For years it troubled and perplexed Dr Ruth Tapsell that her type 2 diabetes patients made little or no progress despite the drugs she prescribed or the healthy eating advice given.
‘If anything, they put on more weight, were hungrier and needed more medication to control their condition,’ says the NHS GP who works in the village of Hartland in Devon.
‘I was also becoming increasingly concerned about the number of drugs we were prescribing to these patients, the cost to the NHS and the side-effects or potential complications the medications can cause later in life — including weight gain. None of it made sense.’
All of that changed three years ago, after Dr Tapsell read an article in the GP magazine Pulse about the low-carb GP Dr David Unwin, whose pioneering work with his NHS patients with type 2 diabetes has previously been highlighted in Good Health — and is featured in a new series starting in Saturday’s Daily Mail.
For years it troubled and perplexed Dr Ruth Tapsell (pictured) that her type 2 diabetes patients made little or no progress despite the drugs she prescribed
Dr Tapsell read how 40 per cent of Dr Unwin’s type 2 patients trying a low-carb diet were in remission and no longer needed medication — as well as losing on average nearly 9 kg (20 lb).
‘I was stunned by the remarkable success Dr Unwin was having reversing type 2,’ says Dr Tapsell. ‘My husband Sam is a GP at the same surgery as me and we were both very impressed by how meticulous and thorough Dr Unwin’s research was.
‘For both of us, this data completely blew apart the traditional idea that type 2 diabetes is a chronic progressive disease that cannot be put into remission.
‘Like many GPs, we’d previously been offering patients standard NHS diet advice for diabetics — to lose weight by eating smaller portions and following a low-fat diet that was high in carbs such as pasta and rice. And it wasn’t working.’
But she says it was clear after examining Dr Unwin’s research that people with type 2 diabetes should actually be avoiding these starchy foods — because they break down into glucose that raises blood sugar levels. ‘This was the most exciting medical discovery we had come across in years,’ says Dr Tapsell. ‘We decided there and then to roll out low carb as the mainstream advice we gave to our patients.’
Dr. David Cavan, Consultant Endocrinologist, who has had success with prescribing low carb to patients with type 2 diabetes
In common with many GPs who recommend a low-carb approach, their advice was very simple: swap cereals and toast for eggs at breakfast time, choose a salad with protein over a sandwich at lunch and meat and veg instead of pasta at dinner time. There was no set carb limit, just that simple advice.
The principle behind low carb is that eating fewer carbs helps blood sugar levels stabilise so the body needs to produce less insulin, the hormone that pushes blood sugar into the cells for energy (or stores it as fat if there is too much).
The body is encouraged to burn fat. Meanwhile, the foods recommended on a low-carb regimen such as protein, abundant quantities of green veg and full-fat dairy help keep you feeling satisfied.
In January, the most recent audit of all 161 patients with type 2 at the Hartland Surgery, where Dr Tapsell works, showed that 32 per cent had reduced their blood sugars to below the threshold for type 2 after going low carb.
‘Most have reduced the medication they are taking and some are drug free,’ says Dr Tapsell. ‘We’re now one of lowest-prescribing GP practices for type 2 diabetes drugs in our region.’
Innovators: Dr Vipan Bhardwaj
The Tapsells are two of an estimated 3,500 UK GPs now offering low-carb programmes as an alternative way to tackle the growing obesity and type 2 diabetes ‘epidemics’ seen across the country.
At the Royal College of GPs alone, 2,600 doctors have now completed the college’s online low-carb training course, designed by Dr Unwin (who’s now regularly invited to speak about his successes at international events).
The low-carb approach is gathering widespread recognition, including last year by the influential American Diabetes Association.
Nurses are also joining the growing army of medical professionals offering low-carb information. The Low Carb/Real Food Nurse Forum, a Facebook group where nurses share tips and success stories, now has 1,000 members. Yet many healthcare professionals, such as nurse Gayle Gerry, first hear about low carb from their patients.
‘Reversing type 2 diabetes with low carb is a grass-roots revolution that’s spreading among patients, doctors and nurses via social media and the internet,’ says Gayle Gerry, who works for Solihull Healthcare Partnership, West Midlands.
She came across low carb via a patient, an overweight, middle-aged man who’d managed to reverse his diabetes after reading about the approach and losing a stone and a half.
‘When I first saw this patient in 2012 I told him that diabetes was a chronic, progressive disease and trotted out the standard advice about eating smaller portions and moving more. At the time he’d been taking metformin but his diabetes was getting worse.
‘He came back two years later with normal blood sugars. I was really impressed — and very curious to learn more. I came to realise how life-changing low carb could be and began offering information about it to my patients: the results were so impressive my GP practice gave me the green light to set up group consultations with the specific aim of reversing type 2.’
Gayle Gerry’s first group of 11 patients in 2019/20 lost on average 1 st 12 lb (11.8 kg) and all substantially reduced their blood sugar levels, with seven patients dropping below the type 2 threshold.
A second group of six patients who adopted low carb over seven months in 2020 lost on average 1 st 3 lb (7.7 kg) and five got their blood sugar readings to normal.
At the Berkshire surgery of Dr Vipan Bhardwaj, all the 40 type 2 diabetes patients who took part in a 2016 low-carb study he ran reduced their medication, and two-thirds came off it altogether.
‘We were amazed by the results, particularly by how rapidly patients’ blood sugar levels started to drop,’ says Dr Bhardwaj, whose Wokingham practice is part of Modality Partnership, one of the largest NHS GP partnerships nationwide. ‘We were also very excited because we could see the potential to help many others.’
Based on the results of this trial, Dr Bhardwaj estimates the NHS could save £20 million a year on diabetes drugs in his local health authority alone.
Further schemes are now under way with Modality (which has 230 GPs) in the North, Midlands, Home Counties and London, including a 150-patient trial in Lewisham, South-East London, funded by the NHS.
And the National Institute for Health and Care Excellence is currently assessing the evidence on low carb and type 2 before issuing formal guidelines.
Particularly noteworthy, say medics using this approach, is the success they’re having using low carb in older patients who’ve had type 2 for many years and are often considered the hardest to treat.
This is partly because the body becomes accustomed to any medication over time, requiring higher doses.
In addition, a variety of changes in the body due to the normal ageing process can contribute to worsening diabetes control.
‘Yet in my experience they’ve done as well on low carb as other patients — with some remarkable successes,’ says Dr Bhardwaj.
Gayle Gerry cites the case of two patients, both in their 70s, who managed to reverse their long-standing type 2 diabetes during lockdown.
‘One 79-year-old man had had type 2 for 25 years but lost 1 st 11 lb [11.3kg] and his blood sugar levels returned to normal after going low carb. Another, aged 72, had had type 2 for 15 years, lost 11 lb [5kg] and his blood sugars also returned to normal. And he’s come off two of his blood pressure drugs — which is brilliant,’ says Gayle Gerry.
Indeed all the patients in her two low-carb diabetes groups have recorded reduced blood pressure readings, with several no longer needing medication.
Dr Bhardwaj and Dr Tapsell have also both noted that a number of their type 2 patients on low carb have improved their blood pressure, with some able to come off blood pressure medication entirely.
A low-carb diet may also help prevent prediabetes turning into full-blown diabetes.
‘Before it like was a runaway train; most patients with elevated blood sugars went on to develop type 2,’ says Dr Tapsell. ‘But thanks to low carb we’ve been able to put the brakes on and the majority of these patients in our practice now will return to normal levels.’
Another potential benefit is for patients with fatty liver disease — linked to obesity and type 2, fat builds up in the liver and can lead to scarring.
‘We’ve seen some amazing results of fatty liver disease being reversed by low carb — subsequently confirmed by ultrasound scans,’ says Dr Bhardwaj. ‘Patients can see an improvement in liver function within weeks.’
Of course everyone’s different and the same approach won’t work for all patients, and that includes low carb,’ adds Dr Bhardwaj. ‘And some people might find it hard to stick to a diet with very few carbs long term’ — a standard criticism of low carb.
There’s also the question of the saturated fat in the full- fat dairy that the low-carb approach allows, because this has been linked to raised cholesterol levels, stroke and heart attacks. However, new research has called this into question.
This has been borne out by the experience of the doctors here, who, mindful of the concerns, have closely monitored patients’ cholesterol levels.
‘In general, our experience is that cholesterol actually improves — and there are clinical trials to back this up too,’ says Dr Bhardwaj.
But it’s not just about the stats, as Dr Bhardwaj explains: ‘The most rewarding aspect for us as doctors is to see how this approach transforms the lives of patients, with so many able to reduce their medication or go drug-free.’
Gayle Gerry concurs: ‘Most patients don’t want to take drugs for the rest of their lives: — this is a very big motivator for many of the people I have come across.’
Her patients ‘have all been evangelistic about their results,’ agrees Dr Tapsell. ‘But this is mixed with frustration that they didn’t know about it sooner and the years that were wasted with poor advice.’
How top specialist found out it really works…
Dr David Cavan
As A distinguished diabetes specialist, Dr David Cavan, pictured, was excited to learn about a new drug that was being hailed as a breakthrough in treating type 2 diabetes.
‘There was a lot of hype,’ recalls Dr Cavan, who was then a consultant endocrinologist at Bournemouth Diabetes and Endocrine Centre, one of the UK’s leading diabetes centres.Back in 2007, eager anticipation surrounded the launch of Byetta, the first GLP-1 agonist drug, which claimed to help type 2 diabetes patients lose weight and reduce blood glucose.
‘This came ten years after a previous “wonder drug” had to be withdrawn within a few weeks because of serious side-effects, so there was a lot of excitement,’ says Dr Cavan. ‘Though some patients did well with Byetta initially, a year later many were back with high blood sugar levels.’
Disillusioned, Dr Cavan began to search for alternative solutions to the rise in type 2 diabetes that he and his colleagues were witnessing. His quest would lead him to become one of the UK’s first low-carb pioneers.
‘It was becoming clear that type 2 diabetes is largely a lifestyle disease — so it made sense to focus on lifestyle change,’ he says. ‘Incredibly, for the first time in my career, I began asking people what they were eating — and was stunned by what I heard.
‘Not just the cakes and biscuits, which most people know contain sugar, but there was also a lot of starchy carbohydrates, such as bread and pasta, which break down to glucose when digested.
‘It was clear most people had no idea how the food they were consuming affected their blood sugar levels. Yet the standard NHS advice for people with type 2 diabetes was to follow a low-fat diet and eat foods high in carb-ohydrates such as bread, baked potatoes and pasta, all of which break down to glucose.
‘My dad was a baker and I bake sourdough so I’m not against carbs, they’re not inherently bad. But if you have type 2 diabetes, by definition your body cannot handle carbs properly. So it seemed to make sense to limit foods that would make the problem worse.
‘Nor am I against the use of drugs — they have an important role in diabetes management — but the focus should be that they help to make your diet changes more effective.
‘You cannot expect any drug to stabilise your blood sugars if you’re constantly feeding yourself foods that cause sugar levels to keep rising.’
Over the next few years, Dr Cavan began asking his patients to consider reducing the amount of carbs they consumed, with the aim of decreasing their medication.
‘I encouraged them to make whatever changes they could — such as swapping cereals and toast at breakfast for eggs or Greek yoghurt. Many were prepared to give it a go.’
One patient was a middle-aged woman who’d had type 2 diabetes for several years and was taking 100 units of insulin a day — ‘a high dose’, says Dr Cavan. ‘Within a few months she’d lost around 2 st, reduced her blood sugars and no longer needed to take insulin, just by reducing the carbs in her diet. I was amazed — and so was she.
‘The realisation that people could actually come off insulin if they changed their diets suggested to me that what they were eating had a far more powerful effect than any medication,’ he says.
It was also consistent with groundbreaking research — published in 2011 by Professor Roy Taylor at Newcastle University — that type 2 diabetes could be reversed by weight loss.
To spread the good news that ‘being diagnosed with type 2 diabetes didn’t have to be a one-way street’, Dr Cavan wrote a book, Reverse Your Diabetes, in 2014 (which he is currently updating).
Within a few months, he was inundated with letters and emails from people who’d read the book, lost weight and been successful in coming off medication — in many cases, reversing their diabetes.
In recent years Dr Cavan has worked largely overseas — for three years he was Director of Policy for the International Diabetes Federation, helping to prevent an explosion of type 2 diabetes in developing countries as their populations adopt increasingly westernised diets.
His approach has been successful in Kenya, including with people on very low incomes. ‘They did very well — which is fantastic as many were unable to afford diabetes medication,’ he says.
Dr Cavan, who is now working part-time as a diabetes consultant at Poole Hospital, Dorset, is involved with setting up similar initiatives in other parts of Africa.
‘We are on the verge of an explosion of type 2 diabetes across the African continent, but there is still time — just — to encourage people to make changes to avoid this happening,’ he says.