As many as two million Britons are at risk of developing type 2 diabetes in the next five years, according to alarming new NHS figures.
They have non-diabetic hyperglycaemia, or pre-diabetes — unhealthily high blood sugar levels. If they don’t take action, they could soon be joining the four million or so already diagnosed with the disease, which significantly increases the risk of premature death.
Type 2 diabetes occurs when the body becomes resistant to the effects of the hormone insulin, which is produced by the pancreas and takes glucose out of the bloodstream and into cells. The condition is typically linked to being overweight, which makes this process less effective, so more and more insulin is needed to do the job.
Ultimately, the pancreas becomes overwhelmed and starts producing less insulin, leaving more glucose circulating. This results in type 2 diabetes. If blood sugar levels are inadequately controlled, this can lead to complications including eye problems, nerve damage, heart attack and stroke.
As well as the personal cost to the patient, the NHS bears the growing financial burden, with one in six hospital beds now occupied by someone with diabetes.
Medication and significant weight loss (through surgery or diet), plus lifestyle changes, reduce the risk of complications in some cases.
A low-carb diet is having significant success in GP practices throughout the UK, as the Mail will reveal in a major series starting this Saturday.
This features Dr David Unwin, one of the pioneers of the low-carb movement — as a NHS GP in Southport, he has seen impressive turnarounds in his patients’ weight and type 2 diabetes — plus low-carb recipes from chefs Giancarlo and Katie Caldesi, written exclusively for the Mail.
The low-carb approach is based on the idea that people who develop type 2 diabetes have a problem with sugar. This includes not only the obvious table sugar, but also the sugar hidden in many foods, such as those with a lot of naturally occurring sugar — fruit juice, for example — and starchy carbohydrates including bread, rice and potatoes, which are broken down into sugar in the body.
The GPs offering a low-carb approach report that some type 2 patients following it have been able to reduce and even come off their diabetes medication as a result.
And it’s not just type 2 patients who are benefiting, as the stories of these patients here reveal. Experts have been warning of an epidemic of non-alcoholic fatty liver disease, which is closely linked to type 2 diabetes and obesity.
It starts with the build-up of fat cells in the liver and, in some cases, can progress to inflammation, scarring and liver failure. As many as one in three people in the UK is estimated to have early signs of non-alcoholic fatty liver disease, according to the NHS.
Here, we talk to patients with type 2 diabetes, fatty liver disease, and even polycystic ovary syndrome (a hormonal condition that affects up to one in five women), who have used low-carb diets to tackle their conditions, with life-transforming results.
I used it for hormonal condition
Sally Reynard, 51, a consultant obstetrician, lives with husband David, 51, and daughters Lexi, 17, and Bea, 16, in Oxford. She says:
Sally Reynard, 51, a consultant obstetrician, lives with husband David, 51, and daughters Lexi, 17, and Bea, 16, in Oxford
I’ve always been on the plump side and struggled with my weight. As a teenager, I tried every diet going, from the cabbage soup diet to the high-fibre diet — you name it, I’ve tried it — but they just left me feeling ravenous.
I couldn’t understand why some people could eat pasta or a jacket potato and be full for hours. I assumed that I was simply greedy, or had no will-power. It felt like my body was conspiring against me.
What I didn’t realise was that I had polycystic ovary syndrome (PCOS), something that I’ve since discovered affects other women in my family, too. My symptoms included irregular periods and storing fat around my tummy.
I don’t tend to weigh myself, but I remember being distraught when, nine days after Bea’s birth, I went shopping for clothes and had to buy jeans in a size 22.
My friend saw how upset I was and recommended the low-carb, high-fat and high-protein Atkins diet. She gave me the book and over the following days, while I breastfed my new baby, I read up on the science behind low-carb diets. It was as if a lightbulb went on in my head as I realised that all the diets I’d tried in the past had been doomed to fail.
Later, when I started my medical training, I learned that PCOS can cause insulin resistance. My body couldn’t process refined starchy, carbs effectively.
I then worked with a doctor in a fertility clinic who advised women with PCOS to try a low-carb diet.
It was the first time I’d come across a medic giving such advice, but he explained that this type of eating plan may result in weight loss, which would improve the women’s chances of getting pregnant, even if they remained above a normal body mass index (BMI).
I started my low-carb lifestyle when Bea was a few weeks old, by cutting out sugar and refined carbs including flour and pasta. I started eating lots of green, leafy vegetables and salad, which are packed with vitamins and minerals.
In the past, I’d always gone for low-fat products, and even my GP had told me to cut down on fat if I wanted to lose weight. But I learned to choose ‘good’ fats such as olive oil and coconut oil to keep me fuller for longer and help stabilise my blood sugar.
Having stopped eating refined carbs, I finally lost weight, and over the next couple of years I dropped from a size 22 to a size 10/12. I never felt hungry, as I ate more chicken, fish and nuts. Not only that, but I found that the cholesterol levels in my blood, which my GP had been worried about, had dropped to normal levels.
In my practice I recommend that women who are larger, and so at risk of gestational diabetes, reduce the amount of sugar and refined carbs they eat, in order to minimise their risk of developing diabetes during their pregnancy.
I advise them to consider the colour of the carbs they eat. They should try to avoid ‘white carbs’ such as sugar; reduce the ‘beige carbs’ such as white bread, pasta and white rice; eat ‘brown carbs’ such as wholemeal bread in moderation; and eat lots of green ‘veggie carbs’.
Following a low-carb diet has made me feel so much healthier. It’s difficult to say whether it improved my other PCOS symptoms, but certainly the stubborn fat around my middle reduced, and in my 40s I had so much energy and exercised regularly — I even took part in half-marathons.
My daughter Bea takes after me and always seemed to love her carbs. When I realised she was struggling with low energy levels and feeling grotty, I suggested that she tried reducing the amount of refined carbs she ate.
At first, she was horrified, but she’s now embraced a low-carb lifestyle. She even had a low-carb cake made with almond flour for her 16th birthday.
I try to stick to my low-carb diet as much as possible. I don’t tend to be hungry in the morning, so rarely have more than a coffee at breakfast time. For lunch I’ll have chicken and a green salad with vinaigrette dressing, or boiled egg with salad and either spinach or avocado. For supper, I eat a lot of chicken breast or salmon with salad.
I heard about the Caldesi cookbook through friends, and Bea now makes some delicious recipes from it. She’s a great cook. We’ve started adapting recipes, too, so we’ll swap a normal pizza base for a cauliflower base, or use spiralised courgette instead of carb-heavy pasta.
Recently, I’ve put some weight on due to going through the menopause and then developing breast cancer. But I’m back to eating well now, and exercise twice a week. At 51, what’s more important to me than looking slim is feeling, and being, healthy. That’s why I’m sure I’ll continue this way of eating in the years to come.
New diet made my skin clearer
Sally’s daughter Bea, 16, also benefited from the low-carb diet. She says:
Sally’s daughter Bea, 16, also benefited from the low-carb diet
Like my mother, I have struggled with my weight since I hit puberty. I noticed that I was fast becoming uncomfortable in size 14/16 clothes. I do a lot of dance including ballet, but, as I got heavier, I was finding it harder.
It got to a point last September where I left a dance class in tears, and I rang my mum saying I had to do something about my weight.
I was aware of the success she’d had on her low-carb diet.
I had always resisted trying it myself, because I love cooking and baking. One of my favourite foods to make is pavlova, and I didn’t think you could make one without sugar. I’ve since discovered you can — with sucralose or stevia instead.
I didn’t want to do the diet half-heartedly, so I cut out all refined carbs straight away to see if it made any difference. I’m at boarding school where we are provided with meals three times a day, and often these are high in carbs — take pasta bake, for instance.
It was quite a challenge, but I started by having bacon and egg for breakfast; a salad with ham or tuna for lunch; then Bolognese with salad for dinner, for example. For snacks, I’d grab some nuts, a slice of salami or a bit of cheese. I noticed the change in my energy levels first. Without the carbs I felt less weighed down and more energised.
By Christmas, I noticed my clothes were getting looser. Jeans I’d worn for three years were suddenly too big, and I had to buy some new clothes. I was amazed when I recently bought some size 10 jeans.
I don’t want to lose much more weight, so I’ve been introducing other foods such as apples and quinoa into my diet.
Bea said: ‘Like my mother (pictured together), I have struggled with my weight since I hit puberty. I noticed that I was fast becoming uncomfortable in size 14/16 clothes’
I gave myself two weeks off at Christmas to enjoy some of the traditional foods, but afterwards I felt bloated and sluggish, so I am not sure it was worth it.
Not only have I lost weight, but my skin is clearer. I now enjoy running, which is something I never thought I’d say. I’ve gone from not being able to jog 100 metres to happily running three miles.
I’d recommend a low-carb diet to anyone who wants to try it to see if it feels right for them. Lots of people think they could never live without refined carbs, but you might be surprised.
You’re never too old to break bad habits
Brian Clark OBE, 81, a retired engineer and widower with two daughters, lives in Southport, Merseyside. He was diagnosed with type 2 diabetes in 2005. After following a low-carb diet his weight has dropped from 15st 11lb to 10st 8lb and he has stopped taking medication for type 2 and high blood pressure. He says:
Brian Clark OBE, 81, stopped taking medication for type 2 and high blood pressure after following a low-carb diet
After I got back from a cruise in 2018, my GP, Dr David Unwin, phoned me excitedly and asked me what I’d been doing, as my blood sugar had come down and I’d lost a few pounds.
I told him I’d been eating well on the cruise, having more protein such as lean meat and fish, and more vegetables than usual, as well as less bread, pies and pastries. It was then that he suggested I try the low-carb diet.
I’d had type 2 diabetes for 13 years and had been on insulin injections for almost all that time. My health had deteriorated quite a bit.
As a young man I was a champion runner, but I gave up athletics when I started work and developed unhealthy habits, including smoking and a liking for pies and chips. I took no formal exercise and told myself I was getting enough by being on my feet at work.
After I retired and became a carer for my late wife I didn’t get much time to look after myself and take exercise, so my weight crept up.
By 2016, I weighed around 15st, so at 5ft 5in tall, I was quite plump — my BMI was 38.4, which made me ‘obese’. I didn’t feel well, either; I had no energy. My blood sugar was also high, and I seemed to need higher and higher doses of insulin.
After Dr Unwin’s call I decided to give the low-carb diet a go.
It was a very different way of eating — previously my breakfast would have been fruit juice and a sugary cereal with milk, but I switched to black coffee, a piece of cheese and an apple, or Greek yoghurt with berries. Once a week I treated myself to a traditional English breakfast. This was not too dissimilar to how I had eaten on that cruise.
For lunch, I’d have a two-egg omelette with mushrooms, or smoked fish with steamed green vegetables. Dinner would usually be a salad with chicken or cured meat, avocado or prawns. I made the effort to include vegetables with every meal so my diet was much more varied.
I also started exercising once a week, and now I do a workout with a personal trainer for an hour a week, too. I’ve become a lot fitter, stronger, with more energy. People say I look ten years younger, and I feel it.
As well as losing the weight, I’ve come off insulin and diabetes tablets, and my blood pressure is 118/68, which I’ve been told is what you’d expect in a 25-year-old. I was proud to be told this.
I’m living proof that it’s never too late to change bad habits.
I beat my fatty liver disease and sleep issues
Anna Eastwood, 60, a retired nurse, lives with husband Peter, 55, in Southport, Merseyside. She weighed 21st 9lb — she is 5ft 3in — and had non-alcoholic fatty liver disease. After going low-carb, her weight dropped to 12st 13lb, reducing her BMI from 53.6 to 32. Her liver is back to normal. She says:
Anna Eastwood, 60, weighed 21st 9lb — she is 5ft 3in. After going low-carb, her weight dropped to 12st 13lb
I’d reached the point where I hardly went out as people would shout insults at me for being overweight. Once I was in a restaurant and someone shouted ‘fat cow’ at me. I felt so hurt and humiliated. My weight problem was partly down to bad arthritis — I could barely walk. I’d been on tranquilisers for PTSD from childhood trauma and weight gain was one of the side-effects.
I did all I could to lose weight. I ate a high-fibre cereal and skimmed milk for breakfast; pasta and chicken in a low-fat sauce with lots of vegetables for lunch; and dishes such as Quorn stews in the evening, or rice or pasta. The portions I ate weren’t overly large, either — I even had a plate with portion sizes marked up on it.
Two years ago, I tried the keto diet [a more extreme version of a low-carb approach that involves eating a diet with 75 per cent fat, 15 per cent protein and 10 per cent carbs] and lost 7st in six months. I didn’t crave carbs as much as I did when I was eating them, as I had no sugar highs and lows.
However, I developed bile duct stones and was told I’d been eating too much fat. My gastroenterologist said I should switch to a low-fat diet. Within eight months I regained all the weight I’d lost. That was proof that the low-fat/high-carb diet didn’t work for me, and I sought medical advice.
By this time not only was I suffering from sleep apnoea, where you temporarily stop breathing in your sleep, but I’d also developed severe non-alcoholic fatty liver disease — my liver was twice its normal size in a scan, and I was told I was at risk of cirrhosis and ultimately liver failure. As a nurse I’d looked after people with end-stage liver disease so I knew what could lie ahead, and it scared me.
Dr Unwin turned out to be my saviour. I went to see him in December 2018 and he suggested I try the low-carb approach, which has a moderate fat level (unlike the high-fat keto approach), and combine it with intermittent fasting for 18 hours, which encourages your body to burn fat.
And so I ate my main meal at 6pm and didn’t eat again until noon the next day — though I had a black coffee in the morning. The carb cravings went after four days, and within a week I began to feel so much better.
I didn’t feel hungry, either — it was a miracle. The weight came off and 16 months on, I have lost 8st 10lb and my liver has returned to normal. My sleep apnoea has gone, too. Losing so much weight has meant my mobility has improved and I can now walk a lot more, albeit with sticks. I don’t use my wheelchair as much.
I’ve had no problem with bile duct stones either, and my cholesterol levels are normal.
Just over a year ago I was wearing a size 30 jacket, but now I’m down to a size 12/14. I’ve also been able to come off some of my medication for PTSD as Dr Unwin got me access to psychological therapy.
I feel so much more confident and happier — I look in the mirror and it’s like the old me has come back.
The bread and pasta that will cut your carbs!
From pasta to jam, you can now buy ‘low-carb’ versions of many foods. We asked Priya Tew, a dietitian in Southampton, to assess a selection.
HOVIS LOWER CARB SEEDED BREAD
£1.20, 400g, morrisons.com
Hovis Lower Carb seeded bread has 30 per cent fewer carbs than an ordinary seeded loaf
Per 100g: calories, 269; saturated fat, 1.6g; carbohydrates, 27.2g; protein, 15.7g; fibre, 11.4g; sugar, 2.9g; salt, 0.98g
CLAIMS: This has 30 per cent fewer carbs than an ordinary seeded loaf, because some of the wheat has been replaced with vegetable fibre inulin.
EXPERT VERDICT: This also has more hunger-curbing protein and twice the amount of fibre found in Hovis Seed Sensations. The seeds provide healthy fats and vitamin E, too. If you want to cut carbs, this is a good choice.
Note, however, that it has no fewer calories than a standard seeded loaf, and the added fibre — though good for boosting gut bacteria — might be hard on a sensitive stomach if you ate too much.
EAT WATER SLIM PASTA FETTUCCINE
£2.49, 200g, ocado.com
Eat Water Slim Pasta Fettuccine is a ‘zero carb’, low-calorie ‘pasta’
Per 100g: calories, 35; saturated fat, 0g; carbohydrates, 8.4g; protein, trace; fibre, 1.3g; sugar, 0.5g; salt, 0g
CLAIMS: This ‘zero carb’, low-calorie ‘pasta’ is made using the konjac plant — an Asian edible tuber.
EXPERT VERDICT: The konjac ‘flour’ contains a soluble fibre called glucomannan, which absorbs water, causing it to expand in the gut and make you feel full for longer. This has a quarter of the calories of standard pasta.
The European Food Safety Authority says konjac can contribute to weight loss as part of a calorie-controlled diet. However, wholewheat pasta supplies more protein, fibre, iron and B vitamins (which help to sustain energy levels).
RAW GORILLA MIGHTY MUESLI KETO BREAKFAST
£5.49, 250g, ocado.com
Raw Gorilla Mighty Muesli Keto Breakfast is made with activated seeds, which are soaked in water then dried
Per 100g: calories, 624; saturated fat, 5.9g; carbohydrates, 8.1g; protein, 20.1g; fibre, 9.6g; sugar, 3g; salt, 0.07g
CLAIMS: This is made with activated seeds, which are soaked in water then dried. The maker claims these help us absorb more iron and zinc by reducing the phytate in seeds, which usually binds to these minerals. It also contains cashews, coconut and cacao nibs, and claims to be 20 per cent protein.
EXPERT VERDICT: This has four times more protein and a little more fibre than typical muesli, mainly due to the high nut and seed content — so it’s a more satiating breakfast. It is also free from added sugar, which is a downside to many cereals. A 30g serving provides our recommended daily intake of vitamin E, which protects cells against damage that can lead to cancer.
Activated seeds may be better for sensitive guts, but a 2017 study found the process didn’t significantly change phytate levels. This also contains around 50 per cent more calories than standard muesli, so could easily lead to weight gain if you didn’t control portion size.
GENIUS GLUTEN-FREE CARB CUTTER BREAD CRISPS
Genius Gluten-Free Carb Cutter Bread Crisps are made with oats, seeds and chicory root inulin
£2 for five 24g bread crisps, sainsburys.co.uk
Per 100g: calories, 514; saturated fat, 3.4g; carbohydrates, 31g; protein, 16g; fibre, 19g; sugar, 1.7g; salt, 0.8g
CLAIMS: Made with oats, seeds and chicory root inulin, which ‘contributes to normal gut function through more frequent bowel movements’, these are also gluten-free.
EXPERT VERDICT: Inulin is a prebiotic, which means it stimulates the growth of healthy gut bacteria. But standard crisp breads such as Ryvita are naturally high in fibre, which has a similar effect and might be a bit easier on the stomach — too much chicory fibre can cause gas and diarrhoea in sensitive people.
These crispbreads are also twice the weight of a standard Ryvita, and higher in calories. They’re not that low in carbs, either — one has 7.3g carbs, so wouldn’t be good for those following strict diets.
LIZZA LOW CARB PIZZA BASE
Lizza Low Carb Pizza Base has 95 per cent fewer carbs than conventional pizza bases
£9.29 for four 80g bases, amazon.co.uk
Per 100g: calories, 233; saturated fat, 1.3g; carbohydrates, 2.4g; protein, 22g; fibre, 19g; sugar, 1.7g; salt, 1.6g
CLAIMS: This has 95 per cent fewer carbs than conventional pizza bases as it is made with linseed and soy flours, psyllium husk powder and sea salt.
EXPERT VERDICT: Compared with standard pizza bases, these are lower in calories and carbs, making them a good choice if you are watching your weight.
Each 80g base has a huge 15.2g of fibre (half your daily intake), and higher levels of protein and ‘healthier’ fats from soya and linseeds (these also provide omega-3 fats, which are useful for brain and heart health).
However, they are around twice as high in salt as standard pizza bases — one would provide 27 per cent of your daily limit, and that’s without any toppings.
CARBZONE LOW CARB STRAWBERRY JAM
£3.49, 320g, ocado.com
Per 100g: calories, 28; saturated fat, 0g; carbohydrates, 27g; protein, 0.4g; fibre, 11g; sugar, 3.8g; salt, 0.5g
Carbzone Low Carb Strawberry Jam contains 75 per cent berries
CLAIMS: This contains 75 per cent berries, and sugar is swapped for the sweeteners erythritol and stevia.
EXPERT VERDICT: On the plus side, erythritol has 70 per cent of the sweetening power of sugar, but none of the teeth-damaging effects and doesn’t affect blood sugar levels.
It’s a good choice if you have type 2 diabetes or are watching your weight. But I would still rather top bread with something that has some nutritional value, such as nut butter or hummus.
Also, despite the high berry content, as with ordinary jam the fruit will have been heat-processed, so won’t contain as much vitamin C as it does when fresh.
And watch out if you have irritable bowel syndrome — erythritol might cause a flare-up of symptoms.
By Angela Dowden for The Daily Mail