ÿþ<head> <title>The DiabeticOptiCarbDiet</title> <meta name="DESCRIPTION" content="Complete Type 2 diabetes lifestyle change package, whose DiabeticOptiCarbDiet's many improvements delay complications and medication probably longer than any other approach."> <meta name="KEYWORDS" content="prediabetic, pre-diabetic, diabetic, diet, exercise, alone, only, control, diabetes, prediabetes, pre-diabetes, DiabeticOptiCarbDiet, Diet Control Diabetes, controled, controlled, DIY safe, mg/dL, Type 2, image, lifestyle, package, optimum, weight, OptimumCarbDiet, OCD, Optimum Carb Diet, DietControlDiabetes, progressive, information, food, calorie, intake, postpone, complications, combinations, Diabetes UK, American Diabetes Association, ADA, EASD, Australia, recipes, postprandial, peak, Roger Grant, HbA1c, Glycemic, Index, GL, low GL diet, Load, Glycaemic, carbohydrate, low GI diet, low carb diet, starch, diagram, picture, American, USA, US, carb, level, eat, recommended, limits, simplified, advice, pyramid, damage, fiber, fibre, meal, snack, maximum, comprehensive, beginner, exchanges, counting, blood, glucose, sugar, tablets, insulin, medication, heart, friendly, GP, targets, primary care, education, breakthrough, help, obesity, depression, dementia, Alzheimer's disease"> </head> <body> <font face="Tahoma" size="8"> <body link="CC3366" alink="CC9999" vlink="993333"> <center><font color=333333>Welcome to <font color=0033CC>The Diabetic<font color="009933">OptiCarb<font color="0033CC">Diet<br> <p> <b><font face="Tahoma" size="4"><font color=333333>Probably the first Type 2 comprehensive lifestyle change package that can reliably <u>delay both diabetic complications and blood glucose control medication over the long-term by healthy diet and exercise alone.</u></b> <p> (If your browser doesn't show some coloured text, please try opening this page in Google)</center> <p> <font color=333333><font face="Tahoma" size="4"><b>PREAMBLE</b><br> <font color=333333>This Web page contains much criticism of the approaches (and lack of good ones) to diabetes care in the UK, though the situation is an international one. Since some diabetics will not be in a position to judge the validity of this criticism, the following excerpt &#150 from the respected journal "The Lancet" &#150 is offered here as supporting evidence<b>:</b><br> &nbsp "A small group of medical scientists was invited to give 10-minute only summaries of crucial issues in their own fields. The timekeeping was muscular, the audience unforgiving. When forced to choose what really mattered, extraordinary facts were squeezed from their lips. Diabetes care in the UK is shamefully bad. ... And why has the gene revolution failed so spectacularly to deliver anything tangible for patients? Because we have underestimated, even wilfully disregarded, the complexity of disease. Our indifference to physiology &#150 (that is) to an understanding of systems in disease &#150 has been a catastrophic loss to medicine."<font face="Tahoma" size="2"> [Horton R. Comment, Offline. Lancet 2011; 378: 1688]</font>.<br> It is an important strength for users of <font color=0033CC>The Diabetic<font color="009933">OptiCarb<font color=0033CC>Diet<font color=000000></b>, that the original experimentation explored systems and the written material describes what is going on in simplified ways.<br> <p> <font color=333333><font face="Tahoma" size="4"><b>INTRODUCTION</b><br> <font color=333333>Imperfect dieting is a <b>major cause</b> of the <b>progression</b> (i.e. inevitably getting worse) of diabetes. Due to insufficient understanding of diabetes (<b>reasons</b> and <b>improvements</b> for this are given below), patients when diagnosed do not receive all the information necessary to reliably control their diabetes by <b>healthy diet and exercise alone</b>. (<font color =CC3366>From now on</font> <b>"diet alone" </b>includes <b>exercise</b>). This shortcoming <b>accelerates progression</b> of their diabetes into both <b>medication</b> &#150; e.g. one tablet, tablets, then insulin for the rest of their life, with a variety of possible side-effects &#150; and also <b>grisly complications</b>. <b>These diabetic complications are mainly: </b> coronary heart disease (from which about 80% of diabetics die prematurely in developed countries), stroke, blindness, kidney failure, lower leg amputation, impotence, and widespread nerve damage. Accelerated mental decline (to dementia and Alzheimer's disease) and depression also occur with poorly controlled diabetes. Ask any diabetic, with any of these complications, if you doubt <b>the importance of taking preventative action while you can, to stay free from them.</b> <p> <b> <font color=0033CC>The Diabetic<font color="009933">OptiCarb</font color="009933">Diet <font color=000000></b> (<font color =CC3366>from now on</font> <b></font>D<font color="009933">OC</font color="009933">D</font></b>) is probably the <b>first comprehensive lifestyle change package</b> that can reliably <b>postpone</b> both <b>complications</b> and <b>blood glucose</b> (<font color =CC3366>from now on</font> <b>BG</b>) <b>control medication over the long-term (i.e. 13 years, and still counting)</b>. <b>So <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> is intended for Type 2 diabetics and pre-diabetics trying to control their BG by healthy diet alone</b>. <b>This ability to postpone<b><font color =CC3366>*</font></b> diabetic complications</b>, ideally up to the end of the diabetic's natural lifespan or until a cure for Type 2 is available (if sooner), <b>is the most important requirement from any diabetic diet</b>. Next most important are usually the <b>lifestyle change not taking over one's life </b>(<b>after the initial effort, <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> becomes second nature</b>), <b>and also the ability to eat enjoyably and healthily</b> (even while losing weight) &#150 <b>which <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> also provides</b>. <p> <b><font color =CC3366>*</font></b>In December 2011, the announcement that an extremely low calorie diet for about 6 weeks could "reverse" diabetes received considerable publicity. <b><font color=0033CC>D<font color="009933">OC</font color="009933">D</font> does reverse diabetes in the same way</b> &#150 although without such extreme dieting. But the word "postpone", rather than "reverse" has always been used here because the latter might give the impression that it is a cure. <p> <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> was created by a Type 2 diabetic (Dr Roger Grant &#150 a scientific PhD, with a GP doctor wife<b>;</b> more background in <b>footnote</b> below), initially just for his own self-preservation and eating pleasure. Roger, while aware of both the uncertain effects of medicinal chemicals on the human body and also of their benefits, <b>preferred to control his diabetes by healthy dieting alone for as long as possible</b>. <b>He is now in his 14th year of freedom from both complications and BG medication</b>, and eating enjoyably. <b>This in spite of <b><font color=0033CC>D<font color="009933">OC</font color="009933">D</font></b> indicating that his pancreas produces little natural insulin</b>, <b>due to significant beta-cell exhaustion</b>. <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> has kept his 6-monthly DCCT-aligned HbA<font size="-1">1</font>c<b><font color =CC3366>**</font></b> test values in the narrow range 6.2-7.3% (44-56 mmol/mol in the new units) since early 2001 (when the test method was revised), after an equivalent value at diagnosis of 8.6% (70 mmol/mol) in 1998. His latest seven 6-monthly values ranged 6.2-6.8%. These figures compare with the general advice to stay below 7.0%, or better still below 6.6%, in order to reduce the likelihood of complications. <b>His findings from the initial highly detailed 5-year case study of himself exceeded expectations</b>, <b>so Roger piloted these findings among other diabetics for 3 years to provide wider perspective on their applicability</b>. He then rewrote <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>, so as to make it simpler to follow and less time-consuming for healthcare professionals, but without reducing its effectiveness. <p> <b><font color =CC3366>**</font></b> HbA<font size="-1">1</font>c (also called A1C) is the average percentage of glucose attached to the blood's hemoglobin, and also a measure of average BG level itself &#150; <b>each</b> averaged over the previous approximate 3 months. <p> <b><font size="4">HOW <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> OVERCOMES THE SHORTCOMINGS OF EXISTING DIET ALONE ADVICE</b><br> Early in the research, Roger recognized <b>some major shortcomings in existing advice on control by diet alone.</b> It is a commonsense principle of control theory, that to control something adequately it has to be <b>measured suitably</b>. The four main shortcomings, together with <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> s improvements, are now described. <b>Without these improvements, existing advice is less than half the solution to lasting control</b>.<br> <ol> <li><b><u>Insufficiently precise ways of finding the  safe </b> (<b>i.e. <font color="009933">optimum</font></b>) <b>weight of each healthy carbohydrate-containing food for each snack or meal</u></b>. This in spite of <b>the amount of carbohydrate </b>(<font color =CC3366>from now on</font> <b><font color="009933">carb</font></b>)<b> eaten being widely acknowledged as the strongest single influence on postprandial </b>(<b>i.e. after eating</b>)<b> BG increase</b>. Each time a person eats <font color="009933">carb</font>, insulin (from their pancreas) helps the resulting BG to enter their muscles' cells and other body cells &#150 thus resulting in a postprandial BG <b>peak</b>. (See diagram below). In <b>non-diabetics</b>, these BG peaks can go up to about 10.0 mmol/L<b><font color =CC3366>***</font></b> (180 mg/dL in US units). In <b>diabetics</b>, the <b>high BG damage leading to complications</b> results during <b>time spent above</b> this 10.0 mmol/L level. So <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> is aimed at keeping BG level <b>below the levels at which the artery damage causing complications occurs</b> &#150; by limiting the postprandial BG <b>peak</b> from going above 9.0 mmol/L (162 mg/dL) <b>normally</b>, and <b>very seldom</b> going above 10.0 mmol/L. By way of perspective, when Type 2 diabetes is diagnosed, <b>macro</b>vascular (i.e. <b>large</b> artery) damage, which leads to coronary heart disease and stroke, has usually been present for some years. If BG values are allowed to spend time above 10.0 mmol/L, <b>micro</b>vascular (i.e. <b>small</b> artery) damage follows, and this leads to the other complications listed in the first paragraph. These high BG levels also aggravate <b>existing</b> <b>macro</b>vascular damage.<br> <p> <b><font color =CC3366>***</font></b> All BG values are for glucose meters reporting their results as <b>capillary whole blood</b> &#150; as distinct from those tuned to report as <b>venous blood plasma</b>, which give approximately 12% higher values. Look in your meter's manual to see which it does.<br> <p> Official past guidelines for determining 'suitable' food weights for snacks and meals have included<b>:</b> Exchanges, Carb Counting, the Food Pyramid, MyPyramid, Divided Plate, and 40-60% of <b>daily</b> energy (i.e. calorie) intake being (mainly starchy) <font color="009933">carb</font>. (40% is a Joslin Center value). <img src="porridge.png" align=right vspace="10" hspace="10" border="2" height="223" width="550" alt="Porridge comparison"> <b>None</b> were sufficiently accurate for proper diet alone control. When the <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> research began in 1998, <b>there was institutional advice to keep postprandial BG below 10.0 mmol/L</b> (<b>180 mg/dL</b>) <b>two hours after starting to eat</b>. See how this criterion works for the diagram. It shows the postprandial curves for a Type 2 diabetic and a non-diabetic eating 70 dry grams of cooked porridge oats (plus skimmed milk<b>;</b> no sugar or cinnamon, but the latter is usually eaten with it) under the same conditions with the preprandial starting point being moved to 6.0 mmol/L in both cases. (The non-diabetic s was actually 5.0 mmol/L). The diabetic s BG comfortably met the above advice to be below 10.0 mmol/L two hours after starting. <b>Yet it peaked at 12.2 mmol/L</b> (<b>220 mg/dL</b>) <b>and spent 65 min above 10.0 mmol/L</b>. <b>Ten years later</b> (late 2008), the UK s official recommendation was changed to keeping below 8.5 mmol/L two hours after eating &#150 could this diagram have influenced the change? &#150 but that would not have improved this situation significantly. Evidently these 'single target' criteria did not serve their intended purpose. <b>The <u>shape of each BG/time curve can vary widely</u> according to the individual eater, the foods present and their amount, and the food previously eaten &#150 thus undermining the use of such spot criteria</b>. They will work better for some medications, but not for diet alone control where typically there is little, or no, first release of pancreatic insulin upon eating and a weak second release somewhat later. Their normal influence is shown by the non-diabetic's curve. <b>This is just one example of an official recommendation, that applies to medication, being inappropriately applied to diet alone control over many years without correction</b>.<br> <p> <b><font color=0033CC>D<font color="009933">OC</font>D<font color=000000> has always followed the official 40-60% <font color="009933">carb</font> advice mentioned above</b>, but not its <b>long-standing</b>  (mainly starchy) <font color="009933">carb</font> recommendation, which was withdrawn in about 2009. This latter advice led to the creation of <b>alternative diets</b> &#150; due to starchy foods having a high Glycemic Index (<font color =CC3366>from now on</font><b> GI</b>) that pushes up BG levels. Among these are <b>low-<font color="009933">carb</font> diets,</b> which approach the difficulty of predicting postprandial peak levels by intentionally selecting very low <font color="009933">carb</font> weights &#150 much lower than <font color=0033CC>D<font color="009933">OC</font>D<font color=000000> s, <b>which is not low-<font color="009933">carb</font></b>. In low-<font color="009933">carb</font> diets, more calories have to come from fats and proteins. <b>The unknown long-term health effects of this</b>, <b>together with less and fewer of the micronutrients gained from eating more <font color="009933">carb</font></b>, <b>involve taking an unnecessary risk &#150 whereas <font color=0033CC>D<font color="009933">OC</font>D<font color=000000> meets the recommended nutritional balance</b>. <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> from its beginnings, has included some aspects of other diets, such as the healthy food in the Mediterranean Diet and the  gentle foods of the Low GI Diet. However <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> followers can also eat healthy  non-Mediterranean foods, and medium and high GI foods, and <b>treats</b> &#150; but not above their <font color="009933">optimum</font> amount. <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> <b>involves eating common conventionally healthy foods &#150 nothing 'weird' or unnecessarily expensive</b>.<br> <p> <b>To chacterize postprandial peak values</b>, the <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> research included over 100 variously structured eating experiments, using finger BG testing at 10 min intervals (as in the diagram above). The main finding from analyzing this data was a method for determining the maximum (i.e.  safe ) weight of any <font color="009933">carb</font>-containing food(s) a diabetic could eat without their postprandial BG peak going above 9.0 mmol/L (162 mg/dL) <b>normally</b>, and <b>very seldom</b> above 10.0 mmol/L (180 mg/dL). Lower upper limits are possible for some people. Piloting the findings among other diabetics showed <b>that each diabetic had their own grouping of such food weights</b>, <b>according to their diabetic severity</b>, <b>etc</b>. This usefully put numbers on the widely held general beliefs that<b>:</b>  Everyone is different and "One size does not fit all". <b>An easy short-cut was developed to enable <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> users to determine their <b>personal</b> such weights &#150 and so avoid the huge amount of testing involved in the research</b>. These food weights are the <b>maximum</b> food weights that can be eaten  <b>safely</b> (i.e. <font color="009933">optimum carb</font>, thus <font color=0033CC>The Diabetic<font color="009933">OptiCarb<font color="0033CC">Diet</font></font></font>'s name), but smaller quantities can be eaten beneficially if desired.<br> <p> <li><b><u>Too much noise</u></b>. The word  noise given to radio interference, is also used for <b>unwanted irregular influences</b> that interfere with drawing conclusions from experiments. (You have probably encountered them in your own BG testing). Commonly, a <b>vicious circle</b> (cycle) is prevailing when a person first starts following <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>. As the pancreas is treated more kindly, by lowering postprandial peaks and other <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> measures, so the <b>vicious circle gradually changes into a virtuous circle</b>, <b>which is more predictable</b>. (There are good biochemical explanations for this slow change). <b>Reducing the "noise" thus, allowed further refinements to be discovered.</b> <b>This does not mean that your diabetes has been cured</b>. <b>It can revert back towards the vicious circle</b>, for example on holiday, due to greater eating and drinking and the different choice of food, but <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> includes approaches for returning to the virtuous circle. Similarly, celebratory meals and  treats can be returned to virtuous conditions, <b>providing they are not too frequent</b>.<br> <p> <li><b><u>No  real time feedback</u></b>. In most industrial manufacturing processes, there are instruments providing continuous measurements of important finished-product properties. For example, measuring the final thickness of a plastic film, so that the finished-product is <b>not too thick</b> and therefore wastefully costly in raw material, and also <b>not too thin</b> and therefore too weak. <b>This is called  real time feedback</b>, because the information is electronically <b>fed back upstream sufficiently quickly for the process</b> <b>to be corrected beneficially</b> (e.g. change the plastic raw material addition rate). Compare this with making a change to your dieting, and then having to wait up to 3 to 6 months for the result of your next HbA<font size="-1">1</font>c (A1C) and other examination results. Even then, since HbA<font size="-1">1</font>c is an average of BG values over the previous 3 months, <b>it can tell you nothing about how you dieted for any particular snack or meal</b>. By contrast, because <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> eliminates most of the  noise that upsets the interpretation of readings (Item 2 above), it does provide <b>simple real time feedback that enables one s dieting techniques to be continuously improved</b>.<br> <p> <li><b><u>Meaningless BG testing</u></b>. There is an on-going debate in the UK National Health Service (<font color =CC3366></b>from now on</font> NHS) as to whether those controlling by diet alone should be given any test strips (or equivalent) for finger testing, because using them has generally not shown BG control improvements.<b><font color =CC3366>****</font></b> The likely explanation, for this lack of success, is patients having been told either to keep below 10.0 or 8.5 mmol/L after 2 hr (as harmfully adhered to in the diagram above), or to do other testing that is not meaningful. By contrast, <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> s use of <b>peak postprandial values</b> to determine <b>the maximum weight of foods that can be eaten without BG going up to dangerous levels</b>, <b>effectively does away with postprandial testing</b>. <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> also looks after <b>preprandial levels</b>, so that once the diabetic has settled down inside <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> (the time depends mainly on how hard they work at it), <b>finger test monitoring can be reduced to once per week</b>. Occasional  spot tests and experimentation are additional. <b>That way <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> patients achieve effective control</b>, <b>and the NHS economizes on test strips</b>. <br> <p> <b><font color =CC3366>****</font></b> In March 2010, an NHS Diabetes Working Group released a report designed to clarify and improve the matter. <font face="Tahoma" size="2">[Heller, S. <i>et al</i>. Self monitoring of blood glucose in non-insulin-treated Type 2 diabetes. http://www.diabetes.nhs.uk/publications_and_resources/reports_and_guidance/]<font face="Tahoma" size="4">. While not always distinguishing between diet alone and non-insulin BG medication (where lasting control is more difficult), the report essentially endorsed some shortcomings long flagged by <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>. Namely, an absence of effective BG test control approaches<b>;</b> the resulting ignorance of both healthcare professionals and patients in interpreting BG test results<b>;</b> and the remote relevance of an HbA<font size="-1">1</font>c value to day-to-day eating. In addition, some patients' inability to get meaning from their BG readings contributed to psychological anxiety and depression. The report's "systematic" analysis of published past trials of self-monitoring BG &#150 found a reduction in HbA<font size="-1">1</font>c of only 0.52% where education and/or feedback were included, and just 0.25% where they were not included. (Compare these with the considerably higher <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> HbA<font size="-1">1</font>c reductions given above and below). Among the report's conclusions, the "few individuals" who got benefits from self-monitoring BG (sometimes just the general effects of eating, exercise, etc) should be given strips to continue testing. The funds for others' strips should be redirected to educating staff and these other patients. Also, that future research should be focussed "on how to identify those who will gain most from self-monitoring BG and establish how they integrate it successfully into their approach to self-management." .... "There is no place for a one size fits all approach". (<font color=0033CC>D<font color="009933">OC</font color="009933">D</font> provides each individual's 'size'). This report is one of several recent publications, showing the low current 'official' level of understanding, which illustrate that <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> is well ahead in the field of diet alone control. Some of <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>'s methodology is probably relevant to improving some forms of medicated Type 2 BG control. </ol> <p> <font color=0033CC>D<font color="009933">OC</font>D<font color=000000>'s above <b>four major improvements and its many other refinements</b>, reinforce the belief &#150 concluded from failing to hear or find anything similar or better elsewhere &#150 that <font color=0033CC>D<font color="009933">OC</font>D<font color=000000> is probably the comprehensive lifestyle change package best able to reliably postpone both diabetic complications and BG control medication over the long-term by diet alone.</b></font> <p> <font color="000000"><b>OPINIONS ON <font color=0033CC>D<font color="009933">OC</font>D<font color=000000> FROM SOME MEDICAL PROFESSIONALS AND USERS</b><br> <font size="4"><font color=0033CC><b>o</b></font> "The two patients I enlisted both spoke highly of it." "I think it" (i.e. the rewrite of <font color=0033CC>D<font color="009933">OC</font>D<font color=000000>) "is now user friendly and professionally presented." "It will be of continuing use to us." "If I were to develop diabetes I would certainly use it and hopefully keep to its principles." Doctor (General Practitioner).<br> <font size="4"><font color=0033CC><b>o</b></font> "Excellent." "Researched thoroughly." "Got a lot of good points." Doctor (General Practitioner).<br> <font size="4"><font color=0033CC><b>o</b></font> "Lots of very interesting stuff." Diabetes Specialist Nurse.<br> <font size="4"><font color=0033CC><b>o</b></font> "It makes absolute sense to me." Practice Nurse.<br> <font size="4"><font color=0033CC><b>o</b></font> "After only 3 months, his HbA<font size="-1">1</font>c was 7.1." (Down from 13.5% in 2006<b>;</b> his latest 6-monthly value was 5.9%). "Today the GP said he didn't think we would succeed but said he was very pleased to be proved wrong. Your information was very useful especially the graphs. We are so glad he is not taking medication!" "Eating the same diet I lost over a stone in weight (> 6.4 kg) and the diabetic 2 a stone and a half (9.5 kg) &#150 we're both healthier as a result on diet alone and taking exercise as part of the normal day. I wish I had found this information earlier." <u>Later</u><b>:</b> "I am beginning to believe that the virtuous circle has many advantages. I have stopped worrying about his food as he now automatically chooses well." Wife of <font color=0033CC>D<font color="009933">OC</font>D<font color=000000> User.<br> <font size="4"><font color=0033CC><b>o</b></font> "Everything seems to be going well. I am not a strict adherent to <font color=0033CC>D<font color="009933">OC</font>D<font color=000000> but I have taken on board your ideas which I think are very useful." <font color=0033CC>D<font color="009933">OC</font>D<font color=000000> User. <p> <font color="000000"><b>WHAT FORM DOES <font color=0033CC>D<font color="009933">OC</font>D<font color=000000> TAKE ?</b><br> <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> is designed for use by primary care medical professionals and Diabetes Educators, to provide printouts to pre-diabetics and Type 2 diabetics not yet on medication. Equally, for use by such diabetic individuals who follow it independently. Roger Grant provides help personally to them. Type 2 diabetics recently put on BG control medication <b>must get their medical professional's agreement to transfer to <font color=0033CC>D<font color="009933">OC</font>D<font color=000000></b>. <font color=0033CC>D<font color="009933">OC</font>D<font color=000000> is <b>not yet advised for</b> pregnant women, because they have different dietary needs, or for those with a medical condition requiring specific treatment.<br> <p> <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> <b>takes the form of a complete lifestyle change package</b>, that provides the information by which the above can be achieved. (This is dependent on the user's diabetes not having progressed to the point where medication is needed. When medication is needed, <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> indicates this to be so). <b>Among many other things</b>,<b> <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> includes:</b> 'Body fitness', including losing weight (and gaining weight), correct waist measurement, and exercise<b>;</b> "Healthy" and "balanced" eating guidelines explained in detail<b>;</b> Reducing blood pressure (hypertension), and improving lipids (i.e. cholesterols, etc) levels<b>;</b> Correction of some 'official' advice, with justifications<b>;</b> Detailed descriptions of strategies, rules and procedures to be followed<b>;</b> Estimating the Glycemic Index for any food (or mixture of foods)<b>;</b> Guidelines for structuring snacks, meals, eating out, 'celebratory' meals, treats and drinks<b>;</b> 'Getting Started' model menus that can be modified according to taste<b>;</b> Eating decision tree, which becomes second nature<b>;</b> Procedures for meaningful self-BG testing and interpretation of results. Also, many simplified explanations of different aspects, which give a rounded picture of what is going on, and so allow the user to make decisions when in unfamiliar territory.<br> <p> <b>The user follows</b> <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> mainly from three MS Word XP .doc and MS Excel XP .xls (2002) files, for good compatibility (other formats are possible). In total they occupy 41 single-spaced A4 pages with 23 diagrams and tables. (American letter and legal paper sizes can also be used). The length results partly from the detail provided to explain everything. Unlike books, these files are updated and improved when appropriate. <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> is <b>intentionally international</b> and draws on the best of global information sources (particularly USA, UK and Australia). It includes dual English-American vocabulary usage for medical, food, and culinary terms. Also an <b>International Supplement</b>, so that users living outside the UK are not at a disadvantage. However, Roger's in-house research provides the main value of the <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> approach.<br> <p> Because <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> deals with quantities more than other diets, it requires the user to be <b>comfortable with elementary math</b>(<b>s</b>) and <b>moderately persevering</b> when learning more about a familiar subject. Using one s brain on <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> provides a fascinating further interest, and helps to keep away both the depression and mental decline that can accompany poorly controlled diabetes. <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> is not only probably the <b>most effective complete lifestyle change package for postponing diabetic complications</b> (<b>and medication</b>) <b>over the long-term</b>. The logical understanding that <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> provides, together with the wide range and known amounts of food that can be eaten, have enabled users to return <b>to enjoying food again with confidence and peace of mind</b>. That is much better than the increasing demands on one's life that deteriorating diabetes makes. <b>The sooner and closer Type 2s follow <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>, the longer it should postpone complications</b>.<br> <p> <b>WHY IS <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> NOT MORE WIDELY AVAILABLE ? </b><br> <u><b>PART 1 &#150 THE PAST</b>.</u> The following was added in March 2010. That was before the May 2010 UK General Election. At the time, its outcome was uncertain and the resulting Government's attitude to changing the <i>status quo</i> could only be guessed at:<br> <p> If <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> includes all the above major improvements and many refinements, surely diabetes institutes and policy makers should have adopted it to retard the global diabetes tsunami at the least expensive point, that is, at diagnosis ? They didn't &#150 <b>due to considerable ignorance about diet alone control among diabetes healthcare professionals at all levels</b>. This has resulted from the following <b>obstacles</b>, which <b>reinforce each other</b>.<br> <p> <ul type = square> <li><b><u>The lack of research into control by diet alone</u></b>, because<b>:</b> <font color =CC3366>a)</font> Large pharmaceutical (<font color =CC3366>from now on</font> drug) companies have understandably no interest in diet alone control, and there are few other sources of funds. <font color =CC3366>b)</font> Research institutes and individuals avoid diet alone research, so as not to prejudice their receiving drug company research. <font color =CC3366>c)</font> The three most difficult aspects, of research on people, are said to be<b>:</b>  Recruitment, recruitment, and recruitment . (The history of medicine includes several breakthroughs by enthusiasts who experimented on themselves, and whose conclusions were initially rejected). <font color =CC3366>d)</font> The little research done has been mainly on the effects of exercise. It has been shown repeatedly to be beneficial, but an incomplete solution.<br> <li><b><u>Failure to distinguish between control approaches applicable to medication and to diet alone</u></b>. Well-intentioned senior diabetologists serve as  safe hands to advise diabetes institutions, medical journals, and primary care medics. However, they have their hands full treating those with diabetic complications, by medication in secondary care. So they are usually the most remote from diet alone control. This lack of familiarity shows up in<b>:</b> <font color =CC3366>a)</font> Diabetes institutional Position Statements, when identical recommendations are inappropriately given for control by both medication and by diet alone. (An example is the persistence of the misleading 10.0 mmol/L after 2 hr criterion, as described beside the above diagram). <font color =CC3366>b)</font> In medical journals, important diet alone papers go unpublished because their significance is not recognised. <font color =CC3366>c)</font> In diabetes magazines, books, and Websites, each meal recipe includes a portion size. Most readers will follow that size, even though it may be dangerously large for them, but <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> users will mentally work out their own safe personal portion size.<br> <li><b><u>Little information on diet alone control is communicated</u></b>, because<b>:</b> <font color =CC3366>a)</font> Medical journals depend heavily on drug company advertising. <font color =CC3366>b)</font> Diabetes institutes depend on drug company funds for supporting conferences. (A paper on <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>, for oral presentation at the Diabetes UK Annual Conference, has for four years running been turned down by their "peer reviewers" &#150 are there any suitably knowledgeable ?). These institutes also need drug company funds for showing that  something is being done. Such activities usually bring in more patients for medication. Type 1 diabetics do rightly receive their helpful DAFNE courses but, as obligatory insulin-users, their longevity has a commercial value. <font color =CC3366>c)</font> Fear of loss of 'face' (reputation). Those whose prime responsibilities should include promotion of diet alone control avoid the subject so as not to show their ignorance. At institutional level, any such important fundamental breakthrough as <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> has to be attributable to the institution, not to a mere patient armed only with a glucose meter &#150 even if his results are monitored by good regular comprehensive NHS testing and inspection plus digital eye screening.<br> <li><b><u>At primary care level there is a definite interest in diet alone control, but the above obstacles starve them of practical material</u></b>. The 10 minutes available per patient could be usefully augmented by a Diabetes Educator's seminar on <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> for pre-diabetics, the recently diagnosed, and other Type 2s whose diabetes has not progressed too far. Meanwhile the available seminars continue to teach less than half the solution to these patients. Praise for these seminars is quoted from patients who knew nothing about the subject, but that does not redeem the seminars' limitations. </ul> <p> I have long hoped that it would not be necessary to write the above and that the 'better mousetrap' principle would apply &#150 namely<b>:</b> "Invent a better mousetrap and the world will beat a path to your door". For more than 7 years I remained silent about the above "obstacles", while communicating with diabetes healthcare professionals and policy makers at all levels. Their reactions have been so uniformly contrary to the intellectual interest one would expect, that it was inevitable their possible background constraints would be considered in the light of their attitudes. Their signals were remarkably unsubtle &#150 invariably with a view to terminating the conversation or communication as rapidly as possible (particularly in the presence of other people) and often with an aggressive element unworthy of the speaker. <b>They did not even ask how <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> achieved its results, or ask to read <font color=0033CC>D<font color="009933">OC</font color="009933">D</font></b>. By contrast, profuse  fine words exist in print, with such sentiments as seeing that no lever would remain unpulled, but the reality has been just the opposite. This mainly refers to the UK, but similar sentiments have been received from other countries.<br> <p> The above-mentioned paper on <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>, refused for the Diabetes UK Annual Conference, could have made a start on rectifying the general level of ignorance. At industry conferences, constructively critical speakers are commonly included so that that industry can improve its performance. Another striking difference between the medical profession and industry is that companies have people who scout out potentially advantageous new methods &#150 including 'screwball' methods, as <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> might be viewed by virtue of its claims relative to the accepted state-of-the-art, until one actually starts reading <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>. By contrast, the formula for acceptance by the medical profession is a number of randomised controlled trials, each on a large number (hundreds) of people, even though these trials often provide confusing and sometimes contradictory conclusions &#150 due to the differences between people. <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> by-passes these contradictions by providing for such individual differences. The medical profession's preference for such "high quality" evidence-based treatment obviously has its place &#150 but also leads to new developments, such as paradigm-changing <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>, being left out of consideration. Diabetes is one of the few medical fields where some patients are able to make a significant contribution.<br> <p> Escalating healthcare costs do need to come down, but drug companies do need a steady stream of better and new medicines. So the big companies are modifying their business model &#150 mainly by reducing in-house research, and forming partnerships with synergistic smaller companies. Other, less straightforward, ways are<b>:</b> <font color =CC3366>a)</font> Paying a company not to bring to market a rival generic (usually cheaper) product that contains the same active ingredient. Its legality is being considered by both the USA and EU, where the cost to their healthcare system was estimated at $1.2 billion pa and Euro 0.38 billion pa respectively. <font face="Tahoma" size="2">[Taylor, P. Screw tightens on pay-for-delay drug deals. Chemistry World. http://www.rsc.org/chemistryworld/News/2010/January/20011002.asp]</font>. <font color =CC3366>b)</font> The alleged selective publication of drug trial results. <font face="Tahoma" size="2"> [Turner, E.H. <i>et al</i>. Selective publication of antidepressant trials and its influence on apparent efficacy. The New England Journal of Medicine. http://content.nejm.org/cgi/content/short/358/3/252 <b>plus</b> many of the titles given as citing this article]</font>. <font color =CC3366>c)</font> A reported explicit compact with the UK government whereby the price of drugs bought by the NHS allows for investment in research.<font face="Tahoma" size="2"> [Foley, S. Big Pharma ignores R&D at its peril. The Independent. <b>Penultimate paragraph of:</b> http://www.independent.co.uk/news/business/comment/stephen-foley-big-pharma-ignores-rd-at-its-peril-1891031.html]</font>. This may be reasonable, if the drug prices and allowance are also reasonable. But the present is an age when public trust in a wide variety of ostensibly respectable activities has proven misplaced. What if this agreement implicitly includes ignoring all aspects of diet alone control &#150 so that the picture sketched out above is essentially correct ? Then this pursuit to expand the number of patients taking diabetic BG control medication surely breaches the Human Rights of those who prefer to control by a reliable diet alone method for as long as possible.<br> <p><u><b>PART 2 &#150 THE FUTURE ?</b></u> The May 2010 UK General Election resulted in a Coalition Government, with courageous intentions to reform the imperfect and wasteful. Among these, a Parliamentary White Paper entitled "Equity and excellence: Liberating the NHS" was published in July 2010 <font face="Tahoma" size="2">[http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf]</font>. Widespread consultation on it followed, to which <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> contributed. The listing of several likely "obstacles", in PART 1 above, should have proved helpful. High among the White Paper s many priorities were <b>"a relentless focus on clinical outcomes"</b>, and <b>"empowering doctors and nurses" ..."to use their professional judgement about what is right for patients."</b> No longer should <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> users make such comments as:  Healthcare professionals are trained, not educated , meaning that they are discouraged from using their judgement in adopting sensible 'unofficial' treatment improvements. (There are four healthcarers' views under "<b>OPINIONS ON <font color=0033CC>D<font color="009933">OC</font>D<font color=000000>...</b>" above). These two White Paper intentions, together with its achieving <b>"healthcare outcomes that are among the best in the world"</b> &#150 <b>more of the same simply won't achieve this</b> &#150 are at the heart of enabling <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> to be adopted. By progressively lengthening the delay before Type 2s need medication and develop complications, <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> could improve patients' health significantly, while saving the NHS around GB Pounds 2 billion/year from reduced medication and secondary care, fewer additional hospital beds, and a national productivity bonus. This is after including a likely requirement for Diabetes Educator participation in GP consortia. Done well, it could also stem the diabetes tsunami that threatens to overwhelm the NHS, instead of the present screening that just brings in more patients for medication.<br> <p><u><b>PART 3 &#150 THE PRESENT.</b></u> The paper on <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>, for the Annual Conference, has been turned down by the anonymous peer reviewers for the fourth year in succession! I questioned the validity of such peer review above. Since then, much more credible witness has come along in the form of a conversation between Richard Smith and John Humphrys on the trustworthiness of peer review on the BBC Today programme of 18/12/2010. Richard Smith was Editor of the British Medical Journal for 13 years, when it was conducting its own research into peer review. He said: "We don't have really good evidence of its benefit, but we have massive evidence of its downside". This included being "easily abused" (said twice), "prone to bias", "lots and lots of problems", and the undesirable anonymity of the reviewers. He concluded with: "I think the time has come to scrap it, and an increasing number of people think that". The previous Government put a lot of money into educational courses for Type 2 diabetics, but my impression was that they were more concerned with showing that <b>something</b> was being done than they were in examining <b>what</b> was being done. At the present time, GP consortia are being asked to choose between the treatments they will use as the purse strings are passed over to them. Could it be that the <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> conference paper was turned down to prevent their learning about a superior alternative product? Or could the anonymous peer reviewers have voted in the interests of their colleague would-be presenters or for more secure employment within the diabetes field? Back to Richard Smith, who pointed out that "science works through a kind of debate". To supress such competition is a route to mediocrity, not to the world excellence that the NHS White Paper seeks. At present the air seems fuller of the old 'fine words' and bureaucratic limitations than the true Enlightenment that both patients and medical professionals need.<br> <p> <b>HOW CAN I BUY <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> ? </b><br> Medical professionals will considerably improve their own expertise by following <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>. If eligible Type 2 diabetic individuals and pre-diabetics feel their longevity is not at the heart of government policy, but rather might contribute to solving the pensions tsunami, then <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> offers a way of taking the matter into your own hands. If such people are also willing to feed back their results (<b>in strict confidence</b>) to Roger Grant, these results will be added (<b>anonymously</b>) to a gathering database. The larger and better quality the feedback, the greater the potential for useful conclusions. Done well and globally, this further research will give a better all-round handle on <font color=0033CC>D<font color="009933">OC</font color="009933">D</font>'s universality that cannot be ignored. This cyberproject may make medical history, of which you could be a part! To make <font color=0033CC>D<font color="009933">OC</font color="009933">D</font> more widely affordable, its price has been reduced to only GB Pounds 15.00 per copy, which is about US$26 or Euro 20, depending on the actual exchange rate. <b>To jump to the Order Form</b>, <b>please <a href="order.htm">CLICK HERE</a></b>. Alternatively, if you are not comfortable with such jumps for security reasons, Select the Order Form's address from here ( http://www.dietcontroldiabetes.com/order.htm ), Copy it, and then Paste it into your Browser's address field. <i><b>PayPal</i> provides the security for the purchase</b>, either through your own <i>PayPal</i> account, or by credit or debit card. <i><b>PayPal</i> gives no confidential account or card information to Roger Grant.</b><br> <p> <font face="Tahoma" size="4"><font color="000000"><b>ABOUT THE CREATOR OF <font color=0033CC>D<font color="009933">OC</font>D<font color=000000></b>. Dr Roger Grant is an Oxford University graduate with research degrees from Grenoble (Ddel'U) and Manchester (PhD) universities &#150 all in chemical subjects. A Chartered Chemist, and Member of the Royal Society of Chemistry for over 45 years, and a Professional Member of Diabetes UK. His entire career was spent as an industrial consultant, working in 44 countries, with 5 years in New York. His work included learning many different disciplines (chemistry was a good 'springboard') to find optimum solutions to complex practical problems, and then simplifying these solutions. He was Director of Special Projects of Reed International Consultants Ltd for 10 years, followed by 20 years as an independent consultant. He wrote over 100 published articles, and papers which he presented at conferences. He completely revised and edited "Grant & Hackh's Chemical Dictionary", 5th Edition, McGraw-Hill, New York (55,000 entries, including medical and pharmaceutical. <font face="Tahoma" size="2">[http://openlibrary.org/books/OL2714542M/Grant_Hackh's_chemical_dictionary]</font>), with his doctor (General Practitioner) wife. Between her medical, clinical and culinary experience, and his being a Type 2 diabetic with a multidisciplinary investigatory career background &#150; solving diet alone diabetes control was 'just up their street' (alley). <font face="Tahoma" size="4"> </table> <p> <p>If you have any queries about <font color=0033CC>D<font color="009933">OC</font>D<font color=000000>, or comments on these Web pages, please send them to me at<b>:</b><center>optimumcarbdiet[at]btinternet.com (No attachments please &#150 they will be ignored).<br><br></center> </body> </html> <table width="100%" border="1" cellpadding="8" cellspacing="0"> <tr> <td width="100%" align=center font bgcolor="FFFFFF"><a href="order.htm">Click here for Order Form</a></td> </tr> </table> <p> <p><center><font face="Tahoma" size="2">Copyright © Roger Grant, 2005-2012. All rights reserved.</font></p> </center> </body>