The DOCTORS who will help you BEAT Type2 DIABETES
As we run our new series with pioneering low-carb GP Dr David Unwin, meet the medics changing lives with a plan that could help YOU too
FOR years it troubled and perplexed Dr Ruth Tapsell that her type 2 diabetes patients made little or no progress despite the drugs she prescribed or the healthy eating advice given. ‘If anything, they put on more weight, were hungrier and needed more medication to control their condition,’ says the GP.
‘I was also becoming increasingly concerned about the number of drugs we were prescribing to these patients, the cost and the side-effects or potential complications the medications can cause later in life — including weight gain. None of it made sense.’
All of that changed three years ago, after Dr Tapsell (pictured right) read an article in the GP magazine Pulse about the low-carb GP
Avoid starchy carbs and choose a salad with protein over a sandwich at lunchtime to keep blood sugars level
Dr David Unwin, whose pioneering work with his patients with type 2 diabetes has previously been highlighted in Good Health — and is featured this week in a new series.
Dr Tapsell read how 40 per cent of Dr Unwin’s type 2 patients trying a low-carb diet were in remission and no longer needed medication — as well as losing on average nearly 9 kg (20 lb).
‘I was stunned by the remarkable success Dr Unwin was having reversing type 2,’ says Dr Tapsell. ‘My husband Sam is a GP at the same surgery as me and we were both very impressed by how meticulous and thorough Dr Unwin’s research was.
‘For both of us, this data completely blew apart the traditional idea that type 2 diabetes is a chronic progressive disease that cannot be put into remission.
‘Like many GPs, we’d previously been offering patients standard diet advice for diabetics — to lose weight by eating smaller portions and following a low-fat diet that was high in carbs such as pasta and rice. And it wasn’t working.’ B UT she says it was clear after examining Dr Unwin’s research that people with type 2 diabetes should actually be avoiding these starchy foods — because they break down into glucose that raises blood sugar levels.
‘This was the most exciting medical discovery we had come across in years,’ says Dr Tapsell. ‘We decided there and then to roll out low carb as the mainstream advice we gave to our patients.’
In common with many GPs who recommend a low-carb approach, their advice was very simple: swap cereals and toast for eggs at breakfast time, choose a salad with protein over a sandwich at lunch and meat and vegetables instead of pasta at dinner time. There was no set carb limit, just that simple advice.
The principle behind low carb is that eating fewer carbs helps blood sugar levels stabilise so the body needs to produce less insulin, the hormone that pushes blood sugar into the cells for energy (or stores it as fat if there is too much).
The body is encouraged to burn fat. Meanwhile, the foods recommended on a low-carb regimen such as protein, abundant quantities of green veg and full-fat dairy help keep you feeling satisfied.
In January, the most recent audit of all 161 patients with type 2 at the surgery, where Dr Tapsell works, showed that 32 per cent had reduced their blood sugars to below the threshold for type 2 after going low carb.
‘Most have reduced the medication they are taking and some are drug free,’ says Dr Tapsell. ‘We’re now one of lowest-prescribing GP practices for type 2 diabetes drugs in our region.’
The Tapsells are two of a number of GPs now offering lowcarb programmes as an alternative way to tackle the growing obesity and type 2 diabetes ‘epidemics’ seen across the world.
In Britain, the Royal College of GPs is offering a lowcarb training course, designed by Dr Unwin (who’s now regularly invited to speak about his successes at international events). The lowcarb approach is gathering widespread recognition, including last year by the influential American Diabetes Association. Nurses are also joining the growing army of medical professionals offering low-carb information. The Low Carb/Real Food Nurse Forum, a Facebook group where nurses share tips and success stories, now has 1,000 members. Yet many healthcare professionals, such as nurse Gayle Gerry, first hear about low carb from their patients. ‘Reversing type 2 diabetes with low carb is a grass-roots revolution that’s spreading among patients, doctors and nurses via social media and the internet,’ says Gayle Gerry,
She came across low carb via a patient, an overweight, middleaged man who’d managed to reverse his diabetes after reading about the approach and losing a stone and a half.
‘When I first saw this patient in 2012 I told him that diabetes was a chronic, progressive disease and trotted out the standard advice about eating smaller portions and moving more.
‘At the time he’d been taking metformin but his diabetes was getting worse.
‘He came back two years later with normal blood sugars. I was really impressed — and very curious to learn more.
‘I came to realise how life-changing low carb could be and began offering information about it to my patients: the results were so impressive my GP practice gave me the green light to set up group consultations with the specific aim of reversing type 2.’
Gayle Gerry’s first group of 11 patients in 2019/20 lost on average 1st 12lb (11.8kg) and all substantially reduced their blood sugar levels, with seven patients dropping below the type 2 threshold. A SECOND group of six patients who adopted low carb over seven months in 2020 lost on average 1 st 3 lb (7.7 kg) and five got their blood sugar readings to normal.
At the surgery of Dr Vipan Bhardwaj, (pictured left) all the 40 type 2 diabetes patients who took part in a 2016 low-carb study he ran reduced their medication, and two-thirds came off it altogether.
‘We were amazed by the results, particularly by how rapidly patients’ blood sugar levels started to drop,’ says Dr Bhardwaj. ‘We were also very excited because we could see the potential to help many others.’
Based on the results of this trial, Dr Bhardwaj estimates millions of euro could be saved every year by health authorities around the world.
As yet, formal guidelines have not been issued by the HSE. But even the latest studies show an improvement in patients.
A recent study published in the British Medical Journal found that patients with type 2 diabetes who follow a strict low carbo-hydrate diet for six months may experience greater rates of remission from the illness compared with other recommended diets without adverse effects .
The findings were based on analysis of data from 23 trials involving 1,357 participants.
Outcomes were reported at six and 12 months and included remission of diabetes (reduced blood sugar levels with or without the use of diabetes medication), weight loss, adverse events and health related quality of life.
Although the trials were designed differently, and were of varying quality, the researchers were able to allow for this in their analysis.
Based on low to moderate certainty evidence, the researchers found that patients on LCDs achieved higher diabetes remission rates at six months compared with patients on control diets.
LCDs also increased weight loss, reduced medication use, and improved body fat (triglyceride) concentrations at six months.
The authors of the study suggested clinicians “might consider short term LCDs for management of type 2 diabetes, while actively monitoring and adjusting diabetes medication as needed.’
More trials and more analysis are needed, but medics are reporting that using the low-carb approach has been successful in various patient types, including in older patients who’ve had type 2 for many years and are often considered the hardest to treat.
This is partly because the body becomes accustomed to any medication over time, requiring higher doses.
In addition, a variety of changes in the body due to the normal ageing process can contribute to worsening diabetes control.
‘Yet in my experience they’ve done as well on low carb as other patients — with some remarkable successes,’ says Dr Bhardwaj.
Gayle Gerry cites the case of two patients, both in their 70s, who managed to reverse their long-standing type 2 diabetes during lockdown.
‘One 79-year-old man had had type 2 for 25 years but lost 1st 11 lb [11.3kg] and his blood sugar levels returned to normal after going low carb.
‘Another, aged 72, had had type 2 for 15 years, lost 11 lb [5kg] and his blood sugars also returned to normal. And he’s come off two of his blood pressure drugs — which is brilliant,’ says Gayle Gerry.
Indeed all the patients in her two low-carb diabetes groups have recorded reduced blood pressure readings, with several no longer needing medication.
Dr Bhardwaj and Dr Tapsell have also both noted that a number of their type 2 patients on low carb have improved their blood pressure, with some able to come off blood pressure medication entirely.
A low-carb diet may also help prevent prediabetes turning into full-blown diabetes.
Another potential benefit is for patients with fatty liver disease — linked to obesity and type 2, fat builds up in the liver and can lead to scarring.
‘We’ve seen some amazing results of fatty liver disease being reversed by low carb — subsequently confirmed by ultrasound scans,’ says Dr Bhardwaj. ‘Patients can see an improvement in liver function within weeks.’
‘Of course everyone’s different and the same approach won’t work for all patients, and that includes low carb,’ adds Dr Bhardwaj. ‘And some people might find it hard to stick to a diet with very few carbs long term’ — a standard criticism of low carb.
There’s also the question of the saturated fat in the fullfat dairy that the low-carb approach allows, because this has been linked to raised cholesterol levels, stroke and heart attacks. However, new research has called this into question.
This has been borne out by the experience of the doctors here, who, mindful of the concerns, have closely monitored patients’ cholesterol levels.
‘In general, our experience is that cholesterol actually improves — and there are clinical trials to back this up too,’ says Dr Bhardwaj.
But it’s not just about the statistics as Dr Bhardwaj explains: ‘The most rewarding aspect for us as doctors is to see how this approach transforms the lives of patients, with so many able to reduce their medication or go drug-free.’