I am writing this after a gruelling series of weekend night shifts as an emergency doctor. Normally an optimist by nature, I returned home completely despondent, a feeling that has become increasingly common in my 23 years of service in the NHS.
It is impossible to provide good care when patients, as they regularly must do, wait for hours in the emergency room just for a bed, and there are dozens of patients crowded in the hallway all day, every day.
But the worst thing is that many of these admissions – perhaps as many as a third – could be avoided.
They are a consequence of high blood sugar levels and type 2 diabetes, and their complications, which include strokes, heart attacks and cancer.
By pure chance, just before starting my last shift, I read a recently published research article that, at first glance, had nothing to do with my work.
The title (‘Preliminary findings from the NHS type 2 diabetes remission programme: a prospective evaluation of real-world implementation’) barely caught anyone’s attention.
But this research, published in The Lancet Diabetes & Endocrinology, showed remarkable data from real-life diabetes patients (i.e. outside of a research setting) that demonstrated how their health could be transformed by a low-calorie, low-carb diet of shakes and soups, in just three months.
You are what you eat, so eat the right foods to keep yourself in top condition.
In fact, over the past decade, a new theory has emerged about the prevention and treatment of type 2 diabetes that has made me question everything I thought I knew about it.
Studies, including this new one, show that compared with type 2 diabetes patients receiving standard treatment (i.e., drugs to control blood sugar along with advice on diet and exercise), those on low-carb, calorie-restricted diets can lose 10 to 15 kg on average, which they then keep off. Half even manage to reverse their type 2 diabetes, so they no longer need medication.
Better yet, five years later, they have half as many diabetes-related complications.
However, in medical school I was taught that the way to treat obesity and type 2 diabetes was to eat less fat and take lifelong medications, an approach that has clearly failed millions of people.
Many could have benefited from this new lifestyle-first advice and avoided diabetes and its complications that often mean they end up in the emergency room.
One of my patients last week was a 78-year-old woman with type 2 diabetes, high blood pressure, heart failure, angina, osteoarthritis, and depression.
She was a typical example of the patients I see. She suffered from a chronic illness and went from one outpatient clinic to another and from one GP appointment to another, and every few months she had to be hospitalized due to a flare-up of one of her chronic illnesses.
This time, the pain in her left leg became severe. When I examined her, she was cold to the touch and any movement caused agony. She had limb ischemia, a vascular emergency caused by a blockage of blood flow to the limbs. Sometimes this can be treated with surgery to restore blood flow, but a CT scan showed that my patient’s diabetes had damaged the blood vessels so much that they couldn’t open.
There was no other option: an urgent amputation was needed.
As I moved on to my next patient, I couldn’t help but reflect on her plight: her precious independence was about to be stripped away.
Over the years, traditional medical care had basically failed her. While all clinical requirements were met and she was on the best accepted medication regimen, the underlying cause of her problems—a high-carbohydrate diet that was worsening her obesity and diabetes—had been encouraged rather than addressed.
And tragically, this woman’s situation is being repeated in hospitals across the country. Cases of obesity and diabetes have skyrocketed (as have illness, disability and infirmity as a result) and our National Health System is unable to cope.
But this is not a plea for more resources, because while extra money may be a temporary patch, I have come to realize that unless we address the root causes of poor health, no amount of increased funding will be able to satisfactorily deal with this onslaught of disease.
Professor Rob Galloway says up to a third of the influx of patients he sees in A&E each night could have avoided hospital if they had changed their diet and lifestyle.
But this latest research shows that we can get out of this hole without having to resort to prescribing more drugs that do not improve quality of life.
A lifestyle change and a low-carb diet could help address the cause of poor health, not just its consequences.
So why is it so effective? Once ingested, sugars and carbohydrates (which are broken down into sugars) are removed from the blood by insulin and stored as energy in the liver. The problem is that modern diets are full of ultra-processed, addictive, high-carb foods, and with constant snacking, blood sugar levels are always high, leading to increased insulin release.
Insulin is a hormone that causes the body to convert the carbohydrates we eat into fat. The result? Obesity.
And the more insulin is produced, the more resistant the body becomes to its function of removing sugar from the blood. As a result, blood sugar levels remain high, leading to type 2 diabetes. The bottom line here is that complications can begin as soon as insulin levels start to rise, years before diabetes is diagnosed.
Obesity and diabetes cases have skyrocketed, but cutting back on carbs can put you on the right path to a fitter future.
It is true that some people have a higher genetic risk of developing type 2 diabetes, but even then, it can often be reversed with dietary changes.
In the battle to keep producing more insulin, many patients with type 2 diabetes end up receiving daily insulin injections. However, one of the side effects is occasional low blood sugar levels, hence the advice to eat carbohydrates and snack frequently. But all this leads to even higher insulin levels, which makes us even fatter. It’s a catastrophic vicious cycle.
But now we have a different way of doing things.
I recently visited a GP practice, Mythe Medical Practice in Tewkesbury, Gloucestershire, where I had heard they were trialling a new approach for patients with type 2 diabetes, similar to that used in the recent study.
The programme was created by GPs Dr Caroline Butler and Dr Simon Fearn, who offered patients with type 2 diabetes (or at risk due to being overweight) a three-month course of making sustainable lifestyle changes. As well as avoiding ultra-processed and carbohydrate-rich foods, they recommend a diet based on vegetables, dairy, eggs, nuts and low-sugar fruits such as berries, and stress the importance of exercising, reducing alcohol consumption, managing stress and getting a good night’s sleep.
This approach has transformed patients’ lives. I spoke to one, Sharron Wilson, 71, who was feeling depressed when she first saw Dr Fearn. She is 1.62m tall and weighs 102kg (more than 16 sts), and her obesity had led to knee arthritis, high blood pressure and type 2 diabetes so poorly controlled that even four insulin injections a day weren’t working.
The traditional model of care would have considered her depression a chemical imbalance and prescribed her antidepressants. But Dr Fearn suspected her condition was a reaction to her poor health. Instead of a medical prescription, he prescribed a lifestyle treatment.
A trial at a GP practice in Tewkesbury, Gloucestershire, for patients with type 2 diabetes recommended a diet of vegetables, dairy, eggs, nuts and low-sugar fruit, as well as exercise, which led to one participant losing 2st in six weeks and losing her depression.
Sharron lost over 15kg in six weeks and her blood pressure improved so much that she now needs half of her previous pills. Her cholesterol levels have improved and so has her diabetes – she has gone from four insulin injections a day to just one.
She told me: ‘I’ve tried diets all my life, but I was so hungry that they all failed.
“This is different. I have a new way of thinking and I feel empowered to make changes, which are easy because I am no longer hungry. Not only have I lost weight, but I feel like a different person, with more energy and I no longer feel depressed.”
Sharron could have become just another patient in my corridor. However, as long as she continues with this new approach, she has years of healthy life ahead of her and will not be a burden on the NHS.
Dr Butler and Dr Fearn’s patients also used a free website and app (lowcarbfreshwell.com), which you can access to improve your own health. Consult your GP before making any major changes.
Addressing the underlying causes of disease in this way is the only viable long-term solution to improving people’s health and reversing the tide of ill health that the band-aids I apply in the ER no longer seem to help.
@drrobgalloway