Open Future New Zealand

Political Action on Diabetes and Metabolic Disease.

Prevention of Poor Health is a Task we Know How to Do

A summary by John

But we don't even try.

A summary by John Veitch

The size of the problem

Close to 1 in 5 people aged 80-84 have diagnosed Type II Diabetes. An additional 20% are overweight and likely have undiagnosed diabetes. The underlying reality is that government policies and commercial exploitation of bad consumer law and faulty dietary advice has created an obesidemic environment, where 60% of the food and beverages people buy are creating the poor health we seek to avoid.

Most New Zealanders don't eat a healthy diet. One reason is the food environment created by commercial incentives, and the suggested diet the Ministry of Health has promoted, is itself an unhealthy diet. There has been a four-fold increase in Type II Diabetes in the last four decades. That is not driven by genetics, nor by "fast food outlets" that are typically blamed. It's the food sold in supermarkets, and service stations and corner stores that's largely to blame.

There is a strong link between poor diet, obesity, diabetes and cancer that the public is largely unaware of. People hate to be told that the "healthy diet" they have been eating for the last 40 years, is causing their poor health. They cannot believe it. They will react to any effort to change their diet with denial, unless they are personally facing a health crisis. If government agencies try to encourage people to change their diet, the accusation of being a "nanny state" will be raised. It's not a simple issue.

The fact remains that private companies profit from selling obesidemic foods and the public suffers chronic poor health as a result. So our health care system picks up the cost of lifelong medication and many hospital visits that should have been entirely avoidable. Blaming processed sugar, high fat and high salt in the diet, for the obesity crisis is lazy and wrong. Very ordinary foods, like bread, rice and pasta in excess are also to blame.

At any time, about 25% of the patients in hospital have diagnosed diabetes. Another 25% are pre-diabetic or otherwise metabolically ill. This is the opportunity cost of community dietary failure, more than half the cost of our entire medical and health system.

The skills of diabetes educators, general practitioners and endocrinologists are not being upgraded in an appropriate manner. For instance in the last 15 years thousands of people have reversed their Type II Diabetes with very little medical intervention. In the last 10 years a few doctors in countries across the world are routinely showing their patients how to avoid diabetes and how to reverse it. Yet this knowledge is denied to 95% of new patients.

There is new technology that makes the management of diabetes, especially Type I Diabetes much easier. Insulin pumps and continuous glucose monitors, are expensive but they need to be supplied. It's a cost saving strategy.

One pregnancy in six results in Gestational Diabetes of the mother. This is an excellent time to educate a whole family about diet, exercise and avoiding becoming another Type II Diabetes victim. Education of the mother at this time, can potentially help the whole family in the future avoid metabolic diseases. But GP's are not "qualified" to give dietary advice, according to dietitians, and dietitians are tied to the faulty dietary guidelines, so there is nobody following their professional protocol, who can give anyone this advice. "Eat a diet with quality protein, fish, meat and eggs, and all the saturated fat that comes with it. Eliminate added sugar, particularly the sugar in drinks, and severely restrict bread, baked goods, pasta rice and potatoes. Avoid vegetable oils in your diet, except olive oil and coconut oil. Eat green and coloured vegetables if you wish, and avoid too much fruit if you want to reduce weight."

The Public Health System tends to fund procedures. With chronic diseases this funding model encourages the system to capture the patient in a process of "Lifetime Management". In contrast the objective should be to invest in prevention, in reversal, and in making the patient independent of the medical system.

We also fund "medical interventions" and expect both GP's and specialists to offer a medicine or a medical procedure as a treatment. Both the public and the medical profession are trapped by this model. We're told that 75% of a GP's time is dealing with chronic metabolic diseases. There is no pharmacological solution to eating the wrong foods. Yet for many patients, unless they understand how their poor diet makes them sick, there will be continued visits to the GP and later to the hospital.

Preventive care depends on patient education and on self management by patients, long before any medication begins. This is the missing link in the system. School teachers, district nurses, nurse educators and pharmacists, need to be well trained with preventative dietary knowledge. It's not acceptable that the Diabetes Association or G.P. or an endocrinologist tells a diabetic patient that it's essential to eat carbohydrate at every meal. The whole dietary field is riddled with pseudo-science such as vegetarian diets are healthy, the body needs 300gm of carbohydrate every day to energize your brain, that eating a low fat diet will help you lose weight, or that exercise is the best way to ensure weight loss.

People with Type I Diabetes are only 5% of those with diabetes, but they have very special needs that are often poorly met. They need counseling and help to deal with social stigma, especially if the patient is young and still at school. They need insulin pumps, and continuous glucose monitors, and help to store and dispose of sharps. Schools need help to deal with a type I Diabetic child's special needs.

A Patient Report

(Edited summary from over three pages of text.)

I come from a family with a history of heart disease.

I was diagnosed the Gestational Diabetes when pregnant with my first child. My doctor tried to use insulin to correct my blood sugars, with little success. He gave me no advice about my diet. But I knew to eat a healthy diet, low in sugar, low in fat, and using vegetable oils rather the saturated fats. I tried very hard. I spent hours reading food labels and buying the "right foods".

After the birth I was diagnosed with Type II Diabetes. I was always hungry, and thirsty, and depressed. As far as I knew there was no "sugar" in my diet. I did use artificial sweeteners. In spite of my strenuous efforts my blood sugar was badly out of control. I was starving myself, I now weighed only 47kg. My GP prescribed Metformin and a statin which caused muscle pain. She said she was pleased to know that I was eating a low fat diet. Later on, my bone health was suspect and I was sent to an endocrinologist.

The endocrinologist prescribed tablets for osteoporosis which had very bad side effects. That was changed to an injection bi-annually, which I'm still getting. He didn't say anything about my diet.

I found the Official Diabetes information on a Ministry of Health website. I knew enough by now to know that the information was unhelpful and probably wrong. But now I'm online, and I discovered people talking about insulin resistance, low carbohydrate diets and remission from Type II Diabetes. I watched hours and hours of video lectures, mostly from  Low Carb Downunder (https://lowcarbdownunder.com.au/), and I went to the bookshop and purchased several books.

I adopted a low-carbohydrate diet with time restricted eating over the next few months. I began to eat real food, more meat, fish eggs and cheese. I started to eat and enjoy saturated fats. My health improved dramatically.

I was a Type II Diabetic for 30 years, despite my continued efforts to do whatever I was told to do by my medical advisers. A year ago on the Internet, I discovered the source of my diabetes, my diet. I was consuming rice and potatoes and bread and pasta because these were low fat recommended foods. I used skim milk with morning cereals, and ate biscuits as snacks which I now understand made my blood sugar control worse. These foods were the "hidden sugar" that made my diabetes worse.

Now that I'm eating a healthy diet of red meat, saturated fat, fish, butter, lard and coconut oil, my diabetes has reversed, or is in remission. So long as I eat in this new way, I expect to remain diabetes free. It makes my very angry to think that for 30 years, such a simple remedy was always available, but in spite of my own effort to control my diabetes that information was never given to me.

The first opportunity to educate me about my diet was 29 years ago when I had Gestational Diabetes. If doctors then had known what the best doctors now know, I believe that I would never have developed type two diabetes, and years of misguided medical care and worry would have been avoided. My current concern is that for newly diagnosed Type II Diabetes patients, today's treatment is no different than I was offered 30 years ago. We have known better for at least 10 years.

Where is the Science on Dietary Guidelines?

There is no evidence that links whole fat dairy foods, unprocessed meat, or eggs with heart attacks, strokes or type II diabetes.

The promotion of unhealthy polyunsaturated oils instead of saturated fats, has promoted chronic disease rather than preventing it. When carbohydrates are restricted, fat becomes the primary source of fuel, providing essential fatty acids, and fat soluble vitamins A, D, E, and K.

Obesity and diabetes are pre-cursors for many other health problems, insulin resistance, non-alcoholic fatty liver disease, Alzheimer's disease, heart attacks, some cancers, blindness, amputations, and kidney failure. These problems are about 50% of government expenditure on "Health" and we know how to prevent most of that. These are all "Metabolic Diseases" and there are treatments for the symptoms, but no medical cure for the problem except to recommend lifestyle changes.

Public health advice often demonizes red meat in the diet, or recommends eating many servings of fruit and vegetables a day, never mentioning the fact that some red meat and saturated fat is necessary for successful brain development and continued mental health.

The basis of a healthy diet needs to be adequate high quality protein, and associated natural fats. The dietary requirement for carbohydrate is zero, and to promote a high carbohydrate diet, that is 60% of one's total calories is to invite insulin resistance and carbohydrate intolerance. The claim that the Dietary Guidelines are science based is nonsense.

Type II Diabetes is not a progressive lifelong disease. Every patient who is pre-diabetic, and every patient who is diagnosed with Type II Diabetes, should be told, and helped, to A) prevent the disease, or B) to reverse the disease, and to live a medication free life. To with-hold information about the strong possibility of remission from Type II Diabetes in newly diagnosed patients is a clear case of neglected medical care.

The standard methodology for the treatment of obesity is based on calorie counting. The mantra is to eat less and to move more. Calories in v calories out, has been long recognised as an ineffective method. The way the body deals with the food one eats, changes depending on the state of hormones in the body, particularly the amount of insulin in the system. If insulin is high, weight loss is prevented, and weight storage is promoted. If insulin is mostly or always high (Because you snack all day.) then some cells in the body develop insulin resistance, and metabolic dysfunction begins to develop.

When insulin is low, fat burning is possible, and the level of ketones in the blood should develop to a healthy level, commonly 0.5mmol/L to 1mmol/L, but rising to 5mmol/L. This is normal and healthy. So long as your body remains capable of producing insulin, the production of ketones is tightly controlled.

Prevention of metabolic disease should be the public health objective. Long before medication is supplied, people should be given adequate guidance and help to prevent diabetes from becoming a health issue for them. Therapeutic Carbohydrate Restriction should be offered as the primary preventative therapy, where the patient takes responsibility for not developing progressive metabolic diseases. Providing CGM's as part of the dietary awareness training is recommended.

There are at least 67 Randomised Controlled Trials of low-carb diets v low-fat diets, none of which showed any significant advantage for the low-fat diet. In contrast 36 of those trials showed significant advantage in a low-carbohydrate diet. Yet official advice continues to promote a low-fat diet. ( Summary of 67 Low-Carb RCT's prepared by the Public Health Coalition in the UK.)

Our kindergartens, schools, hospitals, military, and aged care facilities are encouraged, sometimes mandated to follow the Ministry of Health Dietary guidelines. This creates worse rather than better outcomes. The Dietary Guidelines urgently need revision.

We need systematic change, in the training of medical staff, health educators and dietitians, to understand how faulty diet and obesity are strongly connected. Exercise is not a remedy for a faulty diet and an ineffective way to reduce obesity. The official public information about how to maintain good health needs to change. The provision of devices like continuous glucose monitors, (Probably only for a month or two.) to people who are pre-diabetic or newly diagnosed needs to be free of charge and supported by group counseling, so people can understand that it really is their "healthy diet" that's making them sick.

Remission of Type II Diabetes

An Australian short term trial (130 days), by Rachelle Martin and Robert Casson, gave a low-carb diet (20gm a day) to 61 patients with Type II Diabetes. 26% of participants in this dietary trial achieved non-diabetic blood glucose measures. (HbA1c <6.5 without medication.)

The late Dr Sarah Hallberg, was reporting Type II Diabetes reversal in 2005. Her famous Ted Talk from May 2015 is here.

Dr Sarah Hallberg (19 minutes)

Published by: Tedx

Dr. Sarah Hallberg was the Medical Director of the Medically Supervised Weight Loss Program at Indiana University Health Arnett, a program she created. She was board certified in both obesity medicine and internal medicine and has a Master’s Degree in Exercise Physiology. Her program has consistently exceeded national benchmarks for weight loss, and has been highly successful in reversing diabetes and other metabolic diseases. Dr Hallberg went on to become the Chief Medical Officer at Virta Health.

In the USA,  Virta Health (https://www.virtahealth.com/) extended Sarah Hallberg's programme and has been highly successful treating patients with health insurance, online, reducing medication for everyone, elimination insulin use for most, and reversing Type II Diabetes for 56% of those in the programme. 63% eliminate the use of medication.  Five year statistics are available. (https://www.virtahealth.com/blog/long-term-type-2-diabetes-reversal-remission-clinical-trial-real-world)

In England some eight years ago, Dr David Unwin was (Like many doctors.) introduced to low-carbohydrate weight loss and diabetes reversal by a patient, who had cured herself, and her husband. It's now a famous story. The Royal College of GP's adopted his clinical protocol, and (rather reluctantly) the NHS has followed. In the 2017-2018 year the Norwood Surgery, Southport, where Dr Unwin is a principle GP, saved the NHS £57,000 in drug costs alone.

In Australia, Sydney Low Carb Specialists report having over 1300 patients on a low-carb diet, since 2019. They report a great deal of success.

 Defeat Diabetes (https://www.defeatdiabetes.com.au/) is an Online Programme anyone and join. The ability of a motivated person to change their diet and lifestyle should not be underestimated. Hundreds of people are doing it, once they are given the correct information.

Why is this a Political Issue?

Dietary Guidelines

The dietary guidelines are not science based. It was assumed that a high carbohydrate diet would give people lots of energy, and not be the cause of ill health. That was before we understood the problem of insulin resistance.

The dietary guidelines are excessively enthusiastic about fresh fruit and vegetables, so much so that they seem to be recommending a vegetarian diet. While it might be possible for a well educated adult to be healthy on a vegetarian diet, that's not the case for children with developing brains.

The need for small regular amounts of meat, fish and saturated fat in the diet is never highlighted. Modern science proves that the brain in particular needs both EPA and DHA for healthy development and for the maintenance of mental health. These are not bio-available from plant sources.

Public Knowledge about Metabolic Health

The public don't understand that their metabolic health, the internal energy processes of the body depend on high quality food to function well. Obesity, lack of energy, inability to sleep, type II diabetes, some cancers, non-alcoholic fatty liver disease are all prime indicators of a poor quality diet.

Training of people who are Health Care Professionals.

My test for any professional group, doctors, nurses, teachers or politicians for instance, is to ask them if they weigh more than they did at age 25. I might also ask them if they can sprint for 100 metres, of if they can walk 600 metres in six minutes. My guess is that 50% of the people you work with will fail all those tests. So what do they know about how to be healthy?

I've been in hospital with a heart problem recently. Even in a heart ward where more than 50% of the patients are diabetic, a ketogenic diet wasn't available. When nurses understood that I was a 10 year veteran using a ketogenic diet, they had many questions about it. They should know, but they don't. Most believed that is was a very difficult thing to do, and wouldn't try it themselves. That says a lot about the failure of their education.

Focus on Metabolic Health and Obesity Prevention.

Educating women is the key to educating whole families. A woman with gestational diabetes needs help, lots of help not just for the time of her pregnancy but afterwards to ensure that she doesn't become a type II diabetic and that she can protect her family from metabolic disease and diabetes.

Any patient who is pre-diabetic or newly diagnosed with diabetes should be supplied with a CGM and training and group counseling free of charge. Most of the health burden of metabolic disease and Type II Diabetes is avoidable, but the medical profession can't control that. The means of prevention is in the hands of each person.

That said, the Public Health System is responsible for the obesidemic environment in which individuals make decisions. The environment in which food and drink is sold is designed to maximise sales and is full of misinformation and confusion. This is made worse by the faulty promotion of "Heart Ticks" and badly formulated "Health Star Ratings", and the faulty dietary guidelines. Advertising channels are full of promotion for unhealthy food and drinks. Supermarket shelves are lined with low fat and high protein slogans, suggesting that this food is healthy. Good examples are "Weetbix" advertised as low fat, "Milo" advertised as high energy for children, or bread that is fortified with vitamins. Everyday things that are part of the excess carbohydrate problem.

Moderating Ever Increasing Public Health Expenditure

More than half the cost of health care to the government is caused by the failure to prevent metabolic disease, Type II Diabetes, and the associated complications of diabetes. Even if the effect of attempted prevention is just to delay the onset of any chronic disease condition, that is a great saving for the system.

There are many opportunities for political action that would do much to improve public health. Taxes on sweetened beverages for instance. Constraints on the advertising and packaging of food especially for children would help. The sale of "baby foods" is a minefield of misinformation and poor advice for young mothers. Babies need to be fed with breast milk, and to be weaned onto real food, not Baby Rice and Banana Custard.