World Diabetes Day

Why are diabetics being told to eat what made them diabetic?

Thursday November 14th (2013) was World Diabetes Day.


The International Diabetes Federation (IDF) defines diabetes as follows :

“Diabetes mellitus, or simply diabetes, is a chronic disease that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the blood stream into the cells in the body to produce energy. All carbohydrate foods are broken down into glucose in the blood. Insulin helps glucose get into the cells.

Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood (known as hyperglycaemia). Over the long-term high glucose levels are associated with damage to the body and failure of various organs and tissues.”

Note the mention of the word “glucose” five times and the acknowledgment that all carbohydrate foods are broken down into glucose.

The different types

The IDF definition describes the two types of diabetes – type 1 diabetes is the type where the body is no longer able to make insulin and type 2 diabetes is the type where the body cannot make good use of the insulin it produces.

We used to call type 1 diabetes “juvenile diabetes”, as it only used to occur in young people. The typical age of onset was during teenage years – some children developed type 1 younger and a few in their early 20s, but it was largely a teenage condition. If you hadn’t developed type 1 diabetes by the time of your 21st birthday, you were highly unlikely to do so.

Type 2 diabetes used to be called “maturity onset diabetes”, as it only used to occur in older people. It was typically associated with ‘granny’ who had a sweet tooth, always had humbugs in her handbag and it developed after years of drip feeding glucose.

Neither type 1 nor type 2 diabetes are called juvenile or maturity onset anymore and that’s because these labels no longer apply. We are seeing type 1 diabetes in middle aged people and older. We are seeing type 2 diabetes in children. The latter is particularly horrific. I attended an obesity conference a few years ago where a doctor specialising in childhood diabetes and obesity said that he was seeing an increasing number of type 2 diabetic children come through his door. He had no means of assessing what this would do to their life expectancy, but his prediction was that few children with type 2 diabetes would reach their 40th birthday – such was what he knew about the impact of type 2 diabetes on the body.

The IDF also informs us that more than 371million people have diabetes. Type 1 is seen as an autoimmune condition, with a strong hereditary connection (this is why we are asked for family members with diabetes in medical questionnaires).  Type 1 is the rarer of the two types by far – 92-95% of the incidence of diabetes is type 2.

What causes type 2 diabetes?

If the vast majority of diabetes is type 2 – the type that we used to develop with age – what causes it?

The UK NHS lists four risk factors. Please note – this is not saying what causes type 2 diabetes, but listing risk factors. You can have one of these risk factors and not develop type 2 diabetes and you can develop type 2 diabetes and not have one of these risk factors. Despite this page being called “Causes of type 2 diabetes”, it is not telling us what causes diabetes.

The NHS’s four risk factors are presented as: “You are more likely to develop type 2 diabetes if you:

  • are over 40 years old
  • have a relative with the condition
  • are of South Asian, African-Caribbean or Middle Eastern origin
  • are overweight or obese.”

I accept the age factor – this is the maturity onset aspect of the condition. However, I do not accept that it is age alone that is associated with type 2 diabetes. I think that type 2 diabetes depends on what people eat as they age.

The risk factor related to relatives with the condition is positioned as: “A child who has a parent with type 2 diabetes has about a one-in-three chance of also developing it.” I also think that this is related to diet. A child is eating what their parents eat. If the parents are eating such that they developed type 2 diabetes, the child will be doing the same.

The third ‘risk factor’ may apply in the UK, but it is not accurate globally. The IDF has a chart for the top 10 countries in the world for incidence of diabetes. Six of the ten countries are in the Pacific Ocean and the other four are in the Arabic/Middle East.  It would be useful to study the diets of these nations.

The final risk factor seems an obvious one – we know that people who are overweight or obese more often have diabetes – yes?

The evidence is compelling: The JAMA (1999) article “The Disease Burden Associated with Obesity and Overweight” estimated that a male under 55 and with a BMI of over 40 has 90 times the chance of developing type 2 diabetes than a normal weight male of the same age. (Ref 1) Although this study found the risk for women slightly lower, other studies have corroborated this multiple for women. Colditz et al (1995) found that women with a BMI of more than 35 had 93 times the risk of developing type 2 diabetes than women whose BMI was less than 22. (Ref 2) A BMI of 35 is also not breathtakingly high – 1.2 million people in the UK currently have a BMI of over 40. An average height woman (5’4”) who is 14 stone seven pounds has a BMI of 35 and an average man (5’9”) who weighs 17 stone has a BMI of 35.

I question causation, however. Does obesity cause diabetes? Or does diabetes, with all the accompanying insulin problems, cause obesity? Or do the same foods that cause obesity also cause diabetes?

My view on type 2 diabetes

I think that type 2 diabetes is the body saying “enough’s enough”. Every time we consume carbohydrate – any carbohydrate, as the International Diabetes Federation tells us – glucose enters the blood stream. The body can only tolerate approximately one teaspoon (approximately 16 calories) of glucose in the blood stream at any one time. Any amount beyond this requires the body to call upon the pancreas to release insulin to turn the excess glucose into glycogen (the stored form of glucose) to return blood glucose levels to safe levels.

Only in the past 10,000 years have we even had ‘our daily bread’ and this bread has historically been dense, unrefined, unsweetened and limited in quantity. We used to have vegetables and fruits in season and that was the extent of our carbohydrate intake. No sugary cereal and fruit juice for breakfast; no muffin/cereal bar mid-morning; no sandwich/crisps and drink meal deal at lunch time; no confectionery late afternoon; no pasta/pizza for dinner and no TV munchies in the evening.

Can you imagine how many times we make demands on our pancreas during a typical “base your meals on starchy foods” day? How many times can we do this before the body says “enough’s enough! I simply cannot keep responding to your unprecedented consumption of glucose in this way.”

Age is not the issue – a Paleo pensioner is not going to develop type 2 diabetes; a carb addict child might.

Genetics are an issue for type 1 diabetes, but need not be for type 2. If the type 2 diabetes parents realises what they have done wrong and changes the family diet as a consequence – the child may well be saved from developing type 2 diabetes.

The ethnicity need not be the issue – if Brits, of Asian and African Caribbean origin, recognise that they are particularly unused to the appalling British diet and particularly susceptible to its effects – they too can change their diet to avoid type 2 diabetes.

As for the fourth NHS risk factor, the people who manage carbohydrate intake can avoid both obesity and type 2 diabetes.

Dietary advice for diabetics

The IDF definition of diabetes mentions the word glucose five times and tells us that all carbohydrate foods are broken down into glucose. It warns us how damaging high glucose levels are and how diabetes is the condition whereby glucose cannot be cleared from the blood effectively.

So answer one question – why on earth would diabetics be advised to consume glucose?

This is the dietary advice from Diabetes UK entitled “Healthy Eating”:

Diabetics are advised to consume the following EACH DAY:

* 5-14 portions of Starchy Foods per day “One-third of your diet should be made up of these foods, so try to include them in every meal.” A slice of bread is given as an example portion – a diabetic should therefore eat the starch equivalent of up to 14 slices of bread every single day.

*”Aim for at least 5 portions” of Fruit & Vegetables (5-a-day of course!) That’s a combination of glucose and fructose.

* 3 portions of Dairy Products, and diabetics are told to “choose low-fat alternatives.”

* 2-3 portions of Meat, Fish, Eggs & Pulses. One portion is listed as 2-3oz meat, so the daily guidelines are between 4-9oz meat or bean/pulse/nut equivalents. If the bean/pulse/nut options are chosen instead of meat or fish, this means that every single food that the diabetic consumes during the day will include sugar.

Starchy foods break down into glucose. Vegetables break down into glucose. Fruit breaks down into fructose and glucose. Dairy products (lactose) break down into glucose and galactose. Pulses, beans and nuts also provide glucose.

Can you imagine the strain that this dietary advice places on an already malfunctioning pancreas/insulin/glucose handling system? If my vacuum cleaner isn’t working, I’m not going to spend the day hoovering! If my glucose handling system isn’t working, why would I spend the day consuming things that break down into glucose? That’s where the analogy ends. If my vacuum cleaner isn’t working, I buy another one. Once we have exhausted our glucose handling system, to the point of it being broken, we cannot buy another one. We cannot repair it. We can, however, dramatically curtail consumption of the substance that made it break in the first place – glucose.

Which bit of that do Diabetes organisations not understand?

Ref 1: Must A., Spadano J., Coakley E.H., Field A.E. et al, “The disease burden associated with overweight and obesity”, Journal of the American Medical Association (JAMA), (1999).

Ref 2: Colditz G.A., Willet W.C., Rotnitzky A. et al, “Weight gain as a risk factor for clinical diabetes mellitus in women”, Annals of Internal Medicine, (1995).

30 thoughts on “World Diabetes Day

  • Hi Zoe,
    I have been happily following the Harcombe Diet for the past 2 1/2 years and maintained a healthy weight for 2 years.
    I have 2 adult sons both with type 1 diabetes. 1 eats healthily, the other not so much. I understand your brother is now cutting down on his carbohydrate consumption. I am assuming he still takes his insulin? Do you have any links I can send to my sons to try to persuade them to change their way of eating please?
    Many thanks.

    • Hi Wendy
      This, as I’m sure you know, is an absolute must for working with the diabetes specialist. No one should vary carbs/insulin without expert monitoring. My brother (A) has had T1 for over 30 years, so he has developed an excellent working relationship with his consultant. As A is really fit and super slim, he gets a lot of support from his doc because he’s clearly doing some things right.

      Dr Jason Fung is the best expert I know working in this area. I’m pretty sure he works remotely with other consultants to help with a dietary approach to diabetes (https://intensivedietarymanagement.com/). His videos (https://www.youtube.com/watch?v=FcLoaVNQ3rc) are SO well worth a watch – especially for the less healthy of your sons.

      This is the only book of which I’m aware written by a doc on diet/diabetes (http://www.amazon.co.uk/The-Diabetes-Revolution-groundbreaking-dependency/dp/0091912644) It’s a bit fat/cholesterol phobic, but it’s spot on in terms of carb management advice.

      I hope these help!
      Best wishes – Zoe

  • Hi Zoe

    I have just today been diagnosed with type 2 diabetes. I have a family history with both my father and his sister diagnosed many years ago with adult onset diabetes. I also had gestational diabetes for one of my pregnancies over 16 years ago.

    Whilst I am fit, I usually run at least one marathon a year and run anywhere from 60-110 kilometres a week and don’t consider myself overweight (BMI 22 – weight 61kg). I have never been able to shed serious weight even by restricting my calories when marathon training to 1500 calories a day. 57.5kg was the lightest weight I attained at the peak of my training.

    I’m still coming to terms with being told today that I have type 2 and I’m wondering if I perhaps have now been picked up with the changing standards for diagnosis.

    Either way, looks like its timely to make some changes to my carb/glucose intake.

    • Hi Trish
      I’m sorry to hear this, but the first thing I would check – you are quite right – is the diagnosis. This may help https://www.zoeharcombe.com/2014/06/diabetes-cholesterol-bp-normal-is-no-longer-normal/
      The numbers are continually being revised downwards, so you may be part of the moving goal posts or you may actually have a problem.

      Either way – I highly recommend these videos:
      https://www.youtube.com/watch?v=mAwgdX5VxGc and

      If you do have something to manage – there are far better ways than following the usual meds and eat whole grains advice that you’ll get in the UK. Again – you’re right – time to manage carb/glucose intake. Your exercise regime may well have involved carb loading. Check out The Art & Science of Low Carb living by Phinney & Volek – how and why to fuel on fat, not carb.

      Hope this helps
      Best wishes – Zoe

      • Hi Zoe

        Thanks for responding and providing the links.

        Interesting your point on normal not being normal anymore. I’m keen to read more on those behind the downward revision of the diagnostic criteria, their motivation and rationale for this and where I fit here amongst the revisions.

        I’m from Australia and I assume our dietary guidelines will be similar to that of the UK. And yes being a marathon runner carb loading and low fat eating is a lot of what we do, so I will be clearly making changes here and seeing how my body (and sugar levels) adapt to the change. I’m not one for medicating so the food changes will be happening first. Thanks too for the tip on Phinney & Volek – that sounds like a good place to start.

        I have 2 teenager at home and this is quite a timely reminder that the changes I implement at home now, will impact positively on their future health.

        Cheers & thanks again Zoe. Your site is an absolute wealth of information :)

        • Pleasure – as for why? Follow the money :-)

  • Hi Zoe, great article, which I’ve just found whilst trying to help a friend who’s being hounded by her Type-1-diabetes-kid’s NHS dietician…why, because she’s trying to reduce her kid’s intake of sugars.

    It seems sad that she would be left alone if her kid ate 400g of carbs per day, laced with Coke and cubes of sugar, whilst no doubt having HbA1C’s of 13% etc..

    What can be done?


    • Hi Kev – you may like this one too (https://www.zoeharcombe.com/2012/05/diabetes-uk-low-carb-diets-%E2%80%93-what-is-the-official-advice-for-diabetics/)

      I’m so sorry to hear the harassment your friend is getting for doing the right thing for her child. There will be law suits one day – I hope so anyway – for what has been done to so many people by so few. You just have to ignore ignorance and do what you know to be right. (Ideally refuse to see a dietician – I would never see one unless I wanted a laugh!) I’ve only recently persuaded my older brother (type 1 since teens) to start with the nutritious foods (meat, fish, eggs, seeds, veg – esp green/leafy) and then see what room is left for starchy foods. He liked it put that way more than ‘watch your carb intake’ and he soon found he had little room left for fattening things once he’d eaten the nutrient giving things. He’s lost weight (he was in good shape anyway – but he had to work for it – he doesn’t now) and is just feeling better than ever. Lower blood readings, more stable blood readings etc.

      The questions I would ask are:
      Q1) What is diabetes? (The answer is the inability to handle carbs/glucose essentially)
      Q2) So why are you telling a diabetic to base their meals on what they can’t handle?

      Or just don’t engage
      Hope this helps
      Best wishes – Zoe

  • Vegetables break down into glucose –> eating a lot of vegetables is bad for diabetics?

    Congratulations. You can’t get the basics of diabetes care much more wrong than that. Never you mind the fact that increased intake of fruit & veggies has been consistently shown to be of importance to diabetics.

    • Well, Mie – yes, they are bad for diabetics. But you don’t have to listen to anyone here, why not go out and do your own research. Ask a number of diabetics to eat a meal with the following :-

      Carrots, sweet corn, sugar snap peas, peas, tomatoes, and onions. They will raise the BG levels of most type 2s. Don’t forget, we’re not just looking at a once a week rise, we’re looking at the fact that these will raise them to a harmful point constantly. Everyone has accepted that type 2s get worse as time goes on, but haven’t looked at why that is so. If BGs go up to even 7.1 for long enough, it will cause damage. Then even less tolerance. And therefore more damage. If it is, as many of us know, due to eating the wrong kind of vegetables, and we are then forced to eat more of them, of course diabetes is going to get worse. I know this from personal experimentation, and there are others in the same boat(Dr Richard Bernstein for example). However, I feel certain that you will choose to ignore this because it doesn’t fit in with what you ‘know’.
      Why do you feel that vegetables are so necessary for people anyway?

  • Many years ago a Ukrainian doctor, Dr Petrunin, told me to eat apples in the morning and drink water or tea.
    Then to have 2 glasses of water at lunch and half a kilo of vegetables, not the starchy ones, and with that 250 grams of carbohydrates. For supper he told me to have 2 glasses of water or herb tea and at least 500 grams of non starchy vegetables uncooked in a salad, together with 250 grams of protein. This has been able to allow me to control my type 2 diabetes for many years without medication and to stay reasonably well.

  • Dear Zoe,

    Thank you so much for all of the hard work you do to educate and get the word out about these issues. I just finally listened to your Underground Wellness presentation you gave in the Real Food Summit a couple of summers ago. It was absolutely brilliant. All of you presenters– you just blow the lid off these things. It’s really so inspiring. You are saving lives and improving lives. I just wanted to say thank you. Seriously. I very much look forward to following you and helping to spread the word to help others.

  • Hi zoe,i have recently been diagnosed diabetes 7 3 I have stopped eating carbs should i eat small or large amounts of full fat

    • Hi Monica, you should buy a testing kit and experiment with it. You should be able to tolerate large amounts of fat, BUT it depends on what type of fat. For example, cheese contains lots of fat but it also contains lactose. If you eat a lot of it, you could be raising your BG levels. It is very important to test, test and test some more so that you can see what your BG levels are doing in reaction to the food you are eating. Also, you can then become confident even when health officials tell you that you are eating the wrong thing that you are doing the right thing for you. We are all different, and we all react differently.
      You could try finding a form – Diabetes Daily is a good one – where people have all done this. They can advise you so that you aren’t just doing something that people tell you to do, you are seeing the evidence and facts for yourself. Good luck, you can take control.

  • Hi Zoe

    Great article. Recommending that a third of a diabetics diet comes from carbohydrate is like treating a drug addiction with heroin or an alcohol dependency with a bottle of vodka!

    I’ve had uncontrolled, type 1 diabetes for 27 years, With A1c’s consistently in the teens, no matter what I did I couldn’t stop the glucose roller coaster. I was labelled a bad, non-compliant diabetic even though I struggled continuously to manage the condition.

    Last year, whilst doing a desperate search on the internet, I stumbled upon the idea of eating a low carb diet. Why was I never taught this? I attended DAFNE and yes, learned how to count carbs but was told, ‘it’s ok, you can eat what you want, just match your insulin dose.’ If only it were that easy!

    Now, I follow a LCHF, ketogenic way of eating and follow Dr Bernstein’s rule of small numbers. And it’s working! In 4 months my A1c has come down by over 3% already, my insulin requirement has dropped by nearly 70% and the range of swing in my glucose levels has decreased significantly.

    I am determined that I will become one of the 5%er’s, keeping my A1c in the 5-6% and hopefully, staving off any further complications. This has been the single, most positive action that I’ve taken in gaining near normal glycaemic control. But, it frustrates and maddens me that I had to completely go against conventional dietary recommendations to do so.

    I’m glad there’s so many ‘experts’ coming on board with this way of thinking and really hope that the conventional paradigm is shifting, as further research is carried out. And i’m also grateful for the wisdom of the crowd, the power of people sharing their stories and experience, that then enable us to question everything.


  • Todays papers carry the story about Reducing Sugar Consumption, great news in itself but sadly only a part of it. Obesity doesn’t inherently mean you are ill, it is after all part of natures survival strategy.

    It`s the artificial ingredients that abound in todays “Products” that are key to stopping so many of the Metabolic conditions. Oh and the advice of “experts”.

    Which boiled down and analysed comes down to motive !

  • Dear Zoe,

    This is an old thread, but I don’t know where else to place this. Today there was a press release in Deccan Herald about some UK doctors reversing Diabetes 2 by crash dieting, a.k.a. starvation. Big news… :-)


    However, you may want to straighten them (or their PR guys) out on a couple of metabolism issues. The last sentence, for example, says that the liver starts burning fat when we reduce dietary fat. Shouldn’t that be carbs, or rather general caloric restriction?

  • I’m going to print this and show it to my other half’s father. He’s not allowed meat, he says. I thought that was rather strange so as it’s not a place my nose should go, printing is the way! Thanks Zoe :D

    Oh, I’ve lost about 12lbs myself in the last 2 months. Admittedly I slipped up a bit, with pistachios and the like!

    I totally agree Jessica! Surely they will one day use their noggins – it seriously need addressing!

  • Well, Dave, I’d disagree with you there, I know plenty of women who have benefited and I would suspect anyone would do better on a low carb/high fat diet than the opposite!

    But does it not annoy you that the medical professionals almost always look at your results and say, “Well, it works for you” but don’t say, “I wonder if it would work for more of my patients” or “We should try and see if it works for anyone else out there, in case there’s enough evidence to show that it helps diabetic patients”?

  • This so hits home, twice in life I hit 20 stone, the second time I was lined up for insulin treatment. Through a fair bit of web browsing and a little leap of faith I gave the Lo Carb route a try. Without getting all righteous about it the thing paid off.
    It does however seem to work better for males than females.
    Since 2007 have been 16.5 stone or thereabouts, minimal meds and Hba1c are where I want them. My GP and Spec nurse simply say ” well it obviously works for you”

  • Zoe, I am 53 and have had type 2 diabetes since I was 35. I have spent pretty much all that time battling (1) my blood glucose (2) my weight and (3) my appetite. I have been on THD since mid-July, I have lost about three and a half stone (I’m not fanatical about the scales), I don’t get hungry, I take A QUARTER of the insulin I used to and my blood glucose is normal for the first time in many years. So take some of the credit. :o) best, Ian

    • Hi Ian – thanks so much for sharing this – what a difference! Until the Diabetes orgs & doctors wake up, people need to find health their own way – as you’ve done – well done!
      Very best wishes – Zoe

  • SO frustrating to sit here and know that type 2 can at least be controlled if not reversed somewhat. Whilst I still have nerve damage, I have at least seen my levels drop to a healthy 5.something and seen others do the same. For someone to state that children are going to die when they hit forty is outrageous. Why are people giving up? It does not have to be a death sentence. These children could still have a reasonably varied diet, instead of someone like me who has followed medical advice and totally ruined their body. My diet is restricted, but it is not hopeless or uninteresting. I plan for my future, I invest in a pension because I believe I can live to my alloted span, I don’t assume I’m going to die early and give up the diet.
    They have to get heir heads around the fact that procesed sugar hould not enter their diet and carbs need to be restricted. There are still people who eat carbs, just in small quantities and they simply watch their sugar levels.
    I am never going to donate to diabetes UK again, after they ran a donation day at Tescos and gave away – get this – free sweets with every donation.

  • Janknitz, fyi the “180 2 hours after a meal” (which refers to 180mg/dl or 10.0 mmol/L blood glucose level) is only considered a target by Diabetes organizations such as Diabetes UK and the American and Canadian Diabetes Associations.

    It’s interesting that both the IDF (International Diabetes Association) and the AACE (American Association of Clinical Endocrinologists) have much-more stringent guidelines for post-prandial targets. Both organizations recommend never exceeding 7.8 mmol/L (140mg/dl) post-meal.

    Of course, neither of those organizations are controlled by food or pharmaceutical companies, like Diabetes UK or the Canadian and American Diabetes Associations.

  • While the definition of diabetes may have changed, it hasn’t changed enough. The blood sugar standards are still TOO HIGH, so that by the time people are diagnosed more organ damage has occurred (including, most likely, more damage to arteries) and more medication is required to bring things under control with the recommended diet full of starches and sugars.

    So-called “normal” blood sugars of less than 100 fasting and 180 2 hours after a meal already indicate significant insulin resistance when fasting is in the upper 90’s and post-prandials are spiking toward 180. Yet people with those blood levels are “watched” while they progress on to higher blood sugar levels and damage.

    This is different than the ever-dropping cholesterol levels that don’t correlate to increased mortality. Diabetes is more like a spectrum that goes unrecognized in the earlier stages. Earlier diagnosis would make great sense with a lifestyle change that didn’t involve a diet full of glucose.

  • Very interesting … I have been type II since gestational diabetes some 24 years ago and have just this month been discharged from the Diabetic Clinic. My numbers were so good and my weight was down to ‘normal’ as well, the doctor told me to go away and continue whatever I was doing! Basically, I have been eating virtually no carbs for some months. He was very approving and said to continue. I have been following the ‘2-Day diet’, with a slight modification – ie that I had fewer carbs than then suggested on ‘non-restricted’ days.

  • Well I think you have nailed a lot of it here However I would also like to point out that the definition of the blood sugar level that is considered diabetic has also changed in the last 20 or so years and this creates its own problems when reviewing the literature. Normal is now abnormal. We would probably have had lots of type 2 children in the past had we applied the same standards, but of course we had no easy electronic measuring devices in the past!!!

  • Excellent.

    Having studies the Diabetes UK web site and their Facebook presence I really don’t know what they are for, beyond employment of their officers and staff.

    They seem to want to turn diabetes into a blue hobby to go along with various breast cancer initiatives clothing their supporters / victims in pink.

  • It is difficult to convince a man of something when his paycheck depends on him not understanding.

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