Monthly Archives: March 2014

Scandal of sugar as the norm!

“Being overweight is increasingly seen as the norm, England’s chief medical officer says…Dame Sally blamed the way weight was being portrayed by the media and clothes industry.”  says the BBC this week.

The statistical facts speak for themselves do they not?  Overweight is not simply being seen as the norm: overweight is fast becoming the actual norm!  According to the same BBC report 75% of adults and 33% of children may now be overweight or obese, at a cost of over £5 billion per. year to the NHS.

Just 2 days earlier the BBC reported the scandal of liver disease inaction.   The report declares:

  • Deaths rose by 40% in England between 2001-2012, from 7,841 to 10,948
  • In the past decade there has been a five-fold increase in cirrhosis among people aged 35-55
  • Deaths from liver disease are rising in the UK, but falling in most other European countries.
  • One in five people in the UK is at risk of serious liver damage

One of the biggest contributors to liver disease in the UK is obesity.  Yes – the new “norm” itself is also responsible for a high proportion of liver disease: specifically non-alcoholic fatty liver syndrome.

We increasingly know now that excessive sugar consumption is the root cause.  Dame Sally is right to point to the media as having some culpability here: not by how it portrays weight itself, but by the way it turns a blind eye to the way the food industry promotes sugar-laden foods as healthy!

With all the knowledge out there as a result of recent clinical research:

  • why is the food industry still allowed to advertise sugary, refined carbohydrate-rich foods as the healthy option?
  • why is the food industry still allowed to promote low-fat (aka sugar laden) foods as the healthy option?

It beggars belief that the food industry, the media, and the government are creating the problems of obesity, type 2 diabetes, heart disease, and now, to add to the list, liver disease, whilst at the same time moaning about a lack of action.  A lack of action by whom I would like to ask?

I don’t agree that people are ignorant of their own status as overweight or obese.  I don’t agree at all!  If people were ignorant they wouldn’t be spending a fortune on the so called “healthy options” that make massive profits for the companies that continue to promote and profit from the very products that are causing the problem in the first place!

What people are ignorant of are the true scandals!  The true scandals are that despite all the evidence:

  • the food industry continues to promote sugary, refined-carbohydrate-rich foods.
  • the food industry still claims low-fat to be the healthy option (e.g. a leading brand of low-fat cream cheese contains 50% more sugar than its own full-fat version).
  • the media is happy to profit from advertising revenues from sugar-laden foods.
  • the government continues to collude with its corporate food friends who provide the most harmful foods.
  • the government will not adopt any policy to damage its relationship with the corporate food giants who continue to poison us with addictive sugar – including a suggested sugar tax.
  • the government blames misinformed people – who do try to adopt a healthy diet but fail because food messages are corrupt – for their own failures to take responsible measures to improve available food choices.
  • that obesity is the norm because the food industry, the media and the government are not behaving responsibly.
  • that liver disease is rising in the UK when it is entirely preventable – as evidenced by the falling incidences in other European countries.


Fast food restriction vs education?

burgerAfter a few days away without access to a newspaper, I come back to find that fast food is now the focus of the media in relation to obesity, diabetes and other diseases. Why do our news items insist on singling out specific food products in the healthy vs unhealthy debate on food?  One minute it’s breakfast cereals; then it’s sugary drinks – sodas and fruit juices; now it’s fast food.

The fact is that no one food product will destroy our health or repair our health.  It’s inappropriate to treat diet and lifestyle with the same reductionist approach that is applied to allopathic medicine and mainstream medical care. The suggestion that simply avoiding fast food is a panacea for the current obesity crisis is over simplistic and misleading. Many manufactured food products have the capacity to harm: added sugars, salts, non-food chemicals…all waiting to ambush your health!

On the other hand suggesting that cutting down on food in a generic sense as the magic bullet is not specific enough. This advice fails to differentiate between foods that help and foods that harm: simple calorific restriction without regard for what those calories are made of is nonsensical.  Why?  Because there is plenty of evidence now out there that shows that generic ‘dieting’ is harmful – leading to an inappropriate loss of lean body tissues and impaired body composition rather than a desirable loss of body fat.  Danish studies led the way in quantifying that generic diets lead to 41% of weight lost my men to be from lean tissue, with 35% of weight lost by women comprising lean tissue instead of body fat.  Since then a plethora of studies have been conducted, culminating in a recent suggestion that a 25% ratio loss of lean tissue is an accepted norm in weight loss.  This flies in the face of the fact that research has identified that different nutrients have different effects on body composition in weight loss: simply there is no absolute reason why lean tissue loss should be a given at all.

The crux of the matter – yet one so often missing from media attention or debate – lies in the fact that there is no one-size-fits-all diet that works.  Each person needs to approach weight loss and healthy eating according to several personal factors: current health status, lifestyle factors, targets and goals.  What is healthy eating to one may be quite different to another. Education is key!  Let’s stop the inanity of over simplification, reductionist or broadly generic advice.  Learn what is right for you as an individual, develop your own tailored dietary and lifestyle advice and then implement it.

Education, education, education. Better every time than following media misinformation!


Links between diabetes and liver disease

Research at the University of Edinburgh
has shown that people with diabetes are more likely to develop serious liver disease: death from liver disease is a whopping 70% more likely in those with diabetes.

How can this be?  What are the processes that lead to a build up of fat in the liver? Well, it all boils down to how the body processes sugar, and while this might differ depending upon the type of sugar, excess sugar consumption can readily lead to fatty liver syndrome.

First, let’s define “excess” when talking about sugar consumption.  Glucose is the substance the body needs for fuel – to provide the energy for every one of our bodily processes and functions.  We might get this glucose from sugar or from other carbohydrate foods, but as soon as we take more than we can burn as energy our livers have to get involved to remove the extra glucose from our blood streams, and we can say we have consumed excess sugar indeed carbs.

The liver processes different sugars in different ways.

Glucose which isn’t required to meet our immediate energy needs has to be stored.  First the liver stores this as a substance called glycogen in specialist cells sited around the liver and in our muscles.  Once these specialist cells are full – and they do have a finite capacity – then the liver converts the excess into fat, which it deposits in and around its own tissues.  This is one route to the build up of fat within the liver.

New research shows that fructose metabolism is quite different.  Whilst the body has the capacity to convert any carb into glucose, this new research, led by Professor Robert Lustig, shows that very little of the fructose we eat is actually converted into glucose to meet our energy needs.  The rest is converted directly to fat which finds its way into our liver and into our bloodstream directly.  This is a worry for diabetics – because traditionally fructose is equated with low GI and has been thought to affect blood sugar to a lesser degree.  However, the association with fatty liver syndrome is 2-fold: first it causes disease in the liver itself, and secondly this type of body fay is associated with higher levels of inflammation. Molecules called cytokines are produced by the fat cells and released into the blood stream, carrying the potential for inflammation around the body, and being linked with insulin resistance.  The double whammy for diabetics – i.e. liver disease and further insulin resistance, is therefore more inked with fructose than glucose consumption.  Of course it is fructose that finds its way into many low-fat food products.  The fat may not be present in the food itself, but your body will convert it to fat nonetheless – and the most dangerous kind of body fat!

Ordinary table sugar is a combination of glucose and fructose – so both routes to fatty liver syndrome and further liver disease will apply.  The recent bad press for sugar is more than warranted – and it doesn’t impact just on those living with diabetes!

The evils of sugar is old news!

mediaI am reading with interest all the “news” items pertaining to the dangers of sugar consumption…BUT wondering why it is being considered as news?

After all it is 40+ years since John Yudkin published his (originally-discredited-but-now-hailed-as-a-classic-medical-expose) book “Pure White and Deadly“, alerting us all to the reality of the nature of sugar and its negative effects on our health.

Where, I wonder, was any decent investigative journalism at the time of this crucial work being attacked by the sugar industry?

The fact that the food industry perpetrated one of the biggest public health scandals of modern times; the fact that western governments allowed/colluded with the food industry to get away with that; the fact that the medical profession turned a blind eye and have continued to expound incorrect assertions that low-fat is healthy for far far too long all went unchallenged by our newpapers and media industries. Apparently “Sugargate” attracted no Woodward and Bernstein equivalents! What happened guys?  Was public health just not a sexy-enough subject in those days to warrant your fickle attention?  Or have you actually been complicit with the food and pharmaceutical industries whose views, after all, you have been happy to promote for decades at the expense of our health?  Why promote food as medicine when Pharma has a drug to sell huh?  Why villify sugar when there are such huge profits to be made from prescribing metformin or insulin? “Wonder drug…” makes such a great headline after all!

What!!??“, I hear you journos cry in mock horror! Oh come on guys – despite all the evidence; despite doctors like Malcolm Kendrick and colleagues, men cast in the mould of John Yudkin, who challenge mainstream (profit-oriented) views about statins for example, alerting us to new health scandals, all you still seem to be interested in promoting are views that benefit big business rather than ordinary people.  In just one week we have seen not one but two articles in the Express exhorting us all, perhaps insisting we all, take statins whether we need them or not! Shame on you Express – you have promoted Pharma’s messages without any independent thought or research or opinion.  That’s not journalism – that’s kowtowing! And that’s exactly what you have done until now with regards to sugar!  You have continued to peddle incorrect messages about the dangers of fat, overlooked the real dangers in sugar, and should absolutely take your share of the blame for obesity and diabetes crises you talk so much about!

I smile at the Telegraph article vindicating John Yudkin – “the man who tried to warn us about sugar“.  40 years too late guys for all those people who could have been helped if you had done a little more intelligent digging into John Yudkin’s work 4 decades ago. If only you had wondered why the sugar industry felt such an urgent need to discredit one man’s work.  Now it’s 40 years too late for all those people who have gone on to develop diabetes, heart disease and more as a result of the truth about sugar being suppressed.

Linking your name with John Yudkin now seems to be a cynical move I believe, and disrespectful to all therapists who have supported his views for years only to have been labelled “quacks” in your quest for evermore shocking headlines.  This appalling situation would have perpetuated if it weren’t for Professor Robert Lustig again raising the issue of sugar: and all credit to him for pointing to John Yudkin as his own inspiration for “Sugar – The Bitter Truth“.

The press is incredibly influential in terms of ordinary people’s beliefs about what is healthy and what is harmful. Too often – all too often – I am faced with patients and clients who genuinely try to look after themselves, but who base their efforts on incorrect and inappropriate information gleaned from the newspapers and other media channels.  They have been badly let down!  They continue to be badly let down!

Let’s have some articles that the journalists would stake their own health and lives on!

The truth about your GP’s targets for your diabetes

Doctor waiting for a patientOK, so you’ve been diagnosed with diabetes. It might be a scary time, or you might be able to emotionally take it in your stride, but one thing’s for sure – there’s lots of new information and terminology to get to grips with.

The one that I would like to bring to your attention today is QOF. This is a quality framework that sets targets for your GP. 10% of the targets relate to diabetes – setting out what your GP has to do to attract government funding for the surgery.

Not enough GPs are meeting those targets, and the NHS is looking to “impose strict incentives” according to this article. Hold it right there!! What do they mean “strict incentives”? Isn’t an incentive something nice or attractive that is used to motivate you? So what is the point of the word “strict” when used together with “incentive”? If the NHS isn’t satisfied with the level of GP focus on diabetes, then shouldn’t it be looking to impose “strict penalties” instead? But that rant is just a little aside today really!

With so many GPs apparently failing to meet their QOF targets for diabetes care, you might be forgiven for thinking that they are really tough targets to meet? I encountered the QOF targets at close quarters recently, an was appalled to find that GPs are financially incentivised by the NHS to achieve what I would consider to be the bare minimum in care. Take a look at the table in this report, which defines what different HbA1c reading mean:

“Targets for HbA1c are as follows:

  • For people without diabetes, the range is 20-41 mmol/mol
  • For people with diabetes, an HbA1c level of 48 mmol/mol
     is considered good control, although some people may prefer their numbers to be closer to that of non-diabetics
  • For people at greater risk of hypoglycemia (lower than normal blood sugar), a target HbA1c of 59 mmol/mol (7.5%) to reduce the risk of hypos”

So – what HbA1c reading do you think the QOF targets expect your GP to help you reach? 41 -42? Maybe 48, which is considered to show good control? Actually, 59 is the lowest HbA1c reading your GP has to hit to be paid his maximum incentive by the NHS. Shockingly, all your GP has to do is help you to fall below being “at greater risk” of hypos, and he gets maximum NHS funding for the year. Even more shockingly – your GP will receive a percentage of funding if your HbA1c is below a whopping 75! Take a look for yourself: see targets DM007, DM008 and DM009.

When your GP tells you that you are doing well, check exactly what he means by that. Is your diabetes control where you would want it to be? Is it somewhere between 42 and 48, showing good control? Or does he mean that you are doing well against his QOF targets? Am I just being over-cynical here? I wish that were the case, but I see so many people in my clinical work who are being told that they are doing well with HbA1c readings way above what they would probably want them to be if only the understood what they meant.

So GPs are failing to provide the most basic level of checks? And the NHS is planning to further incentivise them by bundling checks together? I guess it’s a start that the NHS might be noticing that diabetes care is far from acceptable. But even if your GP meets all the QOF targets, YOUR care will still be far from what RebalanceDiabetes thinks is acceptable! Our clients, time and time again, achieve HbA1c readings in the 40s, quickly and easily. Now that’s a target I bet QOF don’t dare to set but unless they do YOU are being failed by the system!

A preview of more QOF-related blog posts coming this way soon:

Think you have a choice in your healthcare? Take a look at DM010 to see why your GP will pressurise you to have your flu jab: that’s right – whatever your own view about the safety or efficacy of the flu jab, your GP will attract funding if you can be persuaded to have one!