“I’m afraid you have diabetes. …it’s nothing to worry about… it’s very common…it’s a lifelong condition but we can manage it with medication”.
Variations on this conversation are happening in the NHS everyday across the country as more and more people are newly diagnosed with type 2 diabetes. The problem is that these statements are almost entirely incorrect; patients are being given inaccurate and potentially harmful information at the crucial time of diagnosis. In April 2023 Diabetes UK estimated that there are now a staggering 5 million people living with diabetes in the UK¹ so perhaps there is at least one thing correct – diabetes is very common!
As healthcare professionals and as the NHS as a whole we are taking a fundamentally flawed and damaging approach to type 2 diabetes care and this starts with these initial conversations when diabetes is first diagnosed. If I told you that you had another condition which could result in blindness, heart attack, stroke, amputations, kidney failure and could significant increase your risk of dementia and many cancers including breast cancer and bowel cancer, you would rightly be very worried. Yet, we consistently underplay the risks of diabetes perhaps because it has become so common and normalised that we have lost perspective regarding the considerable risks of the condition.
The work of Professor Roy Taylor and other influential researchers, including the landmark DIRECT study in 2017², have shown us that type 2 diabetes is not necessarily a lifelong condition and can in fact be reversed in the majority of people with the right dietary approach. The key is to intervene early - the longer you have had diabetes, the lower your chance of being able to reverse the condition and restore metabolic health, although many people who have had diabetes for over 10 years can still reverse their condition. So whilst underplaying the risks we also undersell this crucial positive message of hope – your diabetes can be reversible with the right dietary choices and does not have to be a lifelong condition. Again, if I told you that this other condition which risked blindness, heart attacks, cancer etc could be cured with an inexpensive treatment you would be biting my hand off to find out what that treatment was.
Changing any behaviour is hard. Changing your diet in today’s obesogenic environment is even harder. People need support to be able to do this. Firstly, to cut through decades of misleading information about nutrition that we have all absorbed and to know what are the right changes for them. Secondly to understand how they can successfully change behaviours established over many years and to create a new relationship with food, all based on the latest science around behaviour change techniques. Sadly, those who rely on good old fashioned willpower are almost certainly doomed to fail. The problem in today’s NHS is that whilst the NHS provides a comprehensive “National Sickness Service” there is massive underinvestment in services to support people to maintain good health and to prevent illness including support to achieve a healthy diet.
When many healthcare professionals (including me) were trained, the idea of diabetes reversal/remission was not known or understood, and most NHS professionals still lack any in depth awareness. My hope is that with time, as people grow to understand that type 2 diabetes is a reversible condition, the conversations we see taking place in the NHS start to go something like this:
“I’m afraid you have diabetes, it is very serious and if we don’t act soon it can increase your risk of serious problems such as heart attacks, strokes, amputations, kidney failure or blindness. It can also increase your risk of dementia and many cancers… the good news is that it doesn’t have to be a lifelong condition; you can reverse your diabetes and put it into remission by changing how and what you eat and because we are acting early there is a good chance you can achieve remission from your diabetes…. Changing how and what you eat can be hard and it is sometimes difficult to know what are the right things to be eating; again the good news is we have access to lots of services to support you to understand your diet and your diabetes and to make small but sustainable changes that will have a significant impact on your health and wellbeing”
But until we reach that utopian point in the NHS, I am here for anyone who wants to have a conversation about reversing their prediabetes, diabetes or fatty liver disease naturally through their diet.
Dr Neel Gupta April 2023
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