A cautionary tale...
When I was new to this low carb journey, I was full of excitement and zeal because I could see the positive results it was having with a handful of patients I was supporting. Life was technicolor - diabetes was being reversed before my eyes - something that was almost unheard of back in 2015.
But then, as in all my fave chick-flicks, trouble struck. Two troubles, actually.
First, a man who I'd very gently introduced the concept of carbohydrate reduction to received my suggestions with great joy and went home and promptly cut all carbs out of his diet (Not what I was going for). Unfortunately he was on insulin, and had a hypo that night as a result. That was a huge wake-up call to me - even though I'd been careful with my language, it was not careful enough - I had not warned him to make adjustments slowly and beware of hypos. (For those who don't know, hypos are a drop in blood sugar. They can be mild and cause some symptoms like shakiness or sweating, or they may be severe emergency situations. Any strange symptoms should be checked by doing a finger prick blood sugar test, and treated with food if the blood sugar is below normal - for most people this is below 4.0 mmol/L in Aussie terms.) This guy did not have to go to hospital, but he was drowsy and semiconscious. It's very vulnerable of me to put these stories out here - please don't throw stones - as I said, I was very new to this work, and it was an unexpected outcome.
Nevertheless, I learned a heck of a lot from that incident and it was never repeated. Now I use extreme care to ensure anyone I share this information with is aware of the potential impact of this, and ready to mitigate the situation if it arises.
DO YOU THINK I AM IRRESPONSIBLE?
Well, you may. But here's the kicker. This treatment - a low carbohydrate lifestyle - is powerful enough to reduce need for diabetes medication in many people! I mean, if we health professionals know that diabetes can be improved and potentially even reversed with a low carb diet, aren't we being irresponsible if we DON'T share it? I would say yes, we are. Hypos can be largely prevented by having an action strategy to reduce medications/insulin as the carb intake reduces, so we should proceed with caution, but not with fear... it it a good and logical thing to reduce intake of the very thing the body is struggling to process!
So where's the evidence?
Glad you asked. There's oodles of it, actually. I just spent 2 years completing an Honours program researching this topic, and believe me, there is plenty. But I don't want to weigh this blog down with too many weighty tomes, so here's my top pick:
https://www.frontiersin.org/articles/10.3389/fendo.2019.00348/full
This is the 2-year outcomes data for the Virta health study. Out of 262 patients enrolled in the low carb arm of the study (87 patients were the 'control' group receiving usual diabetes care), need for insulin dropped by 62% and oral medication use dropped significantly as well. Diabetes was reversed or put into remission for 71% of the participants in the low carb group. I won't get all technical and go into how remission and reversal are defined, but suffice to say, it's an amazing outcome that has not been achieved before with any method other than bariatric surgery (e.g. lap band, gastric sleeve etc). Oh, and what about the control group, you ask? They achieved ZERO remission, reversal OR reduction of diabetes medications.
Are you hearing me? THE USUAL CARE THAT WE PROVIDE FOR PEOPLE WITH DIABETES DOES NOTHING TO REVERSE THE DISEASE!
So knowing this, I think we have a responsibility to offer the care that will be most helpful. Yes, weigh up risk by all means, but if it is appropriate and we can provide the level of support that person may need to make this change, then we should do it. Just maybe we can do it a bit wiser in future!
This incident was a big setback and learning curve for me, but there was a bigger setback around the corner. I'll share that in the next post.
What do you think? Should I have quit while I was behind? I don't think so.
- Juliet.
But then, as in all my fave chick-flicks, trouble struck. Two troubles, actually.
First, a man who I'd very gently introduced the concept of carbohydrate reduction to received my suggestions with great joy and went home and promptly cut all carbs out of his diet (Not what I was going for). Unfortunately he was on insulin, and had a hypo that night as a result. That was a huge wake-up call to me - even though I'd been careful with my language, it was not careful enough - I had not warned him to make adjustments slowly and beware of hypos. (For those who don't know, hypos are a drop in blood sugar. They can be mild and cause some symptoms like shakiness or sweating, or they may be severe emergency situations. Any strange symptoms should be checked by doing a finger prick blood sugar test, and treated with food if the blood sugar is below normal - for most people this is below 4.0 mmol/L in Aussie terms.) This guy did not have to go to hospital, but he was drowsy and semiconscious. It's very vulnerable of me to put these stories out here - please don't throw stones - as I said, I was very new to this work, and it was an unexpected outcome.
Nevertheless, I learned a heck of a lot from that incident and it was never repeated. Now I use extreme care to ensure anyone I share this information with is aware of the potential impact of this, and ready to mitigate the situation if it arises.
DO YOU THINK I AM IRRESPONSIBLE?
Well, you may. But here's the kicker. This treatment - a low carbohydrate lifestyle - is powerful enough to reduce need for diabetes medication in many people! I mean, if we health professionals know that diabetes can be improved and potentially even reversed with a low carb diet, aren't we being irresponsible if we DON'T share it? I would say yes, we are. Hypos can be largely prevented by having an action strategy to reduce medications/insulin as the carb intake reduces, so we should proceed with caution, but not with fear... it it a good and logical thing to reduce intake of the very thing the body is struggling to process!
So where's the evidence?
Glad you asked. There's oodles of it, actually. I just spent 2 years completing an Honours program researching this topic, and believe me, there is plenty. But I don't want to weigh this blog down with too many weighty tomes, so here's my top pick:
https://www.frontiersin.org/articles/10.3389/fendo.2019.00348/full
This is the 2-year outcomes data for the Virta health study. Out of 262 patients enrolled in the low carb arm of the study (87 patients were the 'control' group receiving usual diabetes care), need for insulin dropped by 62% and oral medication use dropped significantly as well. Diabetes was reversed or put into remission for 71% of the participants in the low carb group. I won't get all technical and go into how remission and reversal are defined, but suffice to say, it's an amazing outcome that has not been achieved before with any method other than bariatric surgery (e.g. lap band, gastric sleeve etc). Oh, and what about the control group, you ask? They achieved ZERO remission, reversal OR reduction of diabetes medications.
Are you hearing me? THE USUAL CARE THAT WE PROVIDE FOR PEOPLE WITH DIABETES DOES NOTHING TO REVERSE THE DISEASE!
So knowing this, I think we have a responsibility to offer the care that will be most helpful. Yes, weigh up risk by all means, but if it is appropriate and we can provide the level of support that person may need to make this change, then we should do it. Just maybe we can do it a bit wiser in future!
This incident was a big setback and learning curve for me, but there was a bigger setback around the corner. I'll share that in the next post.
What do you think? Should I have quit while I was behind? I don't think so.
Success is not final, failure is not fatal:
it is the courage to continue that counts.
~ Winston Churchill
- Juliet.
You know, when I started the journey, you had no idea I'd discovered it, Juliet. My 'epiphany' came via a workmate and my transformation was profound. The most profound shock for me however, was not the turn-around in my bloodwork and weightloss, but the complete lack of ability of my doctors to;
ReplyDelete1. Understand the science that reversed my almost toxic bloodwork 180 degrees.
2. Accept the science that took me from an Absolute Cardiovascular Disease Risk Rating of 18% (in the top cohort of getting heart, stroke or cardiovascular disease in the next five years) to 7% (lowest cohort).
Indeed, at a BP of 198/115 in his consultation room in 2016, my doctor almost called for an ambulance to get me to Royal Melbourne, had my second and third readings not shown reduction over the next 30 minutes. His prognosis was that my expected 'lifespan' would end in the next 2 years if something dramatic didn't occur to correct my horror indicators. I even reviewed my will that day.
So, imagine his 'surprise' in 2017 when I presented 25kg down and in the next 5 blood tests, my dire prognosis was reversed? His assessment?
"It's all very interesting, Glenn, but my recommendation to your medical board (in the military) will be that your health status is unsustainable and I believe you'll be back and on medication with heart surgery or suffer a heart attack within 12 months, I'm sorry."
That was 3 years ago. I am on 'Keto Maintenance' now with a BP of 115/65 last week and the blood and health quality of an athlete. (Oh, and because of a hernia, I haven't exercised in 12 months.)
The medical profession is afflicted by 'dogma'. They are infused with this, "... principle or set of principles laid down by an authority as incontrovertible truth....", that blinds them from the very science they profess to be experts in. If it doesn't fit, it doesn't sit with them. They become so arrogant in their knowledge that they lock out all possibility of alternate truth even when challenged by the presentation of incontrivertible proof.
I've since gone on to help mentor and influence over 400 people in the application of Keto to help improve their lives.
And don't feel bad about mis-steps on your journey. I once thought a strict, low fat diet with a reliance on the science-backed, traditional food pyramid was responsible nutrition.
It almost took my life.