1. Ian Booth
    Thanks for sharing my cartoon, Andreas - I'm honoured.

    It has been generally well-received, I think. However I have been criticised for using the word 'cure' in relation to diabetes, and have also been asked which guidelines specifically stipulate recommending 'loads of carbs' to diabetics! Ummm, this wasn't a research paper I was presenting, just a cartoon the aims of which were to:

    1) highlight the pressure many health professionals feel to follow certain guidelines, even if a better way exists, for fear of potentially career-destroying repercussions. The expulsion of dietitian Jennifer Elliott from the Dietitians Association of Australia (DAA), for recommending a moderately-low-carbohydrate diet for diabetics, which the DAA deemed to be "inconsistent with Evidence-Based Practice" springs to mind. As does the looming HPCSA vs Prof Tim Noakes case. Surely Medicine is still to some extent an art - otherwise couldn't we just employ a robot with a flowchart and white coat to look after our health?

    2) stimulate discussion and awareness of the (in my opinion) far-from-ideal current treatment model for diabetes; this includes advice to consume a large proportion of daily calorie intake as carbohydrates, and use insulin to 'cover' them. Why not simply reduce carbohydrate intake in the first place? Certainly in light of recent knowledge we should be aiming to control diabetes with as little insulin as possible. (See the work of Dr Joseph Kraft, Dr Jason Fung and others).

    To misquote Oscar Wilde "There is only one thing in life worse than (issues) being talked about, and that is (their) not being talked about". I believe these issues do need to be acknowledged, publicised and discussed. That seems to be starting, and I'm quietly encouraged by this.

    Keep up the great work, Andreas!



    Reply: #2
  2. bill

    Very well put.

  3. chris c
    Ouch, this was close to the bone!

    After I showed the GP that my mother's postprandial BG was routinely hitting 11 - 15, she admitted that she "just had a touch of prediabetes" because her A1c was "only" 6.4%. She told her to eat "lots of brown bread and fruit, that's really good!"

    She admitted that steroids weren't helping and decided to give her a GTT when she was off them. This was a 94 year old with kidney failure and significant diabetic neuropathy in her feet. We even had to buy our own Lucozade. Fortunately she died before she could be tortured further, by 95 she was pretty comprehensively worn out.

    She told me that "diabetes is always progressive" and that "everybody has to eat lots of carbs or you have no energy".

    However she DID admit that my "prediabetic" BG had normalised, as did my lipids, and my BP dropped and I lost the 15kg the dietician made me gain, and that after TEN YEARS she would have expected me to be on "at least two" diabetes medications. Yet she "couldn't recommend" my mother follow my example. Talk about cognitive dissonance . . .

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