I think there is often a misunderstanding about what constitutes 'evidence' for medical / nutrition science - one big problem with the testimony of lots of individuals is that it's not objective but subjective. Dietary studies are notoriously difficult, because on the whole, people are pretty poor at reporting what they've eaten, forgetting the odd biscuit, under-estimating the portion size they had etc. Some studies address this issue by essentially tightly controlling what people eat, by locking them up in a hospital for instance, but obviously you can't do that for a long term study.
Another issue is the problem of self-selection element - if you were take the evidence of the people on here, there would be an issue that meant you couldn't extrapolate to the whole of society - the people on here who'd be happy to contribute are the ones who'd generally had success, or at least were motivated enough to have tried, there are not a random un-biased sample by any means - you might as well do a survey on wealth distribution in Harrods.
What I've found about the LCHF diet is that it's easy if you're doing it for the whole family, but harder when your family still want to have carbs - they're in the house, you have to cook 2 meals sometimes etc; it takes a bit of creativity and cooking skill and a lot of people don't have that; it's very hard to stick you if you travel a lot. I really don't think it would work for everybody - and there's another area of knowledge which we don't have - for whom is LCHF suitable - not just lifestyle issues like the above, but also there are many types of diabetes, in combination with other conditions - and LCHF won't necessarily be the best choice in the case of certain combinations. It's this kind of evidence that doctors are missing - they want clear guidelines - GPs in particular can't be experts in everything, and generally they want to have a distilled simple plan to follow, compiled by the best experts in the field, and based on the best evidence.
It takes a lot for a GP to go against the guidelines they're told to work under. It's the NHS that needs convincing as a whole.
That is much too technical - the evidence problem is is that the only evidence the self-proclaimed "experts" at Diabetes uk recognise is what supports their opinions. I have discussed it with them in great detail, & shown them that reports they cite to prove what they say in fact come to the opposite conclusion.
e.g. Here I quote from a letter to Diabetes uk:
"... there is NO suggestion in your literature that a low carbohydrate (diet) could be beneficial. We only read recommendations:
“Include carbohydrate … Cut the fat”
in spite of your observation, “They (carbohydrates) all break down into glucose, so they will cause your blood sugar levels to be high.....”
........
"Perhaps the best starting point for further discussion is the DUK position statement: -
“Low-carbohydrate diets for people with Type 2 diabetes (Mar 2011)”
https://www.diabetes.org.uk/About_u...ydrate-diets-for-people-with-Type-2-diabetes/
I'll quote your conclusions:
Diabetes UK has concluded that:
- Evidence exists suggesting that low-carbohydrate diets can lead to improvements in HbA1c and reductions in body weight in the short term (less than one year).
- Weight loss from a low-carbohydrate diet may be due to a reduced calorie intake and not specifically as a result of the carbohydrate reduction associated with this diet.
- Despite the short-term benefit there is a lack of evidence related to long-term safety and benefit of following this diet.
My comment on those conclusion:
"Those positive, though tentative, conclusions suggest that further investigation into the “long-term safety and benefit” is likely to be fruitful. As the report was issued 5 years ago, much further information should now be available, both from experience of people like me & others contributing to the
www.diabetes.co.uk/forum and from diabetes professionals responding to the experience of their patients, e.g. as reported by the Public Health Collaboration
www.phcuk.org & of course from on-going DUK research."
The “Position statement” asserts: “Despite the short-term benefit there is a lack of evidence related to long-term safety and benefit of following this diet.”
The Duk claim is that low carbohydrate tests are for “less than a year” yet citations 11, 12, 13 report on-going research for up to 44 months, include control groups some of whom adopted the low carbohydrate diet when they saw the benefits for others.
I strongly recommend that everyone interested should download & read this report - it's not too technical, & totally refutes NHS/Duk diet advice:
https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-5-14
The “Discussion” section of citation 13 (Nielsen, Sweden, 2008) states:
"There is now little evidence for the claim that a fat-reduced diet for weight reduction has any particular value beyond caloric counting [
10]. On the other hand, six randomised studies have shown that carbohydrate restriction with ad-libitum energy intake confers a significant benefit with regard to weight loss in obese persons [
11,
12,
13,
14,
15,
16]. The current study is consistent with these reports and suggests that high-starch, high-carbohydrate diets excessively stimulate appetite and disturb energy balance in patients with the metabolic syndrome and type 2 diabetes [
3]. A reduction of carbohydrates normalises the balance, reduces insulin concentrations and favours utilization of stored fat as fuel as well as significantly reducing insulin resistance [
3].
Considering the solid evidence for the negative effect of hyperglycemia on diabetes complications as well as cardiovascular disease the present high-carbohydrate dietary advice resulting in unnecessary hyperglycemia and insulin resistance seems difficult to support [17, 18, 19] and for diabetes patients, current dietary recommendations seem to be a major part of their problem rather than being part of the solution. Carbohydrate restriction, however, reverses or neutralises all aspects of the metabolic syndrome [
20,
21]."
