At the start of this ‘Sunday Read’, I am going to jump straight in with a brain-teaser to get you thinking about what a huge number £1,000,000,000 (£1 billion) really is.

When it comes to money, figures like this are bandied about in the media on such a regular basis, they barely register anymore. So, to put it into a context that meaningfully illustrates its size, let us say that I was going to give you £1 every second starting from now. How long would it be until you had £1 billion?

So, where are we going with this?

Well, it is not £1 billion pounds that I want to talk about, but £27.1 billion. This is the overall cost of Type 2 diabetes (T2D), across the UK health and economy sectors.

£11.7 billion of this is spent each year by the NHS on the management and treatment of T2D (that’s £1.5 million per hour or 10% of its total budget!).

On top of this are the considerable costs to the economy of work absenteeism, early retirement, and social benefits, which totals another £15.4 billion a year.

So, using the same principle of £1 for every second of time, I would have had to start giving you your money in the year 1168, when Henry II was on the throne, to pay you that £27.1 billion!

Astounding, isn’t it?

Worse still, these figures are on the rise. This is clearly an unsustainable situation. But, can anything be done to help curb this level of expenditure and help people to self-manage this health condition?

Are you at risk from developing Type 2 diabetes?

Before we go any further, let’s define diabetes and differentiate between Type 1 and Type 2.

The NHS definition states that diabetes is a condition that causes a person's blood sugar level to become too high. It differentiates between the 2 types of diabetes as follows:

According to the NHS, you are at risk of developing T2D if you:

• are overweight or obese

• do not have a healthy diet

• have a family history of T2D

• are of Asian, Black African or African Caribbean origin

• take certain medicines such as steroids for a long time

• have high blood pressure

• have had gestational diabetes during pregnancy

Over time, diabetes can lead to serious damage to organs such as the heart and kidneys as well as blood vessels and nerves. So, what could we be doing to help ourselves? Could the power of diet and nutrition help improve our health and create a positive move towards remission from T2D?

I have recently read some very interesting research on this subject. Dr David Unwin, founder of www.lowcarbprogram.com, has been utilising a low carbohydrate diet (LCD) as treatment for T2D in his clinic for many years and has recently published his results.

Over a period of 8 years, the LCD was offered to all his patients with an existing or new diagnosis of T2D. 186 patients started the LCD (this was 39% of his patients with T2D). The average age of these patients was 63 years old.

Patients were given educational materials, plus - on average - 3 additional 10-minute appointments per year. They were also offered 90-minute evening support group sessions every 6 weeks, with relatives encouraged to attend. Behavioural changes were also employed, encouraging patients to consider their individual hopes and health goals, plus the expectation of drug free remission from T2D.

Patients spent an average of 33 months on the diet.

The results

Patients’ progress was tracked using the glycosylated haemoglobin A1C (HbA1c) test. This blood test indicates your average blood sugar level for the past two to three months. A score of under 42 is normal, 42-48 is pre-diabetic and over 48 is diabetic.

The average weight loss was 10kg (just over 1½ stone). Also, encouragingly, there was no weekly calorie counting or weigh-ins or lecturing about food ‘sins’. It was based around eating real/whole foods, with an emphasis on higher levels of the beneficial good fats and protein consumption along with lower carbohydrate intake.

Blood cholesterol levels also fell, on average, by 0.5 mmol/L. It is often the overconsumption of highly processed carbohydrates which leads to an excess of sugar in the blood. This sugar must then be turned into fat and can lead to elevated cholesterol.

Dr Unwin found that the cost to the practice of T2D per patient, per year, dropped to £4.94, while the national average is £11.30. It is sobering to think about the amount of money that could be saved and equally, be re-allocated to other health services straining under the weight of the nation.

Key points to consider if you are thinking of following this approach are:

Ongoing, one-to-one support, is critical. This provides both educational advice and accountability.

Focusing on a LCD as a lifestyle change and not a diet is an important factor, as dieting has been shown to consistently fail.

Discussion about food as an addiction helped patients address their relationship with eating.

Being honest, but empathetic, about the importance of weight loss for health was key to the outcome.

Things to think about

As someone who is continually looking for ways to help his patients manage their T2D, I found it refreshing to read of Dr Unwin's remarkable successes using a patient centred approach and wanted to share it with you, alongside some other interesting research which could be useful if you are hoping to tackle or avoid T2D.

Fasting

Intermittent fasting using the 16-8 method is now well established as an effective way to help improve metabolic health. What is the 16-8 method? It is where you fast for 16 hours each day and utilise the remaining 8-hours as a feeding window. It is not for everyone, but - as a way of kick-starting a weight loss programme by boosting your metabolic health - it can be very useful.

The easiest way to do this is by not eating breakfast, which is usually a very carbohydrate loaded meal. Break the fast around noon and consume 2 large, nutrient dense meals, with a focus on quality fat and protein, minimal carbohydrate with a low glycaemic load.

Alternatively, you may prefer to have 2 normal sized meals with snacks in between, aiming to finish in the evening by around 8pm.

Apple cider vinegar

Anything that can help to avoid blood sugar levels spiking after a meal is beneficial. Interestingly, apple cider vinegar (ACV) has many suggested benefits, particularly in the context of diabetes…

The acid in ACV also helps people digest their food more efficiently if they are under-producing stomach acid (common in older people). The acid is crucial for the absorption of protein, minerals and Vitamin B12. The acidity in the stomach is also the trigger for the release of bile from the gallbladder and pancreatic enzymes, which are critical for fat absorption and proper breakdown of carbohydrates.

First things first

An interesting fact to emerge from multiple studies, is that, if a meal contains a combination of protein, vegetables, carbohydrates and sugars, eating the protein and vegetables first, with the carbohydrates and sugars last, can reduce your blood glucose response in the hours following your meal anything from 20-70%.

Exercise

Not surprisingly, another important consideration is exercise. Any of you who visit the Practice regularly know that we are very pro-active in encouraging patients to do some form of regular exercise. Ideally this should be a blend of cardiovascular low-level activity (swimming, cycling, yoga, Pilates, etc) with some added high intensity exercise (running, skipping, boxing, bums & tums, etc., anything that really gets your heart and lungs going).

Creative Chiro Practice Case Study

David is in his late sixties and has been a patient of the Practice for 9 years. He initially presented with a history of low back pain, which has been conservatively managed ever since. When first attending the Practice, he told me he was pre-diabetic. However, he felt that he would be able to manage this situation on his own. We had ‘that discussion’ about the need to look more at his diet, but David said that this was under control and did not need to change. He felt that as a non-smoker with no other major health issues, being 15kg overweight wasn’t a big issue as he performed regular exercise.

So, when he was diagnosed with T2D in 2021, he felt his life had fallen apart. He was prescribed Metformin and two blood pressure medications. His GP also had a strong word with him about losing some weight. So, by the time he attended his appointment with me, he was very receptive to doing whatever it took to address the T2D. He had also, almost overnight, become vegetarian and was coping well with this sudden and dramatic change in his diet.

I am a strong advocate of the Mediterranean diet, as outlined in Professor Tim Spector’s book, ‘The Diet Myth’ in which he discusses the consumption of whole grains, legumes, nuts, seeds and vegetables, plus higher levels of fats. This is very similar to the diet prescribed by Dr David Unwin. I suggested that David buy the book and after reading it, come back and we would have a discussion about it. When he did return, I was delighted to hear that he had taken on the advice laid-out in the book and was already feeling the benefits.

Just over 12 months ago, David was allowed to slowly reduce his metformin, and finally stop taking it all together. He is still on his blood pressure medication, but his GP has indicated that these may be reduced in the future. David is back to his usual self, with the bonus of losing 13kgs in the process and, most importantly, he is in full remission from T2D.

To Conclude

There are so many health issues that people can develop over time, for one reason or another. Diagnosis of any health condition can be frightening and overwhelming. Treatment can be arduous and challenging. But T2D is one of the few conditions where we have the potential to put ourselves into remission. There is not a ‘one size fits all’ approach and I am not suggesting that every person with T2D will be successful in achieving remission. But, if you take a positive, pro-active approach and get the right support, the odds are on your side.

For further reading on points covered in this article:

• The British Medical Journal’s website has the full evaluation of Dr Unwin’s study: ‘What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss’ - https://nutrition.bmj.com/content/early/2023/01/02/bmjnph-2022-000544.abstract

• For more information on Dr Unwin’s LCD go to https://www.lowcarbprogram.com

• I would also encourage you to read the book by Tim Spector entitled ‘The Diet Myth’ for a fuller understanding of a higher fat/lower carbohydrate diet.

• If you are trying to address your relationship to eating, you may be interested in one of our previous website articles discussing the latest research into the addictive nature of ultra-processed food. To read more, click HERE