How the NHS failed me and mine.
What it did, to the most important person
in my life and how it could happen to you unless
we do something about it!

Monday, 23 May 2011

New Idiots Guide For NIDDM Published!

NICE has published it's latest guideline for the prevention of Type II Diabetes or as I call it, 'the NICE guide to the manufacture of new patients'. And yes, it's the same old drivel, regurgitating all the tired old protocols, most of which have proven pointless, counterproductive, and more based on dogma than any scientific proof.

I state that with considerable conviction, because these guidelines are unlikely to have any effect on the cohort they are aimed at; those with Metabolic Syndrome. There is still some conjecture as to how this comes about, with often touted views regarding Genetics (the medical excuse for pretty much everything 'they' can't explain) being responsible. And, it is often true that Diabetes does run in families, but whether by 'nature or nurture', there is plenty that we can do to thwart its arrival. The problem is that virtually nothing that is in these guideline's is likely to help.

Looking at the main advice, we have;-
Basing meals on starchy foods, such as potatoes, bread, rice and pasta (wholegrain of course)
(That will be the carb's then)
Fibre rich foods, oats, beans, peas, lentils, grains, seeds, fruit, vegetable etc,etc.
(Some more carbs' then)
Five portions of fruit and veg.
(Even more carb's)
Low fat. (Makes you fat, does fat, you know)
Don't increase your fat or calories. (Just starve then)
Don't have fried food, sugar containing foods or drinks, confectionery etc. (Some sense there)
Cut down alcohol (OMG!)
Watch your portion size. (As you eat it)
Eat breakfast. (?)
Be active as part of your routine. (That'll make you slim you know).
Stop lounging around you lazy buggers. (Sell the TV?).
Walk or cycle instead of driving. (And die under the wheels of the No7 Bus).

Well, that's the gist of it, but will any of that make any inroad into most people's risk of becoming overweight or Diabetic. Frankly no!

Eating excessive carbohydrates is more than likely the reason why some of us become Diabetic in the first place. Numerous studies have shown that carbohydrates are the food group most likely to add weight and increase resistance to insulin, especially refined carbohydrates and this includes 'so-called' wholegrains which are pretty much like all grains, err, only 'browner'. Carb's are converted to glucose, just like sucrose (sugar) at almost the same speed, and if large amounts of glucose flood the bloodstream then it cannot be utilised immediately. The liver will keep some as an 'emergency' supply, to smooth out metabolic need (fight or flight requirements while the body accesses glycogen). The rest will go to storage in adipose cells. If you need a more scientific explanation of the process, there's a really complicated diagram here.

Losing weight, especially if you are moving toward Diabetes is best achieved by diet. A large number of studies support this.Such as this one and yes I know the cohort was small! Well what about this one then? Or perhaps this one, and this one too. Or even this one. Increasing saturated fat intake and protein has more benefit than does lowering them and the review of the Atkins Diet came out strongly in its favour for the treatment of Diabetics and those with Metabolic Syndrome, yet mainstream views continue down the road of banning fat, extolling exercise and generally removing pleasure, all founded on virtually nothing more than dogma.

Looking at exercise, do we find that it has virtue? Well a little. It will not make you slim, but it will help to make you more healthy. But to sell intensive exercise or indeed any exercise as a means of losing weight is to raise false hope. This trial was designed to look at dose dependent exercise to see the results on a number of outcome. It will be seen (toward the end) that little to no weight loss occurred even in the upper levels of exercise, on quite fat people. In fact, intensive, long term exercise, such a marathon running, exacts a toll on the human body that costs the NHS considerably more in net cost than does smoking. Knee and ankle injuries cause the joints to wear out long before their usual time, costing vast amounts in new joints and orthopaedic repairs, without of course the financial input to the system exacted from smokers in the form of taxation. From 'runners world forum' you will see that most who exercise at the extreme, even tend to gain and not lose weight when in training. As a 'rough' rule of thumb guide, 1 mile of intensive running will burn 100 calories, so you can imagine how little is burnt in the sort of regime suggested in the guideline
As for 'low fat', well there is no evidence that links fat consumption to any consequence that is damaging to health. It is in fact quite helpful because it is satiating of appetite, as is protein. So those who mainly take their energy from these food groups, become 'fuller' for longer and tend to consume less calories. Anyway, calories in/calories out is a construct that ignores the second law of thermo-dynamics and is little to do with human metabolism. The human body is not a bomb calorimeter, it's a complex and often wasteful organism that utilises energy in many different ways both for immediate needs and storage for the future. There is in fact considerable evidence that Saturated Fats do not cause heart disease or indeed any other illness, in fact those society's that utilise large volumes of saturated animal fats are in fact extremely healthy (The Inuit). We can in fact live devoid of carbohydrates, but not protein. Death would result, because humanoids cannot live without it as it is the 'building blocks' of most cells.

Cutting Alcohol! Well it won't hurt if you are a bit of a lush, but if you drink moderately of high alcohol drinks it will have little effect on your progress to diabetes. If anything, alcohol tends to lower plasma glucose marginally, but if it has a high carb content like ales and beers, it will raise it. That's where the term 'beer belly' really comes from, it should be termed 'carb belly', it's probably more accurate. So the cola, mixers, fruit juice etc, should be avoided, if you want to drink. Go for spirits with water, or soda, or high alcohol wines, that are not fortified. Anything above 11-12% has had virtually all the carbohydrate turned to alcohol. But don't forget that alcohol has calories and we tend to take drink, on top of an adequate diet, so it can add weight in high volumes. It is also an anticoagulant and as such thins the blood. That daily glass of strong red wine is really medicinal, honest!

Being active is not a bad idea, but surely they don't have to patronise quite so much! Exercise, especially if you sit behind a computer every day is quite a good idea. But don't go mad, and exercise before eating, when you have fasted. What little weight loss that can be gained from exercise, works best whilst in a fasting state. However, specifically to lower plasma glucose, a walk about 1 hour after eating will help your insulin resistance and lower the level in the blood, at about the time it is peaking.

Breakfast. Well a number of experts actually recommend no breakfast at all, or at least not every day. If you wish to, then have a high fat/protein type. Yes, the old-fashioned breakfast, eggs, bacon, sausage (high meat content 90% or better), but forget the bread, toast and cereal. They will make you fat! And a cooked breakfast of this type will keep you going well into the afternoon, even until dinner. I personally fast several days until lunch, and I do eat a hearty breakfast occasionally and then eat dinner, missing lunch, because I'm not hungry. There is in fact a YouTube movie that explains some of the myths that have built up around fat and diet and the inevitable cholesterol. It's quite amusing and true. It can be viewed here.

The problem is that this type of government sponsored propaganda is 'dressed up' as being science. The references given are not studies, but other guidance, most from NICE. Worst, it simply restates that which has been refuted by forty years of trying to reduce the number of diabetics and failing! An inexorable rise that seems to confound all efforts at it's reduction. And obesity, sloth, gluttony and worse, is given as the reasons when in fact many people go to great lengths to lose weight, using such protocols and either fail or obtain a brief respite, only to regain all the weight or worse, gain a bit more!

To put things into perspective, we have evidence that the key markers utilised to indicate risk for all cause mortality, BMI (body mass index) and/or waist measurement, are in fact quite a poor guide. In this study, it was found that those with a lower BMI, were in fact at greater risk, than those with high index. So please NICE. base your guidance on real science, not junk science!

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