to progressive worsening of the disease with all its associated complications, such as blindness, kidney failure, nerve damage, peripheral vascular disease, heart disease and stroke.

On the other hand, a diet that doesn’t rapidly increase blood glucose and doesn’t provide too much carbohydrate to the body will help reduce the risk of worsening insulin resistance, and could actually improve it...

The low-carb, high-fat lifestyle

Over the last ten years, a number of clinicians, scientists and nutritionists have begun to question the efficacy of medication to control blood glucose levels, and have been advocating the restriction of carbohydrates in the diet as an alternative control method.

All carbohydrates metabolise into glucose in the blood, so as Dr David Unwin asks in the book, Diabetes Unpacked:

"If type 2 diabetes is largely about sugar, why should people with diabetes take in ‘concentrated sugar’ that is in starchy foods such as bread, pasta or rice?”

The low-carb, high-fat (LCHF) diet seriously reduces the amount of carbohydrate in the diet, typically by avoiding the consumption of high glycemic index foods—mainly bread and baked products, sugar, rice, grains and cereals, potatoes and starchy root vegetables. Adherents are also advised to avoid all processed foods and to concentrate their inputs on healthy fats and protein.

The vanguard of the LCHF movement in the UK is the Public Health Collaboration (PHC), a charity supported by clinicians, nurses, dieticians and LCHF enthusiasts. The organisation’s Healthy Eating Guidelines is a full exposition of the benefits of a LCHF diet, and it recommends that carbohydrates should be from real foods with a carbohydrate density of less than 25% (i.e. less than 25g carbs per 100g of food).

A recent comprehensive review concludes that dietary carbohydrate restriction is the “single most effective intervention for reducing all of the features of the metabolic syndrome” and should be the first approach in diabetes management. In terms of efficacy and cost, the low-carb lifestyle is a game changer that enables the majority of sufferers to take charge of their own condition, control their blood sugar levels by diet restriction and dramatically reduce the cost of medication and medical complications that would otherwise be inevitable.

As an example, a GP practice run by Dr David Unwin (RCGP clinical expert in diabetes, and NHS Innovator of the Year 2016) has pioneered offering patients the lower carb diet as an option to starting lifelong medication for type 2 diabetes. This resulted in improved HbA1c levels, other health benefits and significant savings in drug spend.

The very promising results obtained by LCHF lifestyle changes in combating the complications of the disease are becoming much better known, spearheaded by websites such as Diabetes.co.uk, with over 400,000 users registered for their online Low Carb Program, and DietDoctor.com, a Swedish site with over 500,000 subscribers worldwide.

Recently, restricted carbohydrate diets have been accepted by the NHS as a valid approach to controlling diabetes and The Low Carb Program app, produced by Diabetes.co.uk is available from the NHS app library.

In the last few years, LCHF has become much more established and has gained significant credibility worldwide. For instance:

The low-carb lifestyle has been proven to be very effective at bringing diabetes and other chronic conditions into remission, aiding significant and sustainable weight loss and restoring good health and vitality. However, the lifestyle needs to be maintained to ensure the continuing benefits.

Why low-carb is challenging

The challenge for those wanting to pursue a LCHF lifestyle is manifold, as carbohydrates and sugar are the mainstay (46%) of all food consumed in the UK and to pursue the diet effectively requires learning the basics about food and how to prepare it.

In an era where there has been a huge increase in dependence on high-carb, pre-prepared food and takeaway food, maintaining the LCHF diet in practice means preparing everything from scratch in order to be certain of the contents. The absence of bread and baked goods in LCHF is particularly challenging, as the dependence on the convenience of sandwiches is ingrained into our food culture in the UK, as well as bread being a basic staple food.

Why high fat? Isn't fat bad for me?

We’ve been told for decades that fat is detrimental to our health. Meanwhile, low-fat “diet” products, often full of sugar, have flooded supermarket shelves. It’s been a factor that coincided with the start of the obesity epidemic. While this doesn’t prove causation, it’s clear the low-fat message didn’t prevent the obesity increase, and it’s possible and likely it contributed.

Studies now show that there’s no reason to fear natural fats. Instead, on a low-carb diet, fat is your friend. Simply minimise your intake of sugar and starches and increase the fat you need to feel satisfied. When you avoid sugar and starches, your blood sugar tends to stabilise and the levels of the fat-storing hormone, insulin, drop. This increases fat burning and makes you feel more satiated, reducing food intake and causing weight loss.

If you want to know more, we recommend this handy guide by DietDoctor.com about healthy fats on a low-carb diet.

How did we get here?

The questionable science behind the "low fat" message and subsequent change in dietary guidelines introduced in the US in 1977—followed by the UK public health dietary advice issued in 1983—has had unintended disastrous health consequences, resulting in increased consumption of low-fat junk food, refined carbohydrates and polyunsaturated vegetable oils. The striking rise in obesity immediately following the introduction of this advice suggests that it’s a significant contributor to the problem.

It’s likely that nutrition science has also been corrupted by commercial influences. The recorded influence of the multi-trillion-dollar food industry on official guideline bodies and politicians has posed a significant challenge to public health. This isn’t just a conspiracy theory; it took 50 years from the first published scientific evidence linking smoking and lung cancer until effective regulation was introduced to curb tobacco consumption. Big tobacco companies embraced a strategy of denial, planting doubt, obfuscating, and influencing the opinion of scientists. The recent similarities with big food companies is disturbing.

Well-managed blood glucose is hugely important in maintaining good health, especially in a population such as the UK where type 2 diabetes and pre-diabetes are rapidly increasing year upon year. The role of inadequate dietary advice in this devastating epidemic has been ignored for far too long!

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