Monthly Archives: January 2014

Sugar v fat

twins

It’s delightful, and long overdue, that sugar is being recognised as the unhealthy addictive poison that it is – almost every day something is appearing in the press or on TV about the dangers of sugar consumption.

At the same time, saturated fat is enjoying redemption – no longer the villified enemy of health and weightloss.

But today I want to caution a swing from high carb to no carb – in preference for fat.  What is it with us that we so enjoy subjecting ourselves to extremes?  An article in the press this week highlights that both high carb, low fat, and no carb, high fat diets can be equally unpleasant and unhealthy.

To understand this we need to go back to nutritional basics.  There are 4 “macro” nutrients necessary for good health. These are carbs, protein, fat and water.  Take any of these out of the human diet and already you have something that is inherently unhealthy. With both carbs and fats it all comes down to the types of carbs and fat.

Sugar itself has no useful role in the human diet – it is nutritionally bankrupt.  Highly refined carbs – breads, pastas, flours and processed breakfast cereals are converted very quickly in the human body to sugars which, unless we are highly active at the time and therefore requiring instant energy, are quickly stored as body fat. Complex carbs are a different matter.  It takes time for the body to break these down, and instead of flooding the blood stream with sugars they provide a steady source of energy over a period of hours.  As one of the doctors in the press article found – not providing vegetables to the body (the best source of complex carbs) leads to trouble, including digestive problems such as constipation!

With fats, whilst saturated fats are not necessarily a bad thing, we have to take care of over-consumption: they contain 9 calories per gram compared with 4 calories per gram in carbs.  So swapping to high fat should be done with more than a passing nod to portion control!  The real baddies of the fats world are trans/hydrogenated fats, and unsaturated fats too high in omega-6 – which can be a cause of inflammation in the body, and why these fats are now being increasingly linked with heart disease for example.

As the article concludes, nutrition is a complex matter.  Each of us has our own unique needs to match our unique circumstances and lifestyles.  There is no such thing as a one-size-fits-all diet!  And where will you get the best information?  Well it isn’t from your doctor.  A really crucial, and brutally honest, part of this article admits that doctors are simply not trained in food:

But here’s the problem: despite being doctors – I also have a degree in public health – neither of us knew much about losing weight and eating healthily. 

These topics fall between the cracks at medical school. Yes, we understood biochemistry and food metabolism, and knew a lot about the consequences of being overweight. But which diets work, why we eat too much and why losing weight is so hard don’t sit within any medical speciality.”

Doctors are just as much at the mercy of the incorrect messages that regularly stream from the profit-hungry food industry as ordinary folks.  Worse – they often reinforce those incorrect messages with their patients!  One of the saddest parts of my job is to meet people who truly try to eat healthily – but are basing their efforts on incorrect information and advice.  None of the revelations now appearing in the press and other forms of media are any surprise to a well-qualified nutritional therapist – we’ve known this for years.  And so has the food industry!

I have a few blogs up my sleeve for you in the coming days to expose some of their malpractices – so stay tuned.

The development of diabetes? It’s all monkey business!

Big hungry gorilla eating a snack of bananas for breakfast

By an amazing coincidence – if you actually believe in coincidence – I was relating the part that our human evolution plays in the diabetes problems we are faced with in modern times.  Then low and behold, the news is that a zoo in Devon is weaning its monkeys off bananas for health reasons!

So, for a bit of light relief today… here’s the story:

It was actually really well covered in an article in National Geographic a few months ago, and I would encourage you to read it in full.  But here’s my brief summary:

Some 22 million years ago, before the dawn of man, the prehistoric apes were centred in the African rain forest. Their main diet was an abundance of fruit – straight from the trees, sweet with natural sugar, all year-round. Of course Africa was a very different place 22 million years ago, and still had to go through its own ancient climate changes before it emerged as the place we would recognise today.

Those changes led to a migration by some of the apes out of Africa to settle in the rain forests that then covered ancient Eurasia.  As the climate changes continued and the land became cooler, the tropical groves rich in fruit were replaced by deciduous forests – and a lack of fruit.  Without the year-round abundance of fruits, our evolutionary ancestors faced famine.  And here we see the crux of our modern problem beginning to emerge: rather than die, the apes experienced a genetic mutation that made them amazingly efficient at processing fructose.  So efficient that even the small amounts they could find were easily stored as fat.  This gave them an advantage: survival in winters when food was scarce.

The next stages of evolution saw the emergence of the apes we know today, and eventually humans.  Today all apes, including we humans, still share that genetic mutation.  We still love the sweet taste of sugars, and, at the same time, are amazingly efficient at processing and storing it as body fat!

In times gone by that mutation preserved the lives of our ancestors through lean times, but in modern times it presents us with a huge health crisis. Our food chain is flooded with fructose, even though our bodies have evolved as the ultimate sugar-processing factories.  It’s not just that we don’t need very much, but because we can so easily lay it down as body fat it is positively harmful to us – leading to the specific patterns of overweight and obesity linked with diabetes and other serious inflammatory diseases.

Fruit cultivated for humans is much higher in sugar and lower in protein and fibre compared with wild fruit. It’s that sweet tooth preference thing again that we humans have held on to in all our years of evolution!  So the monkeys in our zoos find themselves eating an adapted diet – we feed them our fruit, not the type their bodies have evolved to tolerate.  And they are experiencing the same consequences that too much sugar has for we humans: tooth decay; diabetes; digestive problems. Them eating our fruit is absolutely the equivalent of us consuming too many cakes and sweets.

Their experience holds up a mirror reflecting the consequences of our own diet and lifestyle choices – if we choose to see it.

First – a diet packed full of leafy green vegetables is so much more beneficial than one laden with sugar – a simple fact of which we are so often in denial.  Food in its original, natural state helps where food cultivated or manufactured to contain higher sugar levels harm!

Second – if we lounge around in our homes instead of metaphorically swinging through the trees – exercise to you and I – our bodies will be less tolerant of our inappropriate diet.  The monkeys in the zoo are limited by their enclosures – we have no such constraints or excuses for not moving around more.

So for a healthy 2014 – let’s get down with the monkeys and back to the way our own natures intended!

Will the new NHS report on Diabetes make any difference?

NHS call to action

A new report by NHS England, entitled Action for Diabetes, has just been released this month.

It’s a response to previous criticisms by the National Audit Office and the Public Accounts Committee in recent years and consists of 32 pages packed full of aspirational ideas and measures for tackling the burgeoning diabetes crisis in England.  And that’s a great start for 2014.  But will it end like many New Year’s Resolutions?

You see, I can already feel my spirits alternately being raised and let down by this report – because we’ve kind of been here before.  Despite previous aspirational reports recommending measures to beat this disease, diabetes care isn’t providing really great results in this country.  The situation now is that:

  • around 3 million people in the UK have diabetes
  • an estimated 850,000 people have undiagnosed diabetes
  • by 2025 5 million people in the UK will have diabetes
  • 7 million people are thought to be at high risk of developing type 2 diabetes
  • about 10% of the NHS budget is spent on diabetes – mainly in relation to complications arising as a consequence of the disease

Here’s my number one issue with this report.  Turn to page 14 and you will find that the top two recommendations by NICE are for structured education, and for personalised dietary and exercise advice for each individual patient.  I have no reservations or hesitation in saying that would be marvellous.

The NICE recommendation for structured education has been around since at least 2005, yet here we are in 2014 and the provision of that education has been dire! The figures below speak volumes:

Patients offered structured education:

  • Newly diagnosed:  2.2% Type 1, 12.0% Type 2
  • All people with diabetes: 1.6% Type 1, 4.5% Type 2

Patients having attended structured education

  • Newly diagnosed – 0.6% Type 1, 3.1% Type 2
  • All people with diabetes – 1.0% Type 1, 1.4% Type 2

That’s a far cry from the NICE recommendation of 2009 that structured education should be an integral part of diabetes care, and “should be offered to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review”.

So what exactly will be different this time around?  That’s the part that the report doesn’t make at all clear.  Let’s hope this isn’t another case of NHS style over substance – time is running out for empty promises!

the 6 diet is now available

DSC_1854

This is a shameless bit of self-promotion for my latest book ‘the 6 diet: food combat for diabetes’.  Available now on Amazon.

I absolutely believe that this is the most healthy way to lose body fat, balance blood sugar and improve overall health through body composition, and I am extremely proud to declare it available!  It ticks all the boxes that we need to beat both the diabetes and obesity crises threatening our health and well-being today.

If you do read it or, better still, actually follow the advice for your own benefit then please let me know what you think.  I will always be pleased to hear from you via my blog here at http://www.rebalancediabetes.com.

Sugar, fat and obesity

salt-sugar-fat

The media is jam-packed full of diet-related information right now.  Sugar is finally being recognised as the biggest dietary culprit of obesity and related illnesses, while saturated fat is emerging from its previous poor, but erroneous, reputation as the enemy.

And great – because the advice that I have been giving will not longer be seen as off-the-wall!  Finally, mainstream advice is catching up with what some of us have known and promoted for several years now.  So I hate to have to reveal that abandoning sugar in favour of more saturated fat will not in itself resolve the obesity crisis, or the health problems associated with overweight and obesity.

The reason being that, while we have definitely identified some of the key pieces, so much of the jigsaw is still missing or being overlooked.

According to the BBC this morning, the obesity crisis is skyrocketing.  It is suggested that previous estimates have become our current ‘underestimates’ regarding the rising incidence of overweight and obesity, and of course all the health problems that will occur as a result.  Here in the UK it was previously suggested that by 2050 a full 50% of the population will be obese.  We will surpass this, it is now estimated by the National Obesity Forum (NOF).  Likewise, on a global scale, we now know that obesity is quadrupling in the developing world. We are all becoming fatter and sicker – fact!

“There needs to be concerted action. There is a lot more we can be doing by way of earlier intervention and to encourage members of the public to take sensible steps to help themselves – but this goes hand in hand with government leadership and ensuring responsible food and drink manufacturing and retailing,” says Professor Haslam, Chairman of the NOF.  Meanwhile, Prof Kevin Fenton, director of health and wellbeing at Public Health England (PHE), said obesity was an international problem that required action at “national, local, family and individual level”.

OK, so the experts are all agreed we need to take action.  And yes, in the past few days we have seen calls for the food industry to be forced to reduce the amount of sugar it needlessly hides in our foods (sadly not immediately shown any enthusiasm by our Government!), but here’s the BUT…

…before we take action, isn’t it sensible that we formulate a sensible plan?   It’s no good reacting in an ad-hoc way on the basis of disparate ideas.  There are several aspects to healthy weight management that need to be considered in a co-ordinated way to ensure the best outcomes.  Having recognised a need, we now have an opportunity to get it right; to establish what helps and what harms; to establish a clear rationale for action; plan for action; and take focused action.  So here are my thoughts based on what I know works with Rebalance:

  • Most diets harm because they fail to take into account the need to protect or improve body composition.  Danish studies have found that weight loss is not the same as fat loss, and on average of the weight lost on an intentional diet a man will lose about 41% muscle rather than fat, and a woman 35%.  Poor body composition is intrinsically linked with poor health.
  • Portion control is key, and should ensure the consumption of a wide range of nutrients to meet all the body’s needs.  It isn’t a case of calories consumed simply being less than calories expended.  What those calories are made of is crucial, because the body processes different nutrient types in different ways.
  • Blood sugar balance is crucial for satiety and to combat cravings.
  • There is no magical one-size-fits-all diet .  Every individual needs to eat according to their own health and lifestyle needs.
  • The food and diet industries have failed us all for decades by continuing to promote so called healthy products and approaches long after research has discredited them.  Turning to the same people who are failing us to find the answer is nonsensical.  It’s time for a sweeping change, not just a policy on a bit less sugar !

I’ll keep you posted!

The need for Rebalance!

Monday 6th January: The official launch of RebalanceDiabetes.

diabetes-1

It was great, thanks to all those who contributed to the success of the launch of 3 products: the RebalanceDiabetes structured nutrition and lifestyle education programme for those living with diabetes; my new book ‘the 6 diet’ published by FisherKing Publishing and soon available on Amazon worldwide; and this website www.rebalancediabetes.com – a single source of all things diabetes-related.

Since 2005, NICE have been recommending that structured education is the way to tackle diabetes in the UK.  Nine years on, it simply isn’t happening.  And that is quite simply not good enough!

The figures speak for themselves:

  •       around 3 million people in the UK have diabetes
  •       an estimated 850,000 people have undiagnosed diabetes
  •       by 2025 5 million people in the UK will have diabetes
  •       7 million people are thought to be at high risk of developing type 2 diabetes
  •       10% of the NHS budget is spent on diabetes

10% of the NHS budget?  Yet the NHS fails to provide the very education that might help to save some of those costs?  One source, Xpert, estimates this at £347 million!!

What remains inestimable, of course, is the value that could be assigned to the improved quality of life that patients might realise from improved clinical outcomes.  Why is it that reports all focus on monetary costs to the NHS, but neglect the value of health to the patient who otherwise faces the horrendous consequences of complications associated with poor diabetes care: cardiovascular disease, blindness, neuropathy, amputations, depression…?

One might be forgiven for thinking that the lack of care boils down to a mere lack of money – but a recent report of proposed moves by the NHS to financially incentivise GPs to provide the simple tests to which patients are already entitled indicates that money per se is not the issue.  Rather it alludes to something much worse than financial constraints – apathy!

Patients should already be receiving:

  •       HbA1c test
  •       Cholesterol test
  •       Blood pressure reading
  •       Albumin to creatinine ratio (a measure of kidney health)
  •       Serum creatinine measurement (another kidney health check)
  •       Foot examination
  •       BMI measurement (height and weight)
  •       Smoking status recorded

The fact that this also is failing to happen is truly shocking – regular routine monitoring of a serious disease not being carried out, and GPs being paid incentives to meet this minimum requirement?

How about the NHS insisting on minimum standards without incentives, and spending the money that it has reserved for that on better education as recommended by NICE to actually improve the levels of care?

Tell me – is that too logical?