Fat v Glucose

1
Fat v Glucose

• Dr Laurence Gerlis IDDT

2
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
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

4
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 Its only type 2 diabetes- I havent
  taken the tablets for a week.

5
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

6
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!

7
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

8
7 fruits a day!!

• very high carb
• Orange juice is synonomous with healthy
• 150ml orange juice69G16 teaspoons sugar
• Lim BMJ Low carb dietlower trigs better HDL.
• Sugar -not fat - is the culprit

9
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

10
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)

11
Van Tulleken Twin TV programme

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

12
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

13
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.

14
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)

15
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.

16
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.

17
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.