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Five Questions with Richard Shaw, author of Conquer Type 2 Diabetes

CRAB & RADISH STACK (VARIATION) PAGE 83

Type-2 diabetes doesn’t have to be a lifelong condition; for many people, especially those who have been recently diagnosed, it’s possible to reverse the symptoms of this malignant disease.  But how can that be done? Inspired by results obtained from research done at Newcastle University, Richard Shaw decided to try and kick the disease by following a carefully structured, low-carb, whole-food diet and starting a modest exercise regime. Conquer Type 2 Diabetes describes what he did to lose 31 kilos and all his diabetes signs (high blood sugar, high cholesterol, high blood pressure) and symptoms. We caught up with Richard to ask him a few questions about his new book and his amazing recovery. 

What was the inspiration behind your book?

When I started this I really wanted to talk to someone who’d managed to put their own T2D into remission: not a doctor, not a dietician, not a medical professional but someone who had had first-hand experience of doing it for themselves.  I couldn’t find anything that really told me what it was like from the patient’s point-of-view, so I thought it might be worth writing my own. Plus, because I like food so much, I really wanted to write some decent recipes to make the point that it’s not all about bland salads, tasteless soups and intermittent fasting.

CRAB & RADISH STACK (VARIATION) PAGE 83
Richard’s book is full of amazing recipes, like this crab and radish stack.

What was the most challenging part of writing the book?

It can be tough to write a book and hold down a full-time job.  I did it by getting up every morning at 4am, writing for 2 hours and going back to bed for a while before heading into work. I wrote it as I went through the process and there was a part of me that worried that if it didn’t work it might all be a bit of a wasted effort.  In hindsight, I think writing the book probably gave me motivation to keep going and made me even more determined to see it through.

What has been the most satisfying part of the writing process?

I’ve collaborated with other writers on books about food and cooking in the past so, to be honest, it was amazing to finally produce something that had my name on the cover. And even a slim book like this goes through so many versions, eventually having your editor tell you one day that it’s finally done is an enormous relief. I also took huge satisfaction from my GP agreeing to write the foreword, she was incredibly generous with her comments.

FRENCH OMELETTE WITH GRUYERE
French omelette

Did anything surprise you while writing Conquer Type 2 Diabetes? 

I spoke to dozens of other people as I was writing it and I was surprised to find so many people attempting to come off the meds and resume a normal life.  Putting T2D into remission is a very active and passionate grass-roots movement but it hasn’t really translated into mainstream medicine yet.  By and large much of the medical profession is treating this disease in exactly the same way, as it was 30 or 40 years ago, with lame public health advice, generic exhortations to adopt a healthier lifestyle and by prescribing a raft of meds that treat the symptoms rather than the underlying cause.  So finding other people doing exactly the same thing all over the world provided enormous encouragement to keep going.

What sort of people would benefit most by reading your book?

Professor Roy Taylor’s work from the DiRECT trials tells us that the earlier we attempt put T2D into remission after diagnosis the greater the chances of success. And for many people this doesn’t have to be a ‘forever’ diagnosis, – something I took at face value for several years. It’s a story for people who want to take a shot at reversing their condition and testimony that (if addressed soon enough) it may not have to be a lifelong, meds-dependant, progressive illness. And if someone who’s as hopeless at exercise as me, who likes food as much as I do and who’s as much of a slacker as I am can do it, then so can many others.

For more information about Richard’s new book,  go to  his website here,  or join the conversation on Facebook.

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Sweets, treats and choco-mania

Just because you have diabetes doesn’t mean you have to go without sweets and desserts. My experience is that sweets, chocolate, ice cream and other treats can be included in a healthy diet that still allows you to keep your blood glucose under control. For instance, when I went on holiday to Cornwall at Easter, I was able to have an ice cream in Padstow because I was about to cycle back along the Camel Trail. And, at my friend’s birthday party, I was allowed a slice of birthday cake because I had an extra unit of insulin to deal with it. And, every so often, a cake or choc ice after dinner is not a problem at all.

Everyone knows that sweets aren’t the healthiest thing ever; it would be much easier if we all craved broccoli and Brussels sprouts rather than choccies and sugar-coated E-numbers. Sweets may be a totally delicious treat, but they’re full of sugar. And – for everyone, not just people with diabetes – too much sugar is bad.

So, how do you eat sweets and treats and avoid hypers? It’s simple. Try to save sweets for after lunch or dinner, because this way the starch in your other food slows down the sugar in the sweets, and the effect on your blood glucose is much less. Also, think about the types of sweets you eat. Chewing gum and chocolate are far better for your blood sugar than sherbet or lollipops. This is because the sugar in chewing gum is released from the gum slowly (that’s how it keeps its flavour) and the fat in chocolate slows down the emptying of the stomach so that the sugar gets into your system more gradually; whereas sherbet and lollipops are both virtually pure sugar, which doesn’t have to be broken down or refined once inside the body, so it can get into the bloodstream straight away. Another way to enjoy sweets and chocolates is by eating them whilst you are playing sport, doing other exercise or taking part in a P.E. lesson.

So being diabetic doesn’t mean you can’t have sweets or desserts, but you do have to think about their effect on your blood sugar, and there are instances where eating sweets would just be out of the question (for instance if you are hyper). It can be really annoying, and as ridiculous as it sounds, it can become a kind of psychological barrier. I’ve experienced this myself.

A couple of months after I was diagnosed, I was starting to become used to the idea that I had a condition that would not go away. It was hard to get it into my head, though, that I’d have to have injections every day just to stay alive. I used to get upset almost every time I did my Lantus (glargine), then get angry with myself for being so miserable, and try to justify my anger by thinking up all the things I hated about diabetes: I had to stick needles in myself every mealtime, which hurt; I was always going hypo or hyper and it made me feel ill; I was constantly having to worry about my blood sugar and I could never just go and help myself to sweets or chocolate.
I told Mom about the way that I felt so angry a lot of the time. “Think about it,” she said, “What are you actually missing out on? Is there actually anything you used to do that you can’t do any more?”

There was only one thing I could think of: I couldn’t just have sweets whenever I felt like it. I picked up on this and felt really annoyed about it. It may seem like a really sad thing if you’ve never experienced this yourself, but I became practically obsessed with chocolate.

Dad tried to rationalise it by pointing out that I wouldn’t be allowed to just go and help myself to sweets whenever I wanted to anyway. It didn’t make a bit of difference, though. The thing is, I wouldn’t be allowed, but I could have. Now not only would I get in to trouble for gorging on sweets, but it would actually make me ill. And there was no point in arguing that I’d still feel sick after eating loads of chocolate anyway – I may have felt sick but I wouldn’t have actually been medically ill. Now I would be.

I decided that this was the thing that diabetes actually stopped me from doing and quickly became fixated on sweets and chocolate; I used to feel depressed if I missed a P.E. lesson and therefore couldn’t have my chocolate exercise snack, and I used to get what I can only call cravings for sweets. Chocolate, chewing gum, mints, ice cream, even dextrose tablets; as long as I had something sugary to eat I’d be okay. But when I couldn’t have anything sweet I’d get annoyed or upset, and feel like I simply had to have something. I turned to sugar-free gum. I bought massive multipacks of the stuff with my pocket money and often had three or four packs on the go at one time. At my worst point, I was chomping through four pieces of gum daily – and that was on a good day.

The gum worked well, but although I always tried to make sure I was stocked up, I sometimes ran out. I usually managed okay for the day or so until I could go to the shops and buy some more, but sometimes I ended up sneaking an extra exercise snack in P.E., or serving myself slightly more ice cream with dinner than I was supposed to have.

And gum didn’t stop me wanting sweets forever.

Once, I had had a really boring day at school and got home feeling really fed up. I wanted some chocolate – but I knew that I wasn’t supposed to have any between meals. I wanted it anyway, so I tiptoed into the kitchen and took a bag of mini chocolate eggs, rummaged around the bag to find one that had broken in half so that I could just have part of it and not go hyper; then I ate it.

I wanted more. I tipped a few chocolate eggs out into my hand and ate them all in one go. Then, still craving more, I took another few and tried to keep them in my mouth and savour the chocolate. A minute or so later, they’d melted and dissolved. But I still wanted more.

I knew that my brother would be able to tell I’d had some of his sweets if I took any more, so instead I took the packet of dextrose from my blazer pocket and ate a couple of the tablets. I suddenly realised I was going to go really hyper if I didn’t have any extra insulin.

So I found my insulin and injected another half unit. But while I was holding the needle in my stomach I remembered that too much insulin would make me go low, too – and I had no idea how much insulin I needed for what I’d just had because I couldn’t remember how much I’d eaten. I pulled the needle out of my stomach before I’d counted ten seconds. Now I had no idea how much insulin had actually got into me either. I got really upset and into a real panic.
Then Mom and my brother came into the kitchen and I burst out in tears and told my Mom what I’d just done. I knew all along it wasn’t really sensible, but all that had mattered at the time had been that I wanted the chocolate.

Half an hour or so later, my blood sugar went up a bit to about 13 mmol/l, but it came down quickly, dropping to 4 mmol/l about another hour on, because of the insulin peaking. I had a snack at this point and then my blood sugar stayed okay for the rest of the day.

After this experience, I started to think that perhaps I had a mental problem or was developing a literal addiction to sugar. I felt really bad about myself and thought I seriously could be going mad. Now I know I wasn’t going mad – I’m sure other people are like this when they feel like they’re not allowed sweets any more…

Unfortunately, there’s no substitute for willpower. The thing that made me stop chewing so much gum was when I was sorting out my bag ready to go on holiday and found that I had (I’m not joking) about six packs of gum on the go. In the cupboard I found a brand new pack that I’d just bought, and I realised just how much I was getting through. I’d also spent most of my pocket money for the last few weeks on chewing gum. I decided it was getting ridiculous and made a pact with myself that I would take one pack, and one pack only, on holiday. I wouldn’t buy any more while I was away, and if I still had some left by the last day, I could keep the rest that I‘d left at home. If I didn’t manage it, I thought, it could possibly mean that I was actually addicted to chewing gum, in which case I would throw away every last piece of gum in the house and never buy any again. I would have to stop the habit.

I did actually manage it. However, when I got back, I’d pretty much stopped feeling like I had to have gum or sweets. I finished off what I had left – but this time it lasted much longer. Since then, I have continued to buy gum, but only occasionally – and because I want to, not because I feel I need it.

If you crave sweets…

  • It’s important to remember that you can still eat sweets. And if you eat only a reasonable amount with meals or exercise, they will cause you no problems.
  • If you’re a chocoholic or have a serious sweet tooth, try sugar-free gum instead of your usual sugary stuff.
  • When you’re out with your friends, you might find it less tempting to eat sweets if you keep a pack of sugar-free gum in your pocket. You can offer it to your friends, too, so you’re not the only one having gum rather than sugary stuff.
  • Bubblegum containing sugar is better than sweets that are swallowed, too, as one piece will not affect your blood sugar nearly so much as a pack of chewy sweets or a tube of sherbet. It also has the advantage that it lasts for longer – a piece of bubblegum can be chewed for an hour or so until it loses its flavour, but a chewy sweet of the same size and weight satisfies your sweet tooth for only a minute or so, and then you want another one.
  • Be aware, though, that most brands of sugar-free gum can cause laxative effects if you get through loads and loads of it, so if you find yourself getting through half a pack every day, try to cut down a bit.

This blog is an extract taken from Fibi Ward’s book, No Added Sugar – A chatty but practical guide to coping with a diagnosis of type 1 diabetes in your teens, by a teenager, for teenagers

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Rethinking Type 2 diabetes

Type 2 diabetes has always been defined by high blood glucose levels. Most people now think of Type 2 as a lifelong battle against high blood glucose levels, usually beginning with tablet treatment, then more tablets, and finally possibly insulin. After twenty years of basic scientific research and some recent clinical trials, we’re now in a good position to understand what drives Type 2 diabetes, and to start using more logical approaches to the basic abnormalities of the condition – and perhaps to change this standard, and feared, course of diabetes towards ever more treatment.

The real problems lie in the liver and pancreas, the two key organs that process our food after it’s absorbed from the intestine. We know that both these organs have been struggling for ages, perhaps as long as 30 years, before the fasting glucose level peeps above 7 mmol/l, the blood glucose definition of diabetes. They’ve been struggling because of overeating, especially carbohydrates. Although they’re robust organs, they weren’t intended to cope with patterns of modern eating, which floods them with food every 4 hours or so during the usual working day, often with snacks between. The liver and probably the pancreas respond to the food-carbohydrate overload by accumulating fat. Eventually the liver can’t store carbohydrate efficiently, and starts breaking it down into glucose again which escapes into the circulation, especially during the night. The pancreas struggles too, by not producing insulin efficiently enough to bring glucose levels promptly down after meals. The heroic liver and pancreas have been battered for years before they finally fail to keep blood glucose levels normal.

Overeating is the problem, but as with most of the population, individuals developing diabetes are usually overweight. But they aren’t necessarily obese. However a combination of genetics and a strong family history of Type 2, low (or high) birth weight, and many other factors, all contribute to their being more easily overloaded with the same amount of food compared with others. Years, before blood glucose levels climb into the diabetic range, important conditions, intimately linked to Type 2 diabetes, can come to light, though they aren’t sufficiently recognised as such: these include fat in the liver that we’ve just mentioned, but also hypertension, gout, polycystic ovarian syndrome in women and obstructive sleep apnoea – all linked to inefficient insulin action and grouped together as the metabolic syndrome. Because we are so focused on blood glucose levels, these conditions are considered separate from Type 2 diabetes: but they are much more sensitive indicators of metabolic abnormality than blood glucose levels, which at this stage are likely to be completely normal.

Recognising that the roots of Type 2 are in our internal organs becoming fat overloaded has stimulated some remarkable research, especially by the team in Newcastle. They stopped thinking about Type 2 as a blood glucose condition, and focused on the liver and pancreas. They used a simple approach. Reduce over-nutrition by restricting calories to 600-800 a day, compared with our usual intake of 2000-2500, see whether fat in the liver and pancreas also reduce, and as a result expect to see blood glucose levels fall, and all the other complicated metabolic blood tests improve as well. As predicted, after 8 weeks of the very low calorie diet, which resulted in about 15 kg weight loss, all the metabolic machinery was rebooted back to near-normality, nobody needed any diabetes medication, and not surprisingly they felt hugely better. Of course, this radical approach didn’t work in everyone, especially if diabetes had been around for a long time, but a recent report found that everything remained stable for at least a year, even when the liquid diet had been replaced by normal food containing the same low calories.

Type 2 diabetes is therefore not a condition of high blood glucose, but one of fat accumulation resulting from long-term overeating that eventually can lead to high glucose levels, by which time the associated high blood pressure and abnormal cholesterol levels may already have caused serious complications – for example heart attack or stroke. Focusing mainly on glucose levels means that we don’t always concentrate on these other factors, which are more important in causing the long-term complications of diabetes.

The second major recent research theme is the type of diet we should adopt. There is no topic more controversial, but there is now encouraging clinical research to guide us. The PREDIMED study showed that a true Mediterranean diet with added extra-virgin olive oil (or nuts) had a huge effect in reducing cardiovascular disease, whether or not you had diabetes. Because most people in this study didn’t have Type 2, there was no particular focus on blood glucose levels, nor actually on weight reduction – but the Mediterranean portfolio reduced the medical complications that really matter – stroke and heart attacks. The earlier DASH diet which has a lot in common with the Mediterranean diet also nicely reduced blood pressure – an opportunity for Type 2s to reduce their blood pressure medication with support from their healthcare team.

Sadly, no individual ‘superfood’ (current hero is the avocado) has any long-term beneficial effects except on the bank balances of people promoting the latest one. Though there’s no shortage of candidate herb and spice extracts that have shown real potential for treating glucose levels in Type 2 they haven’t had big enough trials. Exercise? There’s no doubt that the recommended weekly 2½ hours of moderate exercise improves cardiac and respiratory health, and that after losing weight, this level of exercise might help reduce the tendency to regain weight. Exercise itself doesn’t prevent prediabetes developing into Type 2, and doesn’t help much with weight loss, but fatty liver seems to respond well to structured exercise. Gentle walking is fine for taking in the view, but in clinical trials people with Type 2 needed to do moderate or vigorous exercise to reduce long-term complications of diabetes – and if they managed that, the heart attack rates were much lower.

In summary: too much fat in the liver and pancreas caused by years of food overload can be detected way before blood glucose levels rise to ‘diabetic’ levels, and is associated with the health problems associated with the metabolic syndrome. Weight loss of 15 kg in weight often reverses these abnormalities. We need to focus as much on blood pressure and cholesterol levels to reduce the long-term complications of diabetes as we do on blood glucose measurements. Evidence-based portfolio diets such as the Mediterranean and DASH approaches will reduce diabetes complications: superfoods don’t.

David Levy, physician at the London Diabetes Centre, was formerly consultant physician at Whipps Cross University Hospital (Barts Healthcare NHS Trust) and Honorary Senior Lecturer at Queen Mary University of London. He has written extensively on diabetes for healthcare professionals, most recently the Hands-on Guide to Diabetes Care in Hospital for trainee doctors (Wiley Blackwell, 2016), which was highly commended at the 2016 British Medical Association Book Awards, and the 4th edition of Practical Diabetes Care (Wiley Blackwell, 2018). His book on Type 1 diabetes (Oxford Diabetes Library, Oxford University Press) is now in its 2nd edition (2017). Get Tough With Type 2 Diabetes (Hammersmith Publications) is his second book for people with Type 2 (Available Spring 2018).