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Independents' Day

We can’t base public health policy on one MP’s experience

Dr Ellie Cannon

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The deputy leader of the Labour party has declared he is on a mission to make everyone feel as good as he does, after losing over six stone and reversing his type 2 diabetes.

In a story familiar to many GP consulting rooms, Tom Watson lived on a diet of fast food and curry throughout his political life, seeing his weight gradually climb to 22 stone and the consequential diagnosis of type 2 diabetes.

Undeniably what happened next is absolutely admirable and something I can only hope will happen for many of my patients in a similar situation: he did something about it. Initially paralysed by fear and shame and guilt, after months living with the diagnosis he put himself on a diet and exercise regime with dramatic results. His weight loss was accompanied by a reversal of his diagnosis, as well as better sleep and mood as well as all the other benefits of slashing the health risks that come with his former BMI.

I admire Tom Watson; I really do. Not many politicians would speak up about the guilt and shame of obesity, or share such a personal health story and diagnosis. I think that is hugely inspiring to his colleagues and the electorate. And now predictably, as we have come to expect in today’s world where ‘lived experience’ is king, he has zealously declared he wants to help other people do the same: if Labour comes to power his low carb, zero sugar, zero processed-food will form the basis for his obesity strategy to save the health of the nation and the cost to the NHS of type 2 diabetes.

Personal experience should not govern public health strategy - especially when it ignores the totality of the evidence

The Labour MP has fallen into the trap of believing ‘it worked for me, so it will work for everyone else’. If only life was so simple, we wouldn’t have an obesity crisis in the first place.

Losing weight is not easy. Equally, encouraging patients to lose weight is not easy. Dieting is hard work and takes time and support and also money. Low-carb diets are not cheap, if you’re used to bread and potatoes. I don’t want to be a naysayer – I congratulate Tom, I really do. But his personal experience should not govern his party’s public health strategy, especially when it appears to ignore the totality of the evidence.

The low-carb lobby were no doubt cheering as Mr Watson decried hidden sugars, starchy carbs and ultra-processed food; supporters came out to disparage Public Health England (PHE) dietary advice for ignoring the success of low-carb diets in type 2 diabetes. But please let’s stay sensible and evidence-based in this.

Any diet where you exclude a whole food group will make you lose weight if you create a calorie deficit. Whether you cut carbs, fat, a particular treat, or alcohol – if you create a calorie deficit you will lose weight and you will improve your HbA1c levels. If the diet suits you, it will work. The most common success I have seen in practice is where patients have chosen to ditch treats – usually biscuits. So low-carb is not uniquely successful in this arena – and in fact, the bad-cop approach to dieting has a major flaw: it does not look at all health outcomes. Low-carb diets, for example, include far too little fibre, an essential component for long-term health.

Despite Tom Watson’s experience, PHE can’t adopt his low-carb diet plan because they can’t negate the evidence that doesn’t suit them – large reviews still show carbohydrates should be a part of our diets for holistic health outcomes. Yes our portions need to reduce, as does our sugar intake, but the unilateral carb-attack approach is still backed by book sales not data.

If losing weight and reversing diabetes is a goal of our patients and Labour’s health policy, the key message should be the one from Roy Taylor, the professor of medicine and metabolism who has spent 40 years studying the disease. Diabetes is a disease of too much fat inside the liver and pancreas: shifting that will reverse the diabetes. Taylor’s work revealed Watson-like results on patients who adopt a very low calorie diet of 800 calories – their type 2 diabetes reverses at which point they are maintained on a balanced Eat Well plate diet – indeed including carbs and all.

PHE are now reviewing all their guidelines on diets for type 2 diabetes in collaboration with Diabetes UK, the Scientific Advisory Committee on Nutrition and NHS England, exploring the totality of evidence for what actually works and what dietary advice all political parties should be extolling.

Until we have that whole picture, GPs should avoid being swept up in the low-carb moment and support their patients in following the current dietary advice.

Dr Ellie Cannon is a portfolio NHS GP in London and broadcast media doctor

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Readers' comments (11)

  • Dear Ellie

    I agree that we need a plurality of approaches to losing weight and maintaining that weight loss.

    However, you must agree we have been sleep walking into a sugar scandal. Up until recently, it has been completely unregulated and added to so many kids drinks and foods.

    Couple this with fast food and processed food, you can see why obesity has exploded.

    Government needs to make the food and drink industries accountable and we cannot continue allowing profit to come before health. We have been doing this for far too long with cigarettes and alcohol.

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  • I agree a calorie deficit is needed, but a low carb diet makes it easier to achieve because of the lowered insulin levels and thus lowered appetite.

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  • Key point is spot on.... too many MPs and “celebrities”- think -their experience- is -everyone’s experience- and they appoint themselves “ experts”.....

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  • I suggest you revist some basic medical science - insulin drives obesity, not fat (and there is plenty of evdience for this).
    Carbs (be they starchy or refined) drive insulin production.
    I only hope that PHE starts to take notice of the mounting evidence prsented by 'the low carbers' and actually does something positive to halt the obesity epidemic

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  • we're going about this the wrong way. You want to make the population healthier? Not increased state intervention. Look at how much of a waste Public Health is, and you want to expand their remit?? Instead make the public responsible for their own health, and enable them to do so via education. Less socialist policies, less welfare, less government spending, less taxation, then sit back and watch the majority prosper and take up that responsibility for themselves. This isn't even a new or alien idea, just look to the East.

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  • Got to disagree. Type 2 diabetes is insulin resistance. This in my understanding is caused by excess exposure to insulin (cars while inactive) and downregulation of sensitivity.

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  • I suppose the main factor in any diet is consistency and fat loss being achieved. Secondry to that is how its done. I have to say people often look ridiculously well on low card (not NO carb) versus the emaciated look very low calorie and low fat diets lead to. For 90% of the population just cut out most of the sugar they eat and they'll be doing pretty well.

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  • First, a BMJ editorial reads: "The failure of anti-obesity programmes in schools" and then PHE's own statistics show that its measures to combat adult and childhood obesity have failed dismally.
    But when a well-qualified doctor proposes an evidence-based new approach, he is ostracised.
    Perhaps The Sun is right after all when it shouts: FAT CATS ON MEGA PAY Staggering 325 nanny state public health bosses raked in over £100,000 a YEAR just to say drink less and exercise more

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  • Sorry Ellie but we get plenty of carbs from vegetables and fruit. The High GI/sugar carbs do not provide the fibre we need, fruit and veg carbs do. Evidence is clear that low carb/high unsaturated fat is a good way to lose weight, improve sugar handling and keep the weight off and it’s not all about calorie deficit. Prole don’t want to accept this because it’s teally hard to give up the addiction that society has created: sugar.

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  • Whilst I agree Ellie that to lose fat mass then the body needs to reduce its stored calories (specifically fat stores), we must remember a human is a complex system which includes multiple hormones that can affect fat storage or fat mobilisation. The food we eat, and the various macronutrients and their amounts in a diet, can help or hinder the control systems that relate to fat storage and also to glucose homeostasis.
    Here's a small collection of thoughts on this.

    1. Insulin resistance + incoming glucose (sugar or starch) == hyperinsulinaemia.
    A clinical recommendation... measure the fasting insulin level of a patient with markers of insulin resistance (e.g. The metabolic syndrome criteria) and then give them a glucose load of 75g, and remeasure their insulin at 1 hour and 2 hours. Then consider how this information (hyperinsulinemic response) can help in shared decision making and the application of evidence based medicine in what dietary approach may be most effective and enjoyable for the patient.
    (Joseph Kraft's work on this is insightful... His book "The Diabetes Epidemic and You" is a good read).

    2. Insulin's actions include promoting fat storage, and reducing fat mobilisation. Obesity is reduced when the amount of fat mobilised from stores is greater than the amount of fat moved into stores. Thus a lower insulin level would seem helpful for reducing obesity.

    3. There is a general consensus that "low carbohydrate" means

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