Low carb advocate Dr David Unwin named Innovator of the Year by RCGPs

Congratulations to Merseyside GP and College Fellow David Unwin who has been named ‘Innovator of the Year’ at the national NHS Leadership Recognition Awards 2016.

 

David, who practises at the Norwood Surgery in Southport, spent three years working on a project combining the benefits of a low carb diet with psychological support to help patients with diabetes. As well as having much healthier patients, the practice now saves around £45,000 a year on diabetes drugs!

 

David has been a GP for over 30 years yet this award shows that his mission to constantly improve care for patients and his enthusiasm for the job remain undimmed. As well as being a fantastic personal, achievement, it is excellent to see the work of GPs being recognised on the national stage.

 

The judging panel said that the results of his work were outstanding and that he was ‘passionate about sharing knowledge to achieve a healthier world’. Hear, hear! unwin

Tax on Sugary Drinks Announced

tax on sugary drinksYesterday’s budget news revealed a surprise – the announcement of a tax on sugary drinks.

A surprise because the Government had not previously revealed any enthusiasm for such a tax. More educated commentators and politicians than I have noted that the chancellor George Osborne may well have brought in such a headline move to disguise other less popular cuts, such as the loss of personal independence payments for people with disabilities, cuts in corporation tax and taxes for the very wealthy.

The tax on sugary drinks is due to be introduced in April 2018. It’s expected to be two-tier approach with drinks that contain 5g of sugar per 100ml taxed at one rate and those containing 8g of sugar per 100ml taxed at higher rate. There are 35g of sugar in a 330ml can of Coke for instance.

 

 

Doctors, the NHS England boss, celebrity chef Jamie Oliver and health charities were among those welcoming the budget surprise. France, Finland, Mexico and Hungary already tax sugary drinks and sales in Mexico have fallen by 12 percent since the country introduced a surcharge of 12 percent in 2014.

There is one issue – some type 1 diabetics and other diabetics who use insulin to treat their condition consume sugary drinks when they are hypo – i.e their blood sugar levels are too low and they need something that will bring those blood sugar levels up very quickly. Diabetes UK has said it will be involved in the consultation about how tax on sugary drinks can be introduced to raise this concern so that it does not impact negatively on the way people with diabetes treat their condition.

 

 

Public Health Collaboration: A Group Of Doctors Are Crowd-funding To Solve The Obesity & Diabetes Epidemic

 

Eatwell_PlateIn the UK 25% of adults are obese, the highest prevalence in Europe, and type 2 diabetes has risen by 65% in the past 10 years with no sign of slowing down. Together they cost the NHS £16 billion a year and the UK economy at large £47 billion a year.

These perilous percentages and shocking statistics have presented themselves despite the fact that as a population Britons are following the dietary advice that is being recommended.

Based on the latest National Diet and Nutrition Survey published in 2014 by Public Health England, our total food consumption is on average 383 calories below the recommended, our total fat consumption is just below the recommended 35%, we’re just one portion shy of the recommended 5 fruits and vegetables a day, and lastly we’re only 1 g over the recommended amount of daily red meat intake.

Seemingly the issue of obesity and diabetes in the UK isn’t that Britons are over consuming but that they are following the dietary guidelines, known as the Eatwell plate given by the NHS.

A complete overhaul of these dietary guidelines is needed based on the most up to date scientific evidence in order to improve the health of the UK.

From Monday 1st February – Monday 29th February a group of 12 doctors have come together to solve the UK’s obesity and diabetes epidemics by crowd-funding to set up an independent public health charity called the Public Health Collaboration (PHC).

The group of doctors include deputy chair of the British Medical Association Dr. Kailash Chand OBE, dietitian Dr. Trudi Deakin, cardiologist Dr. Aseem Malhotra, psychiatrist Dr. Tamsin Lewis, general practitioner Dr. Rangan Chatterjee, clinical psychologist Dr. Jen Unwin, diabetologist Dr. David Cavan, general practitioner Dr. Katharine Morrison, general practitioner Dr. David Unwin, general practitioner Dr. Joanne McCormack, general practitioner Dr. Ian Lake and general practitioner Dr. Ayan Panja.

The PHC needs to initially raise £5,000 to publish it’s first public report on healthy eating and weight loss guidelines given by the NHS. Alongside funding it’s ambitious campaign for change within the NHS.

Director of the PHC, Sam Feltham, is closing down his fitness business and only taking a London Living Wage in order to fight for the cause and says “Our £5,000 fund-raising target doesn’t sound like it’s enough to change anything on such a large scale, especially if you’re used to big budgets, but we’re in a fortunate position that our founding members of doctors are not taking any money for helping write our reports and supporting our campaigns.

The PHC will have it’s first public report published in April 2016 on what the scientific evidence tells us should be the dietary guidelines for optimal public health. Once published we recommend that the NHS read the report and takes it seriously for the sake of the nation’s health and economy.”

You can contact Sam Feltham for further comment or to get in contact with our group of doctors by emailing info@phcuk.orgor by calling 07734944349. Website http://igg.me/at/PHCUKorg

 

“A cross-party long-term strategy is needed to combat obesity in children” says Brian Whittle

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Brian Whittle is a gold medallist runner who aims to introduce widespread after school childcare focussed on delivering high quality exercise and physical activities. This is a long term strategy which is fun for children yet could provide immense health benefits and even enhance academic performance.

There are studies which support the validity of Brian’s aims.  But do enough politicians have the long sightedness and will to ring fence funding that is needed?

In order to prevent obesity in our youngsters and the disorders associated with sedentary behaviour a culture change is needed. The unhealthy eating, snacking and reliance on screen based entertainment needs to be replaced by three good meals a day and movement to counteract the long hours sitting in the classroom. Many parents work long hours too, and would welcome group based physical activity for their children in a safe environment.

Brian is seeking support from leaders and health ministers from all parties.  Some headmasters are highly supportive and are delighted with the improved behaviour, reduced truancy and improved grades that they are seeing in pupils who have become more engaged as a result of fun activities after school.

More than 2.3 million children in the UK are overweight or obese and even the under 12s are showing signs of high blood pressure, cholesterol abnormalities, type two diabetes and liver disease.

Dr Tim Lobstein, director of the Childhood Obesity Programme says,  “ It will be tragic if it is not tackled. Chronic diseases are moving forward at an ever increasing rate. Our kids are eating themselves into an early grave. We will have the first generation to die at an earlier age than their parents. Britain along with some other southern European countries are at the top of the list. While soft drink and confectionery sales have rocketed, and TV watching, computer games, and other sedentary media have grown, exercise has fallen. Unless the obesity epidemic is brought under control we are facing the prospect of medicating kids at primary school and for the rest of their lives. If we can just find a way of encouraging healthy growth then we can avoid an enormous amount of grief in the future. Unless we start teaching our children in schools about raising children, feeding them properly, exercise and the difference between good and bad food, then we are just going to exacerbate the problem.”

Getting children to become more physically active and achieve normal weights has been found to improve attention, planning and thus have knock on effects on academic performance. ( Davis CL et al Pediatr Exerc Sci. August 6 2015)

Children who are more active in late childhood can demonstrate lower body weight and lower risk factors for cardiovascular disease and diabetes by their mid- teens.  This means an hour of moderate to vigorous exercise a day. A national approach involving the collaboration of various government agencies would be needed to produce widespread benefit. (Stamatakis E. Pediatrics Vol 135 No 6. 6 Jun 2015)

For younger children under the age of 6, three hours of activity, spread throughout the day is recommended by the US Institute of Medicine. They hope that such recommendations can help reduce overweight and obesity which is currently at 27% in this age group.

For adults at least 30 minutes of activity a day is recommended. The good news is that the earlier you get into exercise the more the habit is like to stick.  Swimming, dancing, walking, running, yoga, jogging, tennis, basketball and football are all suitable. The fitter you are in early adulthood, the lower your total mortality rate and cardiovascular disease rate. There is a clear dose response between exercise and fitness and fitness, well-being and mortality rates. (Shah et al. JAMA Internal Medicine 1-9)

Even if you have been sedentary for years or cannot tolerate 30 minutes a day, it is recommended by the American Heart Association that you start with walking.  Apart from benefits to the individual there is a benefit in health care costs in the future. ( AHA 6 Dec 15)

Emma and I are already into the exercise habit. It certainly is more of a challenge in Scotland with our awful weather and long, dark, winter nights. What good ways have you found to keep active and support your children to be active?

 

 

 

 

Can shared decision making thrive in the current medical culture?

According to a Cochrane review patients are much more satisfied and have better health outcomes when their health care decisions are made in the context of full information and free choice. Patients said that “being in control” was what they most cherished.

At the present time the NHS doesn’t really support true shared decision making and options are likely to become even more limited with a shortage of doctors and strain on budgets. There also is considerable conflict when it comes to following guidelines which are designed for populations rather than individuals. Should a doctor really let the patient take the consequences of their individual choice or would they just be putting themselves at risk from a General Medical Council hearing?

Yet, not all patients want the most expensive treatments. When given full options a fifth of patients decided to avoid or defer surgery for instance.

What is meant to happen is that patients get given option grids with all the risks, benefits and uncertainties of possible investigations and treatments.  They are then asked, “What is the most important thing to you?” and then the doctor is meant to guide the patient accordingly.

Take bowel cancer screening. Currently all 50 year olds get sent a pack for this along with their birthday cards. Nice that someone remembers eh? They then get given the usual barrage of one sided messages about how bowel screening is really easy and could save your life.

If you care to look at this in more depth bowel cancer screening gives a total mortality benefit of six days to the screened population. The main problem is bowel perforation which occurs in 1 in 800 procedures. This is more likely to happen when going round the bends of the bowel.  Diagnosis of this can be delayed. Presumably with the shared decision making model all this is taken into account and the patient gets a truly informed choice.

Breast screening and statins are similarly pushed with considerable information asymmetry in the NHS.  There is no total mortality benefit to women from breast screening or statins yet that does not stop them being promoted. Not much has changed regarding how health care information is put across to patients in decades. An authoritarian stance is taken by the health care promoter and the patient is treated like an idiot.

With shared decision making it is likely that less money would be spent on useless investigations and treatments. If someone particularly wanted to avoid breast cancer “at all costs” they may be happy to be able to have screening perhaps more frequently than occurs at present, or perhaps they may be offered bilateral mastectomy. Many women would however decline to have mammography and that would be a saving not only for the procedure but for the unnecessary surgery and treatments that follow.

Shared decision making certainly doesn’t occur in diabetic clinics. The high carb / low fat diet is a product of “politics based medicine” rather than “evidence based medicine”.  Shared decision making is not for everyone. There will always be people and situations were doing what a doctor thinks is best is the most appropriate option.

But for a lot of non-acute health issues it is appropriate.  I can only hope that shared decision making doesn’t wither on the vine but a large shift in medical culture will be needed before it becomes regular practice.

Based on BMJ Learning module by Alf Collins.

Sugar Reduction Report Publication Delayed

sugarThis week, a UK news report revealed that the publication of a health report that called for the imposition of a sugar tax had been delayed.

The report, Sugar Reduction: The Evidence for Action, compiled by Public Health England (a government advisory group) had set out a number of policies which it believes can help tackle the obesity crisis in this country.

The policies included a sugar tax, a crackdown on the marketing of sugary and other unhealthy products to children, and continued action to push the message that most people need to lower their daily sugar intake.

The report was finally published on Thursday afternoon, although it has been originally scheduled for publication in July. The delay was attributed to the Department of Health (which PHE is part of) so that its findings could be used to inform the government’s forthcoming strategy to combat childhood obesity. The news report revealed that Prime Minister David Cameron had not read the report, dismissing a sugar tax out of hand.

The obesity crisis in the UK is thought to cost the NHS some £5.1 billion a year. The report says its suggested policies, including the sugar tax, are needed to reduce the consumption of sugary foods and drinks that are contributing to this crisis. Continue reading “Sugar Reduction Report Publication Delayed”

Nina’s challenge to the USA food guideline team

Nina Teicholz’s article How dietary guidelines are out of step with science has provoked online furore since it made front page headlines on the BMJ 26 September 2015.

Nina, a journalist who took ten years to research and write her bestselling and highly acclaimed book Big Fat Surprise, has been attacked for having the temerity to explain how bias on the part of the expert panel who decide what should be published in this year’s Dietary Guidelines for Americans, is making people fatter and  sicker, instead of improving their health.

Her opponents claim that as a mere journalist she has no business criticising scientists and doctors who know what is good for patients. They claim that their guidelines are scientifically sound and just because they have missed out studies on low carbohydrate diets that show improvements in weight, diabetes control and cardiovascular risk factors, and also failed to evaluate  studies that show that saturated fat does not cause any health related problem, does not mean that their recommendations are unsound.

Nina is concerned that anything that goes against the low fat/high carbohydrate “healthy eating” advice of the last 35 years is being systematically suppressed.  The committee comprises of only 11-15 “experts” yet the recommendations have ramifications for millions of people, not only in the USA, but worldwide.  A congressional hearing will be set in October to discuss the guidelines, hence the importance of signing Professor Jeff Volek’s petition for clarity over the scientific basis for the guidelines.

The USA government set up the Nutrition Evidence Library in 2010 in order that systematic reviews on nutrition could be comprehensive and standardised. Yet, the current expert team did not use this resource for over 70% of the topics on their review, instead choosing to rely in the opinions of the American Heart Association and American College of Cardiology, both of whom have significant funding by food and drug companies.

Among other inconsistencies Nina points out that the Women’s Health Initiative, in which 49,000 women took part, that the lower saturated fat intervention group had no benefit in heart attacks or strokes. Three meta-analyses concluded that saturated fat did not increase cardiovascular mortality, and yet the recommendation of the group has been to limit saturated fat to less than 10% of calories, saying that the evidence basis for this is “strong”…..Stretching the truth a bit?

Low carbohydrate diet research was also not systematically reviewed.  A meta-analysis and critical review concluded that a low carb diet was the best type of diet to control type two diabetes. Two other meta-analyses showed that low carbing was the best diet for weight loss, and improving cardiovascular risk factors. Despite the evidence that would have been revealed, had it been actually looked for, the guidelines went ahead without it. About the only positive message to come out of the guidelines are that a cap on dietary sugar is being proposed.

The three diets that are endorsed by the new guidelines are the “healthy vegetarian diet”, the “healthy US diet” and the “healthy Mediteranean diet”.  Systematic NEL reviews were done on these diets and the evidence base was given as “limited” which means that the evidence quality was low. Despite this the committee decided to boost the evidence rank to “moderate”. Despite at least three National Institutes of Health funded trials on 50,000 people that show that a low fat and low saturated fat diet is ineffective in combating heart disease, obesity, diabetes or cancer, this is the main thrust of the 2015 guidelines, just like all the other guidelines published in the last 35 years.

Nina thinks that many experts, institutions and industries have an interest in keeping the status quo and that these interests create bias. The potential conflicts of interest in some of the committee members is discussed. This subject has also been discussed regarding our UK guidelines by Hannah Sutter in her book Big Fat Lie.

Nina concludes: Given the ever increasing toll of obesity, diabetes and heart disease, and the failure of existing strategies to make inroads in fighting these diseases, there is an urgent need to provide nutritional advice based on sound science. It may be time to convene an unbiased and balanced panel of scientists to undertake a comprehensive review. There needs to be transparency, disclosure of conflicts of interest, and rigorous scientific evidence that is reliably analysed to produce the best possible nutrition policy.

Well…..Nina, you are quite right, and since Jeff Volek’s petition was launched 4 days ago, at least 4,000 people agree with you. So just how important is having a good food guideline for diabetics?

Take the NICE 2015 type two guideline. A main trust is the promotion of structured education for all types of diabetics. “This should be evidence based ….nutritional advice should be given by a health care professional with specific expertise and competencies in nutrition…emphasise “healthy eating” (also known as the high carb / low fat diet)…limit saturated and trans fats to 5-10% of calories…..reducing hypoglycaemia should be a particular aim for those on insulin or a sulphonylurea…Type two diabetes consists of insulin resistance and insulin deficiency…. Insulin resistance is characterised by increased body weight and is worsened by overeating and lack of exercise…commonly associated with high blood pressure, lipid disturbance and a tendency to thrombosis, fatty liver and abdominal adiposity.”

Surely NICE are kidding? Despite also having a distinct lack in worthwhile evidence for their dietary guidelines, they are pushing all diabetics into nutrition classes led by NHS dieticians. They want them to continue teaching a diet that is well known to increase insulin resistance, burn out the pancreatic beta cells that produce insulin and make hypoglycaemia more likely if you are an injected insulin user who aims for good blood sugar control.

NICE conclude their impossible wish list, ”Aims of education are to improve outcomes by addressing health beliefs, optimising metabolic control, addressing cardiovascular risk factors, facilitating behaviour change, reducing complications,  improving quality of life and reducing depression. The relationship between the person with diabetes and healthcare professionals should be enhanced thereby providing the basis of true partnership in diabetes management.”

Hypocritical or what?

Book review and discussion: What experts say about solving the obesity epidemic

“The shape we are in: how junk food and diets are shortening our lives” by journalist Sarah Boseley is a £13 paperback in which many of the factors that have contributed to the obesity epidemic are discussed.

For much of her material Sarah has gone to obesity “experts” but not a single low carber.  So she has ended up with a  different opinion from what we may have on the causes of the massive surge in obesity over the last 30 years.  Although I don’t share the government “experts” view as to the benefits of a low fat diet,  I think that reading the opinion of “the other side” is a good way to broaden my view and possibly learn a few things that could actually improve the situation. With this in mind I was looking for what I recognise is familiar and  true and also had a chuckle at some of the material as well.

Very little was contentious. I have starred * my own contributions (which I would have given had she interviewed me!)

Behavioural changes at family/individual level: 

Eat meals at meal times at a table with your family. Make meals from proper food. Not processed junk.

Stop dieting and eat good food all the time.

Reduce the amount of processed food that we eat.

Do 45 minutes or more exercise a day to improve mood and use calories.

Don’t snack or eat only healthy snacks such as nuts, cheese and fruit.

Stair climb and walk at every opportunity.

Health service changes:

Offer cognitive behavioural therapy to the overweight.

Expand the provision of bariatric counselling and probably offer this at younger ages.

Advertise the futility and actual harm of crash diets and make such an idea an object of ridicule.

Advise on muscle building exercise for all*

Advise on the benefits on health and physique of the low carb diet*

Educational changes:

Teach cooking in primary school and beyond.

Expand the range of foods served in schools.

Stop serving puddings in schools.

Political changes: 

Tax sugary drinks.

Stop junk food sponsorship of sports events.

Have proper labelling of food.

Subsidise fresh, wholesome food.

Ban sugary food in schools hospitals and workplaces.

Put in cycle paths, street lighting, pavements and redesign towns to make walking attractive.

Have stairs, showers and secure bike parks in offices.

Limit fast food advertising especially to children.

Give proper meal breaks in the workplace.

Put calories/carbs on drinks as well as food.

Food production and service changes:

Reduce portion sizes.

Stop check out sweets and goodies marketed to children.

Stop buy one get one free promotions.

Cut salt, sugar and fat in manufactured foods.

Get food manufacturers to produce more genuinely healthy products.

Decrease plate sizes at buffets.

Actually, I don’t have any gripe with these.  I would simply say that my idea of good food is meat/fish/eggs/cheese/nuts/veg and some fruit with butter, cream, olive, coconut and avocado oil NOT starch, fruit juice, industrial fats. I would also prioritise weight /resistance training over cardio because it make you burn more calories, makes you stronger, doesn’t wear out your joints, and reduces osteoporosis better than cardio.

As you can see the obesity problem and therefore solution is multi-factorial. There are things we can do ourselves, but there  is a much wider framework regarding political will, town planning, working hours and facilities, food manufacturing and advertising, food costing, and education by health services, schools and the media.

We can’t go back to the so called “Good Old Days” like this attractive, affluent, family circa 1949. Will the government get so fed up with the devastating health bill that that they will take some of the steps outlined in Sarah’s book? Or will corporate interests, the low fat/high starch dogma and the high working hours culture win out?