Fat v Glucose

Dr Laurence Gerlis IDDT

1973-Sleeper (thanks to C4)• This morning for breakfast he requested something called "wheat

germ, organic honey and tiger's milk."• Dr. Aragon: [chuckling] Oh, yes. Those are the charmed substances

that some years ago were thought to contain life-preserving properties.

• Dr. Melik: You mean there was no deep fat? No steak or cream pies or... hot fudge?

• Dr. Aragon: Those were thought to be unhealthy... precisely the opposite of what we now know to be true.

• Dr. Melik: Incredible

• (see also) Nina Teicholz The Big Fat Surprise

3.2 million people with diabetes

• 90% type 2• 850,000 undiagnosed• 6% of UK adults

• Important- young people and children with type 1 diabetes need to grow- carbs needed

Conversation September 1st

• Me: Do you have any illnesses or take any medication?

• Patient (BMI 30) : No• Me: Your urine is full of sugar• Patient: It’s only type 2 diabetes- I haven’t

taken the tablets for a week.

Cardiovascular mortality

• In the days before statins there was a major concern about heart disease and diabetes- hence the start of the anti-fat campaign

• See Le Fanu-there was a cohort of men whth cardiovascular disease int he 1960s/70s

Low fat diet

• Thus high carbs were introduced• Patient admitted to hospital “Diabetic diet”• Yellow form stuck above bed “Diabetic”• No distinction type one or type two• 3 meals and 3 snacks daily high carb!

Obsession with type 1

• Thus high insulin to match carbs• Not appropriate even for type 1• Fear of “coma”• DKA or Hypos?• The word diabetes still strikes fear and panic

into many doctors and nurses

7 fruits a day!!

• =very high carb• Orange juice is synonomous with “healthy”• 150ml orange juice=69G=16 teaspoons sugar• Lim BMJ Low carb diet=lower trigs better HDL.• “Sugar -not fat - is the culprit”

2013 NHS diet advice for type 2 diabetes

• “Eat plenty of starchy carbohydrates”• “Choose lean meat remove fat”• “Avoid fried food”• “Base meals around Potatoes Cereals Pasta

Rice Bread”

Mediterranean diet

• Fruit, Veg, Grains, olive oil, nuts, pulses, poultry, eggs, cheese, yoghurt

• Rich in anti oxidants and monounsaturated fat.

• WHO/American Heart Assoc-sugar in normal diet should be less than 10% of energy-

• (Scientific Advisory Committe on Nutrition-say 5%)

Van Tulleken Twin TV programme

• No diabetes and not overweight• One had zero fat diet other zero carb diet• Both diets miserable• Pointless experiment

Patient JC

• Age 60 previously lost 5.5 stone on Atkins diet• Has lost 1.5 stone in one month on Atkins • Needs cholesterol check

Saturated fats beat diabetes

• Dairy products eg yoghurts reduce risk of type 2 diabetes

• Odd chain (odd number of carbon atoms) saturated fatty acids are good for you basically more dairy products.

Fizzy drinks

• Prof Ian MacDonald SACN working group:

• “There is an association between sugar sweetened beverages and type 2 diabetes.”

• In my personal view this is the number one current Public Health issue, more than cigarettes (helped by smoking ban in pubs) and alcohol (already on radar)

Fat

• When you take the fat out the food tastes worse-so the food industry have added more sugar.

• Statins are very useful medications despite the various side effects.

Current NHS advice for type 2 Diabetes

• You can make adaptations when cooking meals, such as reducing the amount of fat, salt and sugar, and increasing the amount of fibre.

• You don't need to completely exclude sugary and high fat foods from your diet, but they should be limited. It's possible to achieve good blood glucose control by including sugary foods in your diet.

• The important thing in managing diabetes through your diet is to eat regularly and include starchy carbohydrates, such as pasta, as well as plenty of fruit and vegetables. If your diet is well balanced, you should be able to achieve a good level of health and maintain a healthy weight.

Bristol study

• Insulin use in type 2 has increased 7 fold• 1991 to 2010• Once you are on insulin, you are much more

committed to carbs to avoid hypos.