This is a guest post by Dr Joanne McCormack, GP who has recently won an award from the Royal College of General Practitioners for her low carb approach and her "Food As Medicine" course for health professionals and patients alike. A selection of her slides are throughout the post.
Medical Disclaimer -Before embarking on any change in diet, lifestyle or activity, you may need to be under the supervision and care of your primary healthcare provider. This article should not be construed as medical advice, nor should it be substituted for medical advice from your healthcare provider. By continuing to read this article, you assume all responsibilities and risks for instituting lifestyle management.
Food As Medicine - awards vs silencing
In November 2016 I received an RCGP award for my work on low carb, obesity and diabetes from the Royal College of General Practitioners Mersey faculty around the same time as Dr Gary Fettke, the orthopaedic surgeon, was censured by the AHPRA in Australia. I was astounded that ANY doctor would not be allowed to give any dietary advice, let alone one who appeared very knowledgeable.
In the UK, health care workers are expected to give nutritional advice to the level of their knowledge and to consider the preferences of the patient, as well as give appropriate advice on carbohydrate and alcohol levels.
I am a family doctor in the UK. I worked in the same practice for 23 years with 5 doctors and 2 nurses, covering a population of 7k people. When I started in my practice approximately 1% of people were diabetic, but now the proportion is 7-8% with another 15% being prediabetic. In the UK, a fifth of 5yr olds and a third of 11-year-olds are overweight or obese. This is a crisis situation.
UK GPs are paid to see people who are ill, and also to do something systematic called QOF. This is a method of payment that relies on us measuring up to 400 parameters and often putting people on drugs like statins and anti-hypertensives to achieve QOF targets. All UK GP practices do this, as payment from it makes up a large proportion of the practice remuneration. It seems like a good thing at first as people receive the same care throughout the country, but it makes us focus on testing and measuring and not on what causes a person’s problems.
While it has now been downgraded it still exists and has created large cohorts of medicated people. In addition, we have something called the Eatwell plate/ guide that suggests that everyone over the age of 2 should eat similar proportions of carbohydrate, fats and proteins.
The public health and education authorities have taken this up so that school, nursing home and hospital meals are now high in carbohydrate, and there is nothing we can do but challenge. This is a problem for those who are already overweight and have what is called insulin resistance, as a high carbohydrate diet will cause them to put on even more weight or become Type two diabetic.
Food As Medicine - my story
My personal and professional life changed in 2013. Even as a child, I had a tendency to put weight on easily so was always interested in any new ideas that would help with weight control, because I knew the old ways like ‘eat less/move move’ and calorie control did not work for me, or many of my patients. The first books I read about this were ‘Fat chance’ by Robert Lustig and ‘Pure White and Deadly’ by John Yudkin.
So in November 2013, I started eating a lower sugar diet, and in April 2014, a lower carbohydrate diet too. I did low carb out of curiosity while reading ‘Grain Brain’, a mild ketogenic diet by Dr David Perlmutter in the USA. I was delighted when 4 months later I had lost 2 stone and felt fantastic. A low carb diet feels easy to me and I have continued it to date.
Over the same period of time, my sister also followed a specific low carb diet (called the London AS diet) and it sent her ankylosing spondylitis into remission. This would have saved her GP over £9k per annum in drug costs alone, but for her as a mum of three children, the improved mobility and the reduction in her medication were very welcome.
Food As Medicine - in practice
In my medical practice in July 2014, I discussed the low carb way of life with another GP and together we educated the staff by putting a section on our website, printing patient information and directly talking to the other doctors, nurses, and ancillary staff. This change of nutritional advice worked well and largely without any external comment.
In April 2015 I moved onto a training role in child safeguarding and a salaried job in another GP practice so took my methods there. For a while I also worked as an advisor to the Australian site I Quit Sugar, and then brought out my own website Healthy Living Site in which I signposted other low carb sites around the world- including Ditch The Carbs.
I find having my own health information website very useful because we family doctors only have 10-15 minutes for each consultation and the website enables my patients to find out more information from me once they have left my room. It then enables them to formulate a plan for looking after their own health. In addition, they can email me, and I get long-term feedback as well as short-term questions.
In 2016 I started a newer more patient-friendly website called Fat Is My Friend, to project the new knowledge that people did not need to be concerned about natural fats, and that fat is also formed by the conversion of excess glucose, so preventing harm to the body from excess glucose. Fat is not all bad!Food as medicine - how doctors are saving lives through low carb real food.
Food As Medicine - doctors unite
In 2016 I was also asked to become a founder member of a UK nutrition charity (application pending even though we have already run our first national conference!) called the Public Health Collaboration which campaigns for better nutritional advice. It is composed of 12 doctors, some of whom are very prominent in the UK media. Below is just one of the many booklets available free on the website.
I also started running what I call “Food As Medicine” courses and have had about 12 in the last year.
Food As Medicine - Training Courses
These started off for doctors and nurses but rapidly evolved into ones that welcome all types of health care workers and lay people wanting to find out how food can help their health. I reach my audience via pre-existing networks and social media and invite doctors and dietitians to talk about low carb, ketogenic diets and lipid metabolism.
The doctors presenting have so far included several GPs on the PHC, Dr Malcolm Kendrick who has a fantastic blog about cholesterol, Trudi Deakin, the dietitian who started the X-pert diabetes programme, a preventive cardiologist from Liverpool, Scott Murray and Dr David Unwin who with his psychologist wife Dr Jen Unwin has been running low carb behavioural change groups for 4 years. You can read about them all on the PHCuk website. The PHCuk has also had our annual conference in Birmingham, which you can watch here.
My Food As Medicine talks have been very well received, and together with my speakers, we have covered diabetes, arthritis and autoimmune disease, weight loss, hypertension, fatty liver disease and lipids, as well as my favourite subject- protecting children from nutritional harm. I have had funding through the local NHS CCG group well as a ketogenic food company.
When food is provided it is always low carb and I arrange the menus directly with the chef. I find seeing, eating and reading about real, low-carb food is an excellent learning tool and I supply the recipes sheets beside the serving hatch.
I have recently spoken to Dr Partha Kar of the UK Diabetes Prevention Programme (DPP) and asked him about rolling this ‘free of refined carbs’ concept to the food at the DPP meetings. My dream is that we stop serving refined carbs in all schools, nursing homes, hospitals, and in increasing numbers of workplaces.
We do not serve tobacco, alcohol, or drugs in these places, so why sugar? High carb/transfat food is often provided by default and by approaching the chef directly we can persuade them to make something much more nutritious. What is being provided in many settings does not conform to the Eatwell guide as is evidenced by some of the hospital food pictures on Twitter!
Unlike Dr Fettke, we have been able to do this freely because of patient choice and because of recent changes of NICE (National Institute for Clinical Excellence) for type 2 diabetes. Below is a slide from Dr David Unwin showing the helpful changes.
Incidentally, David also won an award this year from the RCGP for Innovation in Healthcare. You can see his low carb programme on www.diabetes.co.uk that has had 180,000 users in the first year. This is one world and we have free access to the Internet, so anyone can learn from any site, no matter what the country of origin, as long as it is written in a language they can understand.
Food As Medicine - what you can do
This is a direct plea to your readers. All of you, who organise meetings, listen up! Speak directly to the chef and see what they can do with your budget. Take it from me- they are not given any direction- sensible or otherwise- so direct them and get them to provide tasty and nourishing food.
I also call upon each individual reading this to think and ask themselves - does the advice I am being given by my health authority work for MY body? If not, it would be sensible to get other information from your doctor or nurse. If your health care worker does not have another suggestion, there is much information available on English speaking and other sites.
Many people have worked out what works best for them by rejecting what does not work, and moving onto new ways if those make logical sense and feel worth a go.
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