British doctor pioneers low-carb diet as cure for obesity and type 2 diabetes

FAB RESEARCH COMMENT:

The word 'cure' in media headlines should always be treated with extreme caution - especially when it's used in connection with conditions as complex and multifactorial as Type 2 diabetes and obesity.

However, this new observational study from Dr David Unwin and his colleagues reports data from their UK general medical practice which strongly indicates that Type 2 diabetes can not only be prevented, but is reversible via diet and lifestyle changes, especially if these are implemented early. 

And as one of them says:

• "If you had a drug that did half of what we have done with the low-carb approach, it would be worth an absolute fortune.  No one is shouting about it because it is not a drug that’s making a profit for a big pharmaceutical company.”

Instead, as these pioneering doctors point out, their small GP practice is not even currently allowed to keep any of their annual savings on drug treatments that their patients no longer need - just half of which could allow them to expand their support services to help more patients achieve successful weight loss and remission from their diabetes. 

Given that the economic costs of obesity and Type 2 diabetes to the NHS and the wider economy - let alone their incalculable personal costs to those directly affected - this situation seems more than counterproductive, so one can only hope that a workable solution is quickly found.

According to a newly published report from Diabetes UK, the number of people living with diabetes in the UK now exceeds 5 million - and as they emphasise, effective government action is urgently needed to address both this and obesity (which raises Type 2 diabetes risks 7-fold).
And the primary cause of both is poor diets.


DIET AND PUBLIC HEALTH - WHAT WENT WRONG? 

The current 'twin epidemics' of Type 2 diabetes and obesity are testimony to the total failure of public health policy with respect to nutrition and diet for almost half a century now (although historical evidence for 'modern, industrialised diets' as a cause of chronic disease goes back further).

Both obesity and Type 2 diabetes were still relatively uncommon - and particularly rare in younger people - until the late 1970s, when official dietary guidelines (backed by absolutely no good scientific evidence) were introduced first in the US, and then the UK and other countries,  which effectively branded 'dietary fats' and 'high-fat foods' as unhealthy, and a major cause of heart disease.

From that point on, public health guidelines encouraged people to reduce their intake of nutritious whole or minimally processed foods such as meat, eggs, butter, cheese and full-fat milk & dairy products (on the grounds of their saturated fat content) and instead to consume more ultra-processed (but supposedly 'low-fat') foods - and drinks - rich in sugar, refined carbohydrates, and artificial additives.

The demonisation of saturated fats similarly drove a massive increase in industrially-refined vegetable oils, rich in omega-6 'polyunsaturated fats' (and until recently, toxic trans fats) which - like sugar - have metabolic effects that promote obesity when consumed in excess, as is the case for populations consuming modern, western-type diets with a high omega-6/omega3 ratio.

• Controlled trials show that ultra-processed foods promote significant overeating, and weight gain.  And being overweight or obese raises risks for Type 2 diabetes by three and seven times respectively.    

The result of these dietary changes has been nothing short of disastrous for public health - with rates of both obesity and Type 2 diabetes soaring from the 1980s onwards - such that 2/3 of UK adults, and 4/10 children leaving primary school are now overweight or obese.

(By contrast, it has done wonders for the profitability of both the huge multinational food companies responsible for the massive increase in our consumption of ultraprocessed foods and drinks, and the pharmaceutical industry, owing to the corresponding explosion of chronic diet-related diseases over the same period, for which drugs may help manage symptoms, but usually do little or nothing to address the underlying causes).

Before this dramatic industrialisation of our food supply (ultra-processed foods now make up 60% of typical UK diets), Type 2 diabetes , which is caused primarily by diet and lifestyle factors, was not only rare, but was largely a disease of old age.

Now, Type 2 accounts for 90% of diabetes cases, and is occurring at younger and younger ages, with even children and adolescents now affected.  Diabetes is a major cause of heart attacks, kidney failure, stroke, amputation and blindness, among many other debilitating and disabling health conditions.  It can also have numerous negative effects on mental health, wellbeing and performance, e.g. 

• The brain requires a steady supply of glucose for energy, poor blood sugar control impairs brain function and can exacerbate 'everyday' difficulties with mood, behaviour and cognition. 

• Insulin resistance - a key feature of Type 2 diabetes that also precedes its development - can lead to many symptoms that may be mistaken for depression

• Type 2 diabetes is also associated with increased risks for many mental health conditions, including depression, dementia and schizophrenia in particular (independent of atipsychotic medications, which can increase risks further).

DIET AND PUBLIC HEALTH - HOW CAN WE DO BETTER? 

It can only be hoped that the NHS may rapidly approve (and provide support for) a much wider evaluation of the pioneering approach that Dr Unwin and colleagues have shown in their pilot studies to be both effective and cost-effective in reducing obesity and managing or reversing Type 2 diabetes.

Currently, NHS guidelines still emphasise only 'low-calorie' rather than 'low-carb' diets for weight reduction in patients with obesity - although the latter approach is based on sound scientific evidence in terms of underlying mechanisms, as well as its acceptability to patients and therefore its sustainability in the long-term.

See also this recent book by another pioneering NHS doctor, specialising in obesity management, whose pilot studies with colleagues show that a low-carb, real food diet-and-lifestyle approach appears as effective as bariatric surgery for helping obese patients to lose weight (and seems rather likely to be better for their longer-health than such surgery - although clearly long-term randomised clinical trials would be needed to find that out for certain).

• The Full Diet: The revolutionary new way to achieve lasting weight loss

For details of the underlying research:

• Unwin D et al 2022 - What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss

For further information please see:

• Ultra-Processed Food Causes Weight Gain – Firm Evidence At Last

• Study confirms that processed foods key to rising obesity

• Hydration, and Low fat vs Low carb diets? Learning more about the endocrine system could lead to fewer cases of type 2 diabetes and obesity

• New year health kick losing momentum? Scientists find key to curb the cravings