I am writing this after a gruelling set of weekend night shifts as an A&E doctor. Usually upbeat by nature, I came home utterly despondent – an increasingly common feeling in my 23 years of NHS service.
Good care is impossible to provide when patients, as they regularly must do, wait for hours in A&E just for a bed, and there are tens of patients packed into the corridor all day, every day.
But the worst part is that many of these admissions – perhaps up to a third – could be avoided.
They are a consequence of elevated blood sugar levels and type 2 diabetes – and their complications, including stroke, heart attack and cancer.
Quite by chance, just before I started my last shift, I read a recently published research paper which, on the surface, had nothing to do with my job.
The title (‘Early findings from the NHS type 2 diabetes path to remission programme: a prospective evaluation of real-world implementation’) hardly grabbed the attention.
But this research, in The Lancet Diabetes & Endocrinology, showed remarkable data from real-life diabetes patients (i.e. outside a research setting) that proved 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 tuck into the right foods to keep you in tip-top condition
Indeed, the past decade has seen a new theory emerge about the prevention and treatment of type 2 diabetes, which has made me question everything I thought I knew about it.
Studies – including this new one – now show that compared with type 2 diabetes patients on standard care (i.e. medications to control blood sugar alongside advice on diet and exercise), those on calorie-restricted, low-carb diets can lose 10-15kg on average – which they then keep off. Half even manage to reverse their type 2 diabetes, so they no longer need medication.
Better still, five years later, they have half as many diabetes-related complications.
Yet at medical school I was taught that the way to treat obesity and type 2 diabetes was to eat less fat and take medications for life – an approach that has clearly failed millions of people.
So many could have benefited from this new lifestyle-first advice and avoided diabetes and its complications that often mean they end up in A&E.
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 so typical of the patients I look after. Chronically unwell, she bounced between various outpatient clinics and GP appointments and would get admitted to hospital every few months due to a flare-up of one of her chronic conditions.
This time she had worsening pain in her left leg. When I examined her, it was cold to touch and any movement caused agony. She had ischaemic limb – a vascular emergency caused by a blockage in blood flow to the limbs. This can sometimes be treated with surgery to restore the blood flow, but a scan showed my patient’s diabetes had damaged the blood vessels so much they could not be opened up.
There was nothing else for it: she needed an urgent amputation.
As I moved to my next patient, I couldn’t help but reflect on her plight: her precious independence was about to be stripped away.
Down the years, traditional medical care had essentially failed her. For while all the clinical boxes were ‘ticked’ and she was on the accepted best medication regimen, the underlying cause of her problems – a carb-heavy diet that was worsening her obesity and diabetes – had been encouraged rather than addressed.
And, tragically, this woman’s situation is replicated in hospitals up and down the country. Obesity and diabetes cases have rocketed – as has illness, disability and sickness as a result – and our NHS is unable to cope.
But this isn’t a cry for more resources, because while extra cash may provide a temporary sticking plaster, I have realised that unless we treat the root causes of ill-health, no amount of increased funding can satisfactorily treat this deluge of illness.
Professor Rob Galloway says up to a third of the stream of patients he sees in A&E each night could have avoided hospital by changing their diet and lifestyle
But this latest research shows that we can dig ourselves out of this hole without simply resorting to dishing out yet more drugs that don’t improve quality of life.
A lifestyle overhaul and a switch to a low-carb diet could help tackle the cause of poor health, and not just the consequences.
So why is it so effective? Once eaten, sugars and carbohydrates (which are broken down into sugars) are cleared 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 food, and, with our constant snacking, blood sugar levels are always high, leading to more insulin release.
Insulin is a hormone that drives the body to convert the carbs we eat into fat. The result? Obesity.
And the more insulin produced, the more the body becomes resistant to its role of clearing sugar from the blood. So blood sugar levels stay high and this leads to type 2 diabetes. The crucial thing here is complications can start as soon as your insulin levels start to rise – years before a diagnosis of diabetes.
Obesity and diabetes cases have rocketed, but cutting back on carbs can set you on the right path to a fit future
True, some people have a higher genetic risk for type 2 diabetes, but even then it can often be reversed with changes to diet.
In the battle to keep producing more insulin, many type 2 patients end up on daily insulin injections. Yet one side-effect is occasional low blood sugar levels – hence the advice to eat carbohydrates and have frequent snacks. But all this leads to even higher levels of insulin, 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 surgery, Mythe Medical Practice in Tewkesbury, Gloucestershire, which I’d heard was trialling a novel approach for patients with type 2 diabetes, similar to that used in the recent study.
The scheme was set up by GPs Dr Caroline Butler and Dr Simon Fearn, who offered patients with type 2 diabetes (or at risk because they were overweight) a three-month course to make sustainable changes to their lifestyles. As well as avoiding ultra-processed and high-carb food, they advocate a diet of vegetables, dairy, eggs, nuts and low-sugar fruits such as berries – and stress the importance of exercise, reducing alcohol, managing stress and getting good quality sleep.
The approach has transformed patients’ lives. I spoke to one, Sharron Wilson, 71, who had been feeling depressed when she first saw Dr Fearn. She’s 5ft 4in and weighed 102kg (over 16st) and her obesity had caused knee arthritis, high blood pressure and type 2 diabetes so poorly controlled that even four insulin injections a day were not working.
The traditional model of care would have viewed her depression as a chemical imbalance and antidepressants prescribed. But Dr Fearn suspected her condition was a reaction to her poor health. Instead of a medical prescription, he prescribed the lifestyle course.
A trial at a medical practice in Tewkesbury, Gloucestershire, for patients with type 2 diabetes, advocated a diet of vegetables, dairy, eggs, nuts and low-sugar fruits, as well as exercise – leading one participant to lose 2st in six weeks and blew away her depression
Sharron lost more than 15kg (over 2st) in six weeks and her blood pressure improved so much she needs half her previous tablets. Her cholesterol levels have improved and so has her diabetes: she’s gone from four insulin jabs a day to just one.
She told me: ‘I’ve tried diets all my life but felt so hungry that they all failed.
‘This is different. I have a new way of thinking and feel empowered to make changes, which are easy as I don’t feel hungry. Not only have I lost weight, I feel like a different person, with more energy, and I no longer feel down.’
Sharron could have become another patient in my corridor. Instead, as long as she continues this new approach, she has years of healthy living ahead of her and will not be a burden to 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 major changes.
Tackling the underlying causes of illness in this way is the only long-term, viable solution to improve people’s health and reverse the wave of ill health that the sticking plasters I apply in A&E no longer seem to help.
@drrobgalloway
