After living with type 2 diabetes for a decade, Ann Geoghegan was used to feeling exhausted all the time, struggling with her weight and failing to control her blood sugar levels.
‘My vision was also becoming blurry, which was worrying, but I didn’t think things would ever change,’ says Ann, 70, from Southport, Merseyside.
Yet within just three months, she has reduced her blood sugar levels by a third, is the lightest she’s been for 20 years (dropping 1st 4lb) and feels more clear-headed, energetic and positive.
What may surprise many people is that this is not down to any new drug but to simple changes to her eating regimen — in particular, losing weight by following a low-carb diet. And the benefits for Ann go way beyond just feeling slimmer and mentally sharper.
After living with type 2 diabetes for a decade, Ann Geoghegan was used to feeling exhausted all the time, struggling with her weight and failing to control her blood sugar levels
Her GP, Dr David Unwin, who has been pioneering the low-carb approach to treating type 2 diabetes at his practice in Southport since 2013, says: ‘Losing weight by adopting a low-carb regimen can not only improve your diabetes control but also your life expectancy.’
He estimates that Ann has added at least five years to hers, thanks to her success on the low-carb plan.
Ann’s remarkable story is not an isolated one. Groundbreaking research, published today in the journal BMJ Nutrition and reproduced exclusively in the Mail, shows that patients with type 2 diabetes who switch to a low-carb diet can dramatically improve their blood sugar levels, quality of life and life expectancy — in the space of a few months (see Dave Rowat’s story, below).
But most significantly, this was possible for people such as Ann, who have long-term type 2 diabetes — the kind of patients that many health professionals had assumed would be beyond improvement either through medication (which would only control the disease) or lifestyle changes.
Indeed, a new NHS soup and shakes programme being rolled out this year will only be available to patients who have been diagnosed with type 2 within six years.
Yet in the new study, more than 60 per cent of the 186 participants had long-term type 2 diabetes — i.e. for six years or more — and 97 per cent improved their condition by following the low-carb diet, with many able to reduce their medication because their blood sugar levels were under better control (improved blood sugar levels are beneficial for long-term health).
Two people in the study, who had been struggling with type 2 diabetes for 15 years, even managed to put themselves into drug-free remission.
Dr Unwin, one of the authors of the research, says: ‘This study shows there is great hope for nearly everyone with type 2 diabetes, whether they have been more recently diagnosed or, like Ann, have long-term diabetes.’
His co-author, Roy Taylor, a professor of medicine and metabolism at Newcastle University, who has pioneered short-term, strict, low-calorie programmes for type 2 and was awarded an MBE in this year’s New Year’s Honours list for services to diabetes research, hailed the results of the study as ‘impressive — because of the sheer amount of weight that was lost and kept off’.
Type 2 diabetes is on the rise, largely due to poor diet and obesity. It is estimated that more than 4.8 million people in the UK have it — that’s one in 14 of us.
The most efficient way to check blood sugar levels is via a blood test to calculate the HbA1c (an average measure of the sugariness of blood over two to three months). Anything below 42 mmol/mol is healthy, while 42 to 48 mmol/mol is ‘pre-diabetic’ (where you’re heading towards type 2). Above 48 mmol/mol is in the diabetes range.
Dr Unwin’s goal was to improve HbA1C levels as much as possible because each year your HbA1c reading is over 58 can shorten your lifespan by around 100 days, according to estimates by the National Diabetes Audit office and the Office for National Statistics.
Dave Rowat, 61, a private hire driver, lives with his wife Michele, 56, a cleaner, in Southport. He says: I was shocked when I was diagnosed with type 2 diabetes early last year after a routine blood test for my enlarged prostate. When I mentioned I was always thirsty, the nurse recognised this as a symptom of type 2 and a test confirmed this
This is because, over time, high blood sugar harms blood vessels, potentially causing complications including nerve damage, chronic wounds that lead to amputations, heart disease, blindness, stroke and breast and colorectal cancer. In early pioneering research, Professor Taylor found that people with type 2 have excess fat in the liver and pancreas. This is because our body responds to a sugary meal by producing insulin, the hormone that normally pushes sugar into the cells for energy (or stores it as fat if there is too much).
Professor Taylor has previously shown that losing significant amounts of weight — on soup and shake regimens of 800 calories a day — can trigger changes that strip fat from the liver and pancreas and restore blood sugar control.
The principle behind low carb is that eating fewer carbs — less than 130g a day — can help blood sugar levels stabilise, so the body needs to produce less insulin and, in search of energy, the body is instead encouraged to burn fat.
Low carb doesn’t mean just cutting out the obvious sweet foods such as biscuits; it also rules out starchy foods including bread, potatoes, rice and root veg. This is because all such foods are broken down into sugar and can raise blood sugar levels significantly.
Meanwhile, the foods recommended on a low-carb regimen, such as protein-rich meat and eggs, abundant quantities of green vegetables and full-fat dairy, can help you feel satiated.
‘Patients I treat with a low-carb diet are amazed not to feel hungry,’ says Dr Unwin.
‘But if you eat 500 calories of ice cream, you’ll still feel hungry afterwards. However, if you eat the same calorie value of steak and broccoli, you won’t feel hungry because they’re higher in nutrients that fill you up,’ Dr Unwin explains.
Professor Taylor and Dr Unwin have been at the forefront of the drive to make dietary changes a central part of the NHS approach to type 2 diabetes.
Type 2 diabetes is on the rise, largely due to poor diet and obesity. It is estimated that more than 4.8 million people in the UK have it — that’s one in 14 of us
Professor Taylor was one of the first in the world to demonstrate that type 2 diabetes could be reversed with weight loss.
His approach, which cuts food intake short-term to 800 calories a day, using nutritionally balanced soup and shakes, has been proven in a number of studies — and the NHS is now set to roll it out this year to people with type 2.
Professor Taylor says that the key to his and Dr Unwin’s approaches is that they share the principle of emphasising the importance of shedding excess weight — and that this is what makes the difference for patients’ health. Other methods can also be successful.
However, the low-carb approach has fast been gathering momentum among doctors and patients.
The Royal College of GPs says 1,100 GPs (there are 36,000 in total in England) have so far completed its online low-carb course, designed by Dr Unwin.
The hope is the latest findings will make mainstream medicine sit up and take more notice of this drug-free approach and GPs will offer it to more patients.
To better understand which patients could be helped by a low-carb regimen, the latest study involved analysing Dr Unwin’s database of 186 patients with type 2 diabetes who had followed a low-carb diet for almost three years.
The average patient lost 10kg (1st 8lb) in 33 months. Those diagnosed within the previous three years were most likely to go into remission (with a 50 per cent chance of success). Remission is where blood sugar levels are healthy without the help of drugs.
But the big surprise was that those with longer-term type 2, who did not reverse their diabetes, still experienced great improvements in their blood sugar levels — in fact, even more than those who had achieved remission.
Dr Unwin says: ‘Initially, this may seem odd but it makes sense if you consider that the non-remission group started off with far worse diabetes control. Yet there were two individuals who put their diabetes into remission despite having had type 2 for more than 15 years.
‘I feel our results mean that more doctors should be encouraged to help more of their patients cut the carbs.’
Yet another positive from the research was the significantly reduced cardiovascular risk after adopting a low-carb diet. An initial concern had been that replacing carbs with more red meat, eggs, cream and cheese would have a negative effect on cholesterol levels in particular — but in fact the opposite was true.
All the measures of cardiovascular risk that were tracked (cholesterol levels, blood pressure and weight) improved significantly for the entire group.
Levels of one blood fat in particular, triglyceride (considered key to assessing cardiovascular risk), declined by an average of a third.
This echoed findings in 2018 from a larger study in Liverpool, published in the journal Nutrition Reviews, on 1,633 patients with type 2 diabetes, whose authors concluded: ‘Large randomised controlled trials of at least six months with carbohydrate restriction appear superior in improving lipid [naturally occurring blood fats] markers when compared with low-fat diets.’
Moreover, the Government’s Scientific Advisory Committee on Nutrition said in 2021 that lower carbohydrate diets appeared to have no adverse effects on the cardiovascular health of overweight people with type 2 diabetes, the British Journal of Nutrition reported.
Ann, a factory worker who lives with her husband Terry, 77, and their son Paul, 35, was diagnosed with type 2 after a routine blood test.
She’d struggled with her weight and her blood sugar levels despite, she says, ‘not eating cakes, biscuits or sweets’. She followed NHS advice to base her meals around carbohydrates such as pasta and baked potatoes (as advised on the NHS Eatwell Plate.)
‘I didn’t realise that these foods [carbohydrates] would break down to so much sugar in my bloodstream until I was referred by my GP to Dr Unwin in August and he explained it to me,’ she says.
‘Bread was my big downfall, but I also used to eat a lot of starchy root vegetables such as potatoes, carrots and parsnips — which I now know also break down quickly into sugar.’
Within three months of starting a low-carb diet, Ann, who is 5ft 5in, had lost 1st 4lb (going from 11st 2lb to 9st 12lb) and went from a dress size 18 to a 14. Crucially, her blood sugar readings had plummeted from a sky-high 113 mmol/mol to 74.
Ann remains on a low-carb diet and is optimistic she can eventually put her diabetes into remission. For now, she still takes the same dose of the drug metformin to control her blood sugar levels, but feels infinitely more healthy.
‘I used to be in a complete fog, but now I have my energy and enthusiasm back,’ she says. ‘Now I get up and take the dog for a walk and we stride out together.’ Her eyesight, too, only rarely blurs now.
Professor Taylor says of the low-carb study participants: ‘The weight loss took place largely at the beginning, but they maintained it over time and avoided excessive regain (which can be a problem for some who lose a lot of weight).’
Dr Unwin says the key to avoiding excessive weight regain is to provide close support for patients.
‘It is possible that for some people, food, much like nicotine or alcohol, may be addictive,’ he says. ‘Highly processed foods (such as white bread or sugary breakfast cereals) can be difficult to give up permanently.’
Food addiction is a controversial subject, but one of those working in this
field is Dr Unwin’s wife, Dr Jen Unwin, a clinical psychologist, who says that rates of food addiction are higher in people with diabetes, obesity, eating disorders and depression.
She was recently part of a team that published research in the journal Frontiers in Psychiatry last year on treating food addiction: teams in the UK, U.S. and Sweden were able to show that online group treatments focusing on educating people to understand the effects of sugar on the brain and offering support could successfully help people to change their eating behaviour.
‘Quitting sugar and processed foods might be hard but it is possible with the right information and support,’ she says. ‘For many people moderation doesn’t work.’
But if low-carb doesn’t suit you, there are other ways to shed excess weight and put diabetes into remission, including intermittent fasting (limiting food consumption to certain ‘windows’ of eating), short-term very low-calorie diets (600-800 calories a day) and bariatric operations (where making surgical changes to the digestive system physically prevents overeating).
As Dr Duane Mellor, a dietitian and lecturer at Aston University, explains: ‘There is no one best dietary approach to manage type 2 diabetes — the best diet is the diet that is most suitable for each individual.’
But Dr Unwin remains convinced that low-carb will be the right choice for many. ‘Only last week, I took a patient off her diabetes medication and she gave me the most massive hug! She’d previously been told she’d have to take it for life.’
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