午夜福利1000集合

鈥淧EOPLE have told me what I do is dangerous. They have walked away from me at meetings,鈥� says , a doctor practising in Southport, UK. Unwin suggests to his patients with type 2 diabetes or who want to lose weight that they do the opposite of what official health advice recommends. He advises them to stop counting calories, eat high-fat foods 鈥� including saturated fats 鈥� and avoid carbohydrates, namely sugar and starch. Telling people to avoid sugar is uncontroversial; the rest is medical heresy.

But crazy as it sounds, Unwin has found that most of his diabetes patients who follow this advice are getting their blood sugar back under control, and that some are coming off medication they have relied on for years. Those who are overweight are slimming down.

This might seem like just another controversial fad diet, but a growing number of researchers, doctors and nutritionists around the world are backing it, and reporting their findings in . Last month, the National Obesity Forum, a UK body for health professionals involved in weight management, , telling people to ditch calorie-counting, low-fat foods and carbs in favour of fats.

The recommendations provoked a furious backlash from mainstream scientists and dieticians, but they should concern us all. If the advice is to be believed, starchy food isn鈥檛 just bad for diabetes, it makes us fat and causes heart attacks. This is analogous to finding that smoking protects people from lung cancer, says , an obesity specialist at the Lister Hospital in Stevenage, UK, and head of the National Obesity Forum. 鈥淚t is terrible,鈥� he says. 鈥淲e have let people down.鈥�

For decades, standard dietary advice has been to shun fat and fill up on starchy food like bread, potatoes and rice. We are told this is good for our waistlines and our hearts, and is especially important for anyone with diabetes. Guidelines in the UK, the US and Australia, for instance, tell people to fill around a third of their plates with starchy food (see 鈥淔ood fight鈥�). When the UK government agency Public 午夜福利1000集合 England earlier this year, it cut added fats (such as oils and spreads) down to a mere 1 per cent of the recommended food intake.

Fat first came under suspicion when research early last century found that the arterial plaques that can lead to a heart attack contain the Then came several studies showing that heart attack rates were higher in countries where people ate more fat, especially saturated fat from meat and dairy foods. Fat was also deemed the enemy of people wanting to stay slim, since it has over twice the calories, gram for gram, as carbohydrates and protein.

From the 1950s onwards, these ideas crystallised into official dietary guidelines, and the , low-fat milk and swapped butter for vegetable-oil based margarines. And they filled up on starchy carbs.

Yet average body weight has continued to climb, as have rates of associated problems such as type 2 diabetes, culminating in what is now arguably a health crisis. In the UK, US and Australia, .

The orthodoxy was challenged when some dieters adopted the Atkins diet, which caused a sensation in the early 2000s. This urged people to shun fruit and veg and scoff meat, butter and cream. Doctors warned it couldn鈥檛 work and all that saturated fat was a heart attack waiting to happen.

And yet, research showed otherwise. One trial directly compared 156 women on either the Atkins diet or a low-fat diet. After a year, those following Atkins had , and their blood pressure and cholesterol profiles were, if anything, better than those on the low-fat diet. Another trial, which lasted two years, .

The idea that those with type 2 diabetes should ditch carbs has also been led by people defying medical advice. Unwin first learned of it when he called in a diabetes patient who had been missing check-ups. 鈥淗er blood tests were amazing,鈥� he says. 鈥淭hey seemed to show that she wasn鈥檛 diabetic anymore.鈥�

This broke all the rules. Type 2 diabetes is supposed to be progressive and irreversible. It is the result of our cells becoming increasingly resistant to insulin, a hormone made by the pancreas to help with the uptake of glucose from the blood. The pancreas works ever harder until it cannot produce enough insulin to keep blood sugar levels under control. As a result, blood sugar gets too high after meals and this gradually harms blood vessels, leading to a range of nasty consequences such as foot amputations and heart attacks.

Newly diagnosed diabetics are usually advised to lose weight with exercise, and by eating less fat and more fibre, including bread, cereals and fruit and vegetables. But like most dieters, they usually don鈥檛 succeed, and the majority need oral medication to control their blood sugar within a year of diagnosis.

Unwin鈥檚 rebellious patient told him she began low-carbing after stumbling across a website that recommended it. As Unwin researched the idea, it started making sense. Diabetics are , but starch is basically long chains of sugar and is quickly digested into sugar in the gut.

Yet diabetics are told to eat starchy food just like everyone else to help them eat less fat. Fat is the bigger enemy because it leads to heart disease, says .

And even wholegrain carbs, which are recommended, cause our blood sugar to rise, albeit more slowly than their milled equivalents. A slice of wholemeal bread raises blood sugar the same amount as three teaspoons of pure sugar, according to research due to be published by Unwin and his colleagues in the Journal of Insulin Resistance. A jacket potato 鈥� archetypal healthy fare 鈥� is akin eating 9 teaspoons of sugar (although how fast it is released depends on what you eat with it 鈥� fat or protein lowers the speed).

The sugar triggers release of insulin, which stimulates insulin resistance. Eating fat and protein, in contrast, , and , so will suppress appetite more.

People with type 2 diabetes are sometimes told to eat food with a low glycaemic index (GI), a measure of how quickly blood sugar rises. The faster the blood sugar rises, the harder it is for cells to take up glucose quickly enough to avoid a spike. But a strictly low-GI diet .

Startled into action, Unwin took the maverick step of offering weekly meetings on this dietary approach to his patients with diabetes or who were overweight. He put them on a less extreme version of the Atkins diet, telling them not only to cut down on starchy food but also to eat lots of non-starchy vegetables and the less sugary fruits, such as blueberries and raspberries. In place of carbs they should fill up on meat, fish, full-fat dairy products, eggs and nuts (see 鈥淔ood fight鈥�).

Under control

It seemed to work. 鈥淭hey weren鈥檛 hungry and every week they came back smaller,鈥� he says. Their blood tests showed , as well as blood pressure and cholesterol levels.

Unwin published the results from his first 19 patients in 2014. It wasn鈥檛 a randomised trial, but there have been such studies in the US. In one study of 34 overweight people with type 2 diabetes, those on a low-carb, high-fat diet with no obligation to calorie count ended up with significantly better blood sugar control after 3 months than those following the low-fat guidelines for diabetes. Three times as many low-carbers were able to stop taking at least one diabetes drug as those on the standard diet.

Unwin鈥檚 unorthodox approach has not gone unnoticed. Earlier this year he received a , partly in recognition of the savings being made at his practice, Unwin says. Their per-patient spend on diabetes drugs is about 70 per cent of the local average.

So is it time to overhaul official dietary advice? The National Obesity Forum is certainly leading the charge with its new report. But in an official statement, Alison Tedstone, chief nutritionist at Public 午夜福利1000集合 England, called its contents irresponsible, saying the report was based on opinion rather than evidence and that it ignored 鈥渢housands of papers鈥�. Her colleague John Newton said it was at odds with the international consensus. And it has also caused a rift within the National Obesity Forum, with a number of members unhappy about the report.

Critics of the idea argue that mainstream nutritional advice is based on decades of research, involving many hundreds of thousands of people, showing that .

And yet in the past few years, a body of literature has emerged to suggest that the question of fat might not be as straightforward as we once thought. For instance, a recent analysis of past studies found that . Another found that the effects of reducing saturated fat depended on what people ate instead; there was a small benefit from replacing it with polyunsaturated fats, but . The best kind of study is a randomised trial that alters people鈥檚 diet to see how their health changes. Here too, there is conflicting evidence 鈥� some trials show a , while others indicate none or .

A high-fat diet could also be concealing other aspects of lifestyle or diet, such as too much sugar or a lack of exercise, which may be the real culprits for heart problems.

It also seems fat is a more diverse food group than it first appeared. Oils from plants tend to be unsaturated fats, liquid at room temperature; we thought of these as 鈥済ood鈥�, unlike saturated fat, mostly found in meat and dairy products and solid at room temperature. But recent studies suggest that dairy fats, which are saturated, do seem to and . Unsaturated fats too, are a mixed bunch (see 鈥淪lippery substance鈥�).

The role of insulin resistance, the key problem in diabetes, also seems to be a bigger player in heart problems than we thought. One recent study found it is for men than high blood pressure, high cholesterol and being overweight. 鈥淲e have been focusing on the wrong things,鈥� says , a cardiologist at the Lister Hospital, who is a vocal advocate of low-carbing.

鈥淭he question of fat might not be as straightforward as we once thought鈥�

Still, many mainstream dieticians remain unconvinced. at the University of Reading, who is a member of the UK government鈥檚 Scientific Advisory Committee on Nutrition, says that while not all the studies show consistent findings, 鈥渁 diet high in saturated fat is not optimal for cardiovascular health鈥�. , professor of diet and population health at the University of Oxford, takes particular issue with the idea of not bothering to count calories on a low-carb diet, . 鈥淰ery few people manage to control their weight without some dietary restraint,鈥� she says.

Such conflicting advice might well leave many of us scratching our heads over what to eat. Almost the only thing both sides agree on is that sugar is bad for you (see 鈥淔ood fight鈥�). If you tried to hedge your bets and avoid both fat and carbs, there would be little left. A more moderate approach is to limit just saturated fat, added sugars and refined carbs, leaving you more or less with an extra-oily Mediterranean-type diet, high in whole grains, fish, fruit, vegetables, nuts and olive oil.

This diet is higher in fat than the standard recommendations, but a recent large trial of a Mediterranean diet supplemented with extra olive oil or nuts found that either approach cut heart attacks by nearly a third over five years compared with the .

People with type 2 diabetes, who are most at risk of heart disease and weight gain, seem to be voting with their feet. Unwin has published his diet advice on a free website and since its launch last November, 110,000 people have signed up, and over 80,000 people have completed the 10-week course. Of 2500 who took a survey 6 months later, the proportion taking diabetes drugs had dropped from 70 to 60 per cent. Although this was not a randomised trial and the results need to be replicated, Unwin thinks it鈥檚 a sign of what the diet can achieve without much input from health professionals. 鈥淭he internet is democratising medicine, and patients have taught me so much,鈥� he says. 鈥淚t鈥檚 a new world 鈥� doctors should join in鈥�

This article appeared in print under the headline 鈥淔at lot of good鈥�