There’s no debate about the increase in obesity or overweight increasing a person’s risk of developing type 2 diabetes (T2D) – it accounts for about 80-85% of their risk, according to research. Those extra stones are a key modifiable risk factor for the condition. As people get fatter so the rate of T2D goes up and up.

It’s not just T2D, of course: other conditions including heart disease and stroke, osteoarthritis, many types of cancer and mental illness are linked to piling on the pounds. Which is happening at a truly alarming rate. Between 1993 and 2019 the proportion of obese adults in England nearly doubled - rising from 14.9% to 28%.

In the 2021 Health Survey for England, 25.9% of adults 16+ were obese and a further 37.9% were overweight, making a total of 63.8% who were either overweight or obese. Meanwhile, the number of people in the UK living with diabetes – 90% of whom have T2D – has now topped five million.

The reason? Sugar in all its forms. ‘For 95% of people with type 2 diabetes and poor blood sugar control, the true cause is years of consuming too much sugar and the starchy carbs that digest down into sugar,’ says Merseyside GP Dr David Unwin. One solution? A low carb diet. Both the US and Canadian Diabetic Associations have come out in support of a low carb diet, he adds.

 Dr Unwin had a light bulb moment about carbs in 2012 when a patient with long-term type 2 diabetes completely reversed her condition with a low carb diet, based on information she found online. ‘I had been prescribing her drugs for years without any change,’ he admits. ‘Now she had lost three stone, looked marvellous and achieved drug-free remission without my help.’

He was struck by how upset his patient was that he hadn’t explained that all carbohydrates are, in fact, sugars. It’s not just the fine, white, sparkly stuff, which most of us know is not good for our health; bread, potatoes, breakfast cereals and pasta all digest down into surprising amounts of glucose.. For instance, there’s the equivalent of six teaspoons of table sugar in two slices of ‘good for you’ wholemeal bread. Likewise, a 150g serving of boiled rice has the equivalent of ten teaspoons of sugar, with nine teaspoons in a serving of potatoes.

It’s useful here to explain what carbs and insulin do in type 2 diabetes.

• Type 2 diabetes is a condition where there is too much sugar in your blood. Normally, the role of the hormone insulin, which is made by the pancreas, is to allow cells to absorb and use glucose (sugar) and to regulate the amount of sugar in the blood. But in type 2 diabetes, insulin doesn’t work properly.
• Your diet influences your risk of type 2 diabetes in this way. When you eat sugar, the pancreas sends out insulin as a chemical messenger to tell the sugar/carbs where to go. Normally, it would go to all the cells in the body to be converted into energy. But if the cells are full because people have consumed so many carbs/sugars, the excess is stored as fat round the belly or in the liver.
• This leads to a pre-diabetic condition called insulin resistance, where the body’s cells take less notice of (in other words, ‘resist’) signals from the insulin.
• So… the pancreas goes into overdrive producing more insulin to try to stabilise blood sugar levels. But it can’t keep up the supply of extra insulin to compensate for the cells’ increasing resistance and blood glucose (sugar) levels shoot up. Unless the situation is put back into balance by diet or medication, the result is type 2 diabetes.

With the support of his wife Jen (a consultant psychologist), and his practise nurse, Dr Unwin started weekly Low Carb Diet groups at Norwood Surgery in 2013. ‘It was such fun, and the results since have been amazing.’ One of his simple mottos is ‘swap out the white stuff, eat green instead’.

Over the last decade in Dr Unwin’s practice of 9,500 patients, half (129 patients from a total of 258) of those diagnosed with type 2 diabetes who chose to follow a low carb diet are in remission after over 30 months. ‘This is 20% of the entire diabetic population of the practice,’ he points out.

Mainstream medical opinion is often still resistant to offering patients the choice of drugs for life or trying a low carb diet but the situation is changing. An increasing number of UK doctors now accept that treating every patient with drugs to balance a carb-based diet is not the answer for every patient and a low carb diet can help a significant number.  

With about 4.5 million diagnoses of type 2 diabetes in the UK and much earlier age of onset (from an average age of 60 two decades ago, children are now being diagnosed), the £1 billion drug bill is clearly not good value. Because of offering the low carb option, Dr Unwin’s practice now saves over £68,000 annually on diabetes drugs. Sadly, the Treasury keeps all the saving. ‘So GPs are not incentivised to make those savings,’ he comments. 

Obesity is accepted as the biggest risk factor for type 2 diabetes. With three in five adults in England now overweight or obese, it’s clearly vital to give patients the option of lifestyle changes that may mean they will never need to go on drugs. ‘Since we started, not a single practice patient has refused the opportunity to try a low carb diet as an alternative to lifelong medication,’ says Dr Unwin.

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