I came across this interesting story the other day. It concerns an American, Bob Krause, who has just turned 90. Nothing to extraordinary about that, perhaps, in these days of enhanced longevity. What makes the story interesting is that when we was 5 years old, Bob was diagnosed with type 1 diabetes.

This is condition is characterised by insufficient insulin secretion from the pancreas. As a result, blood sugar levels tend to be higher than normal. The conventional medical treatment for type 1 diabetes is insulin injections. However, despite treatment, many type 1 diabetics die prematurely, often having suffered adverse effects from their diabetes including blindness, nerve damage, kidney disease, skin ulcers and amputation. In comparison, Bob Krause appears in great shape (especially bearing in mind his advanced years).

Read the article I link to above, and what is clear is that Bob has managed his diabetes with meticulous care. What is especially noteworthy is that his eating regime contrasts sharply with the standard advice given to diabetics, namely to:

1. Eat three meals a day
2. Include starchy carbohydrate with every meal

Actually Bob normally eats twice a day. His breakfast is usually made up of nuts with some prunes. His dinner is protein (e.g. meat) plus salad. He doesn't eat much. And critically, he doesn't eat much carbohydrate.

Back in the day before insulin was discovered and made available as a medication, diabetes was treated with a diet low in carbohydrate. The doctors back then took the view that if diabetics couldn't handle sugar, then the best thing was for them not to eat it (in the form of sugar and starch). It makes sense, and even a 6-year-old understands this concept. What a shame many health professionals seem to be blind to what is blindingly obvious. And it's a shame that leading diabetes charities continue to promote a diet that is, by virtue of its high carb content, actually contraindicated in diabetics. See here for an example from Diabetes UK. I've recently been told that Diabetes UK is changing its policy regarding carbohydrate consumption, though if it has, their dietary recommendations are yet to reflect this.

Reading about Bob reminded me of someone I met a few years ago after a presentation I delivered. She was a middle-aged woman who had been diagnosed with type 1 diabetes early in life. In conversation, I asked her what her HbA1c level was (this is a measure of blood sugar control over the preceding 3 months or so). Non-diabetics will usually have a HbA1c level of 5 per cent or below. This lady's HbA1c was normal - a highly unusual situation with a type 1 diabetic of several decades standing. How had she done it? Not by following standard dietary advice, that's for sure. Her main meals were generally made up of meat or fish, accompanied by non-starchy vegetables. Not only was her blood sugar control good, but she took tiny doses of insulin in comparison to most type 1 diabetics.

One of the pioneers of effective (low-carbohydrate) nutritional therapy for diabetes is Dr Richard Bernstein, himself a type 1 diabetic and author of The Diabetes Solution. You can learn more about Dr Bernstein and his work here.

In a former life, Dr Bernstein was an engineer. Bob Krause was an engineer too. Is this just a coincidence? Perhaps not. This is purely anecdotal, but I have found that many of the most creative-thinkers in the area of health and nutrition have a background in engineering. What is it about engineering that might make these people great nutrition and health commentators? Here is the opening description of engineering to be found on Wikipedia:
Engineering is the discipline, art, skill and profession of acquiring and applying scientific, mathematical, economic, social, and practical knowledge to design and build structures, machines, devices, systems, materials and processes that safely realize improvements to the lives of people.
Engineers don't get very far designing bridges that don't stay up or computer circuits that don't work. Yet, in healthcare, it seems money can be made from approaches that not only don't work, but actually jeorpardise health. I think we doctors and other health professionals often have a lot to learn from engineers, to be honest.