Open letter for your family doctor, hospital doctor and/or dietitian

Dear Doctor, Nurse Practitioner or Dietitian,

I am an NHS GP who qualified in 1986.
I won a Mersey faculty RCGP award in 2016 for my work in diabetes and obesity. I ran a NHS General Practice 1992-2015, and have since worked for the local Clinical Commissioning Group and 2 practices.I say this only to reassure you that I am a bona fide GP.

I have a small professional website www.fatismyfriend.co.uk for my patients which is read by patients from the UK and a few in the wider world.

3 years ago I realized that numerous doctors in various countries were advocating a way of eating for people who did not get the results they wanted with the Eatwell plate. These doctors seemed to be getting better results with their diabetic and overweight patients than I was.

Your patient has probably been following this method, or hopes to start. I encourage people to chart their progress with standard metrics like HBa1c, weight, waist circumference, thyroid, liver function, FBC and lipids, so they may ask you for some blood tests.

As an example of what can be done
, a patient of mine who was diagnosed with T2 diabetes in February 2017 with an HBa1c of 116. By June 2017 his HBa1c was 39, a 66% drop. You can see how he did it by following my website www.fatismyfriend.co.uk or visiting www.diabetes.co.uk or www.dietdoctor.com

Many of us have followed these methods for years now, and some like Dr David Unwin have published their results, and won awards for their work. The methods are known to help people with diabetes, overweight, fatty liver and epilepsy (the latter if they go as far as a ketogenic diet)

DR J R MCCORMACK

joannemccormack@nhs.net
www.PHCuk.org
“Hyperinsulinaemia and Insulin Resistance” Google group

4.7.2017

APPENDIX FAQS

APPENDIX FAQs


Q. What about fibre. Won’t I get constipated?

A. You can get plenty of fibre from vegetables so should not get constipated. Wheat is not essential.

Q. What, no healthy whole grains?

A. Whole grains cause a big rise in your blood glucose, and so are not recommended on this plan.


Q. So what do you eat for breakfast then?

A. Most people eat eggs (omelettes, or scrambled or boiled eggs), or meat or cheese with some salad or vegetables. Some people eat normal Greek yoghurt with nuts and seeds. Or last night’s left overs. If you are not in the habit of having breakfast you don’t need to start.

Q. What about my cholesterol, I thoughts eggs/cheese were bad for cholesterol?

A. It is now accepted that eating healthy fat such as that in meat, cheese and eggs does not usually lead to a rise in cholesterol in the blood. It has also been shown that this way of eating normalizes the blood lipids in over 90% of people. If it does not then advice is available from www.dietdoctor.com

Q. I love bread and pasta. Do I really have to give them up?

A. No, but you can choose to. Both bread and pasta raise your blood glucose significantly so are not recommended. If you are overweight, they will probably have contributed to that. Many people now choose to spiralise vegetables and use those instead of pasta, and use cauliflower rice instead of rice.

Q. Do I have to do it all the time? What if I am going to a restaurant or going on holiday?

A. It is up to you. If you want to make a difference, aim to follow it for around 90% of the time.

Q. What is not recommended on this plan?

A. Take Away foods, Fast Foods, diet foods, processed foods, fizzy drinks whether sugar free or not, and foods from the gluten free section, apart from oats. We are advising you to stick to unprocessed foods, so no bread, cakes, pasta, pies or any food made with flour, and no sugar, apart from what is naturally present. Studies have shown that people on diet foods put on more weight than people eating non-diet foods, so they are best avoided.


Q. I thought fruit was really healthy?

Fruit also raises your blood glucose significantly. For this reason it is best regarded as a treat. Remember that this is a guideline, so aim for twice a week, or a small quantity daily and have it with a meal.

Q. That makes me think of the 5 a day rule. What about the famous 5 a day?

A. Did you know that the whole idea was made up by some fruit and vegetable producers and has no basis in science? Vegetables are much better than fruit, as they have less sugar in them. Eat 5 vegetables a day?

Q. It sounds expensive. Is it expensive?

A. Not usually. This plan gradually retrains your appetite so you eat less food, which costs you less. Also, you do not need a great quantity of meat per meal( 75g or 3-4 ounces will do). You will probably buy little and often, as fresh food goes off more quickly and so have less waste too. Bob Briggs on “Butter makes your pants Fall off” talks about low cost food from Wal Mart and says that you don’t have to eat organic and grass fed to get healthier.

Q. Is it the same as the Atkins diet?

A. No, although the idea of “ healthy fats” is the same. This plan is high in good fat, medium in protein and low in carbohydrate. If you also consider you will be doing it 90% of the time it is quite flexible.


Q. I am vegetarian/ vegan. Can I follow this plan?

A. Yes. Vegetarians should have no problem. There is a section giving advice to Vegans on the website www.drperlmutter.com and www.dietdoctor.com


Q. I am diabetic. Can I follow this plan?

A. Yes. If you are on diet alone or just metformin it is straightforward. If you are on other medication, consult your doctor, but in general it can be halved, and you will need to check your blood glucose every 2 hours to ensure you do not go too low for the first few days. Once you are used to it, you will just need to check 1-2 hours after meals as a learning tool.
If you are insulin dependent you should consult your doctor for advice on your insulin requirements in advance of following the new plan. People’s insulin requirements usually go down to a half or a third and I refer people to a dietitian who knows how to manage low carb to help you through the process. You will also have to check every 2 hours and even through the night at first till you are confident you will not go too low. Some patients have chosen to follow Dr Richard Bernstein’s Diabetes Solution, which is free on line, as well as being in book form, and follows similar principles to the basic food list that we use.
Also see Dr Troy Stapleton’s You Tube clip of how he manages his own Type 1 Diabetes.
“I manage my type 1 diabetes using low carb high fat”

Q. I have IBS- can I follow this plan?

A. Yes, it is generally low in FODMAPs, but if you do react to anything take note and stop it. Further advice on FODMAPs is available by googling FODMAPs and IBS

Q. Can anyone follow it e.g. children, elderly people

A. Yes, anyone can live by this guideline, and the flexibility to do it 90% of the time makes it quite easy. For children you may prefer to take a look at the Low Carb Living for families book by Monique Le roux Forsland or just feed them real, unprocessed fresh food and avoiding packet foods with lists of ingredients.

Q. Is 30 minutes exercise an essential part of the plan?

Exercise is good for you but it is not essential for weight loss. You certainly do not need to overdo it, and a taxing exercise schedule is not necessary. Exercise as much as you can within your capabilities, even if it is just chair-based exercise. It is good for your general health.

Q. Why don’t the government/ department of health/ DiabetesUK recommend this plan

A. These are relatively new ideas and change at a national level takes time.
HOWEVER, UK NICE has already started advising type 2 diabetics to eat low GI food, which is similar to low carbohydrate food, and to have individualized advice. This means you can tailor your carbohydrate intake to get the blood results you want.
Many people would benefit from reducing sugar significantly, by looking for and avoiding hidden sugar in food, as well as reducing the quantity of foods containing wheat, if only because it is often combined with sugar. Reducing sugar intake is part of government policy.

Q. Structured education on diabetes?

If your area offers “X-pert” , ask for the low carb version of the plan.

If not, a free 10 week course on the low carbohydrate way of life -with support-is available on www.diabetes.co.uk

Q. Fast or slow change?

A. Up to you. If you are going to do it fast you will need some advice, as people can get carbohydrate withdrawal symptoms, so buy one of the books and follow the guidance. www.iquitsugar is an 8 week programme to help you come off sugar in all its forms. I was an Expert Advisor on the programme starting in June 2015 and October 2015 and it is gradual and gentle. I have also known people to come off all refined foods quickly and wait till the withdrawal symptoms go. It can be done and takes 1-5 weeks.

Q. I have heard people can reduce BP and cholesterol tablets?

Yes, sometimes your BP or cholesterol goes so low you can progressively come off your medication- with your doctor’s guidance, of course.

Q. Any other questions?

Send me an email joannemccormack@nhs.net