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Following a low-carb diet in Africa
When we ask Dr Katambo whether it is realistic to expect Kenyans to give up their much beloved ugali, or West Africans to abandon jollof rice in a bid to combat type 2 diabetes, he bursts out laughing. “I am not saying Africans should stop eating their favourite meals, but we need to make people aware of a very simple fact: we’ve been eating ugali and other starch for the longest time, but we also used to be a lot more active” he explains. “When I am advising people to lower their carbohydrate intake and be more active it’s not just theoretical, I’ve seen results and people being able to live a healthier, happier life.”
Dr Daniel K. Katambo is one of the physicians advocating for the adoption of a low-carb diet to combat type 2 diabetes across Africa. His trademark approach is a mix of practical thinking and educational instincts that often resonate with people who are newly diagnosed and are determined to make a lifestyle change – provided they are given the right information.
Eunice Nwogu is one of them. She has achieved diabetes reversal or remission in record time and describes her meeting with Dr Katambo as “a turning point” in her journey. “I had read a lot about diabetes and I knew that other people had been able to reverse their diabetes.” she explains, “but the first physician I saw encouraged me to accept my condition rather than fight it. I wasn’t satisfied with this approach.” Her conversion to a low-carb diet, which she undertook under the supervision of Dr Katambo, helped her reduce her HbA1c level, a marker of diabetes, from 17.4% to a healthier 6.9% over the course of six months. She now hopes to come off all medication in the near future.
Diabetes remission can also be achieved later in life. Kepha Oyaro, a retired lecturer, managed to turn around his type 2 diabetes, having had to wait twenty years to receive well-informed, comprehensive advice on the remission process. His first doctor had the right reflex but incomplete information. When Kepha was diagnosed with pre-diabetes, his physician advised him to “get off sugar”. “I was very obedient, but I asked him, what can I replace sugar with?” he recalls. “-Replace it with honey,” was his doctor’s advice, notwithstanding the amount of sugar honey contains and the eating habits of his patient. Fast forward to the present day, Kepha is a different person. Having been on a supervised low-carb diet for two years with a different doctor, he is no longer on medication for blood pressure and diabetes.
Picture 1. Ugali, a type of maize or cassava flour porridge, is a staple item across Africa, also known as akamu, pap or bando in other countries. It is high in carbohydrates.
Picture 2. An alternative low-carb meal in Kenya could include chicken and traditional fried cabbage.
Training people living with diabetes and healthcare professionals
Dr Katambo is not surprised that advice on lifestyle changes for people living with type 2 diabetes is sometimes incomplete or flawed. “Of course, in medicine school, we hear that the first line of treatment for diabetes is lifestyle” he explains, “but this often ends there.” In low and middle income countries, “training swiftly moves on to metformin, then to a combination with sulfonylureas as a next line of care, then insulin.” “There is a gap to fill,” he observes “to complement, not to replace professional training.”
For this reason, low-carb lifestyle training and type 2 diabetes reversal has been the subject of training programmes run by Dr Katambo and other experts over the past three years. Dr Eva Njenga, Chair of the Kenya NCD Alliance welcomed this addition to the diabetes landscape: “I was delighted to meet a young physician with so much passion for helping type 2 diabetes patients,” she says. “We got a team together who were interested in a pilot study for diabetes reversal/remission and started a 6-week training programme in Nairobi back in 2019.”
Initially focused on people living with diabetes, the training has expanded to healthcare professionals. The first training took place online in November 2020, and three annual sessions will be scheduled going forward. The objective of the training is to encourage nurses, doctors and healthcare workers to “step back and look at a wider range of options for the people they’re treating,” explains Dr Katambo. “Some people will definitely be on medication, but some others may be able to reduce their medication with the help of a low-carb diet.” “Among other things, we train healthcare professionals to follow these people and adjust their medication accordingly.” To encourage healthcare professionals to upskill and attend the three-day course, 10 CPD points are awarded to participants.
Another tool to treat type 2 diabetes
Much of the knowledge passed on by Dr Katambo is the result of a 3-year placement in Bermuda, where he was introduced to type 2 diabetes remission by Dr David Cavan, a world-renowned expert in the field. “Studies show that low carbohydrate diets can lead to up to 50% remission after two years”, explains Dr Cavan. But experts in type 2 diabetes reversal insist that a low-carb diet is a no-regret option: with the appropriate follow-up, lowering carbohydrate intake has not been showed to worsen the condition of people with diabetes. “Everyone can benefit from lifestyle changes to promote type 2 diabetes reversal” Dr Cavan explains.
Bermuda, one of the world’s wealthiest countries per capita, is where inspiration for the type 2 diabetes remission training programme originated. “I used to think that our problem [in Africa] was the lack of wealth and consequently the lack of access to good drugs, which meant that people were more likely to suffer from serious consequences of diabetes. But I noticed that despite having access to the best medication and the best healthcare, people in Bermuda were still severely affected by type 2 diabetes”. “We can’t wait for better drugs,” says Dr Katambo “the cheapest way to deal with type 2 diabetes is through lifestyle changes, and a low-carb diet provides the strongest foundation for this change.”
Dr Cavan supports this analysis. “By encouraging people to reduce sugars and other refined carbohydrates, and increase their intake of fresh natural foods, we have shown that it is possible for people to achieve remission of type 2 diabetes in Nairobi, including many who were on low incomes” he says. “This is hugely encouraging, as with limited capacity of health systems in many countries, using a lifestyle approach is the only feasible option to tackle the big increases in type 2 diabetes that is forecast across Africa.”
Dr Katambo now hopes to convince many other healthcare professionals to follow in his footsteps. They will need to share his passion for education. “Daniel’s enthusiasm for the lifestyle approach to managing type 2 diabetes and his skills as an educator were instrumental to the success of the Diabetes Reversal programme,” Dr Cavan observes. Listening to the people who have followed the course, there will be no shortage of enthusiasm to accomplish this.