Petition: Reinstate Dr David Unwin's sugar infographics as a NICE endorsed resource

[Oldvatr]

Personally I think a this should only be bumped when it has slid down the recent thread page.

I think you will find that in practice there are enough repeating staples threads such as what have you eaten today that can knock topics off the page overnight. If you are watching and standing by to resurrect it as necessary, then ok but it can 'vanish' very quickly. Being a petition it is in itself time limited.

The other thing is that there are possibly many forum members who go and vote but do not come back to the thread to report it so the thread can go seemingly dormant quite quickly.

 

[zauberflote]

I'd sign the petition, but I doubt I should as I'm a US taxpayer....?

 

[ringi]

Now got over 1800 people who signed it, how soon will it be over 2000?

 

[pdmjoker]

Just seen this on Twitter

In 2018, the National Institute for Health and Care Excellence (NICE) endorsed a set of infographics created by NHS Innovator of the Year 2016, Dr David Unwin. These infographics illustrate how certain foods may affect blood glucose in terms of equivalent teaspoons of sugar. The calculations presented on the infographics are based on the well-studied rating systems of glycaemic index and glycaemic load.

Unfortunately, on Sunday 12th July 2020, The Mail on Sunday published an article that pushed NICE to remove the infographics from its website and assess its endorsement. Following this assessment, NICE conceded that the science upon which these graphics are based is sound, and yet decided to remove its endorsement, citing that such an endorsement implies support for a low-carbohydrate diet
​

See http://chng.it/67XhPCRqJ9 for the details and to sign the petition.

Part of a NICE email from the FOI reads:

It seems to me that, whether or not we’re happy that Dr Unwin is using our endorsement appropriately,
the case that MoS and others are making is that it is based on flawed evidence and could potentially be
harmful.
​

Note "could potentially be harmful" in contrast to high carb and sugar consumption which, as we all know, is totally benign for everyone!

Looks like MoS took what Dr Unwin said ('If you have type 2 diabetes, sugar becomes a sort of metabolic poison,') and asked a somewhat different question to elicit contradictory quotes:

So does sugar become a poison to type 2 diabetics? 'That's not supported by the evidence,' answers Prof Kar.​

Prof Kar stated in his followup article https://nhssugardoc.blogspot.com/2020/07/good-night-and-good-luck_20.html

my national role portfolio sits around Type 1 Diabetes, Technology etc- not to do with prevention of either Type 2 Diabetes or Obesity.​

which, given some of the things he's said recently regarding diet, really doesn't surprise me...

 

[Oldvatr]

Anyone wanting to comment direct to NICE could use this
https://pathways.nice.org.uk/contact-us

I have already sent them an email, so will see what happens

 

[pdmjoker]

Anyone wanting to comment direct to NICE could use this
https://pathways.nice.org.uk/contact-us

I have already sent them an email, so will see what happens

What did you say in the email?

 

[Oldvatr]

What did you say in the email?

Sent them a link to a new clinical trial on elderly T2D using Low Carb that seems to have a similar pedigree to the original Newcastle Diet including MRI scans of adipose tissues.
https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-020-00481-9

Told them that IMO it was better evidence then the MoS report and that it is worthy of further consideration.

 

[nanabon]

Signed and wish I could sign a bazillion times. It's so frustrating to find something that helps and then have the access to it restricted because a little pressure was applied. Someone will benefit monetarily; don't know how many members of NICE or the media have their snouts in the Big Food/Pharma trough but it's really wrong that the general public suffers so that they can make money, protect their precious reputations, or both.

 

[Ceppo]

Happy to sign. Its so immediate and helpful. The politics of diabetes....

 

[mike@work]

Did also sign, but it's questionable if it counts - comes from Finland
Had to do it, just for the sake of it...

Mike

 

[pdmjoker]

Sent them a link to a new clinical trial on elderly T2D using Low Carb that seems to have a similar pedigree to the original Newcastle Diet including MRI scans of adipose tissues.
https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-020-00481-9

Told them that IMO it was better evidence then the MoS report and that it is worthy of further consideration.

Thanks. Seems odd that NICE should endorse the infographics yet have a website disclaimer saying they have:

‘not made any judgements about the quality’​

of Dr Unwin’s resources. On what grounds did they endorse them? Were they wanting to promote his work yet remain mealy-mouthed about Low Carb?

Edit: Mealy-mouthed = not brave enough to say what you mean directly and honestly

 

[BrigitteGoretzky]

Done. Even though I'm from the other side of the Channel.

 

[Oldvatr]

Thanks. Seems odd that NICE should endorse the infographics yet have a website disclaimer saying they have:

‘not made any judgements about the quality’​

of Dr Unwin’s resources. On what grounds did they endorse them? Were they wanting to promote his work yet remain mealy-mouthed about Low Carb?

Edit: Mealy-mouthed = not brave enough to say what you mean directly and honestly

It seems this website here was where he got his info, rather than from the 'official' Diabetes website which probably irks someone.
https://healthinsightuk.org/2014/11/13/high-fat-low-carb-diet-for-diabetes-a-gps-tale/

 

[ringi]

Thanks. Seems odd that NICE should endorse the infographics yet have a website disclaimer saying they have:

‘not made any judgements about the quality’

I think it was bases on them being helpful, but NICE had not checked all the calculations etc. Eg the number of suger cube equivalents are not independently proven.

 

[Oldvatr]

I think it was bases on them being helpful, but NICE had not checked all the calculations etc. Eg the number of suger cube equivalents are not independently proven.

Like this?
https://www.pinterest.com/pin/791226228261168628/

Or this from the Daily Wail (MoS sister publication)
https://www.dailymail.co.uk/femail/...-cubes-everyday-items-surprising-results.html

But you are right. the above seem to be based on the package label which states of which Sugar = xxxg whereas a carrot has no label. So it is the algorithm that converts grams[carb] into grams[sugar] that is being queried.


Researchers use: one gram of carbohydrate == 0.224 grams of glucose based on empirical measurements (i.e. OGTT) based on the finding that 1 g glucose raises bgl by 1mmol/l (or 17.8 mg.dl)

 

[pdmjoker]

I gather the infographics came out of https://insulinresistance.org/index.php/jir/article/view/8/11 which says

The GI is calculated as 100 times the 2-h post-prandial blood glucose response (incremental area under the curve) to a food containing 50 g of carbohydrate divided by the 2-h post-prandial blood glucose response to 50 g glucose, each in 10 persons of normal health.​

and some quarters disagree that "incremental area under the curve" is right (subtracts any negative response), claim it "unscientific" and say that total positive area is the right approach.

With Michelle's rice vs sugar graph in MoS I got rice had 85% glycaemic response of sugar if incremental, 79% is just positive values and 91% when correcting for the 0.6 initial dip in rice graph. Of course, the amount the rice is cooked affects how much starch is released when it is eaten.

The graphics are designed to be an accessible communication tool/guide and were never claimed to represent a totally accurate expression of how the body functions, as mentioned in the paper I cite above.

 

[Oldvatr]

I gather the infographics came out of https://insulinresistance.org/index.php/jir/article/view/8/11 which says

The GI is calculated as 100 times the 2-h post-prandial blood glucose response (incremental area under the curve) to a food containing 50 g of carbohydrate divided by the 2-h post-prandial blood glucose response to 50 g glucose, each in 10 persons of normal health.​

and some quarters disagree that "incremental area under the curve" is right (subtracts any negative response), claim it "unscientific" and say that total positive area is the right approach.

With Michelle's rice vs sugar graph in MoS I got rice had 85% glycaemic response of sugar if incremental, 79% is just positive values and 91% when correcting for the 0.6 initial dip in rice graph. Of course, the amount the rice is cooked affects how much starch is released when it is eaten.

The graphics are designed to be an accessible communication tool/guide and were never claimed to represent a totally accurate expression of how the body functions, as mentioned in the paper I cite above.

Sadly the GI and GL concepts are as much an anathema to SACN and NICE as Low Carb is; They do not accept that it can be calculated like that, and is therefore an artifice and obviously 'quack'. It is not based on scientific evidence and cannot be proven by RCT trials. It is in their mind blogger material to sell books, not suitable for serious consideration. EATWELL is not based on such false premises.

That is my jaundiced and cynical view of it anyway. Your last paragraph rings very true to my mind. It is akin to the parables of the Bible that some fervently believe to be totally true stories from history (so immutable fact), but others hold as being simple stories to demonstrate a moral point or two so that they are easily assimilated by children and can be easily handed down verbally through the generations or down the pub.

 

[ringi]

As a Engineer at heart, I believe all models are incorrect, but some models are very helpful when trying to operate a system. I see controlling BG in DM2 as a system operating problem and like all system operating problems a model that helps predicts the effect of changes to inputs is helpful.

 

[Oldvatr]

I gather the infographics came out of https://insulinresistance.org/index.php/jir/article/view/8/11 which says

The GI is calculated as 100 times the 2-h post-prandial blood glucose response (incremental area under the curve) to a food containing 50 g of carbohydrate divided by the 2-h post-prandial blood glucose response to 50 g glucose, each in 10 persons of normal health.​

and some quarters disagree that "incremental area under the curve" is right (subtracts any negative response), claim it "unscientific" and say that total positive area is the right approach.

With Michelle's rice vs sugar graph in MoS I got rice had 85% glycaemic response of sugar if incremental, 79% is just positive values and 91% when correcting for the 0.6 initial dip in rice graph. Of course, the amount the rice is cooked affects how much starch is released when it is eaten.

The graphics are designed to be an accessible communication tool/guide and were never claimed to represent a totally accurate expression of how the body functions, as mentioned in the paper I cite above.

I can see why there are two ways of interpreting the AUC. The areas under the curve shows how the density of sugar varies with time. The overall AUC should show the total amount of glucose passing in the blood. But in the normal body there are two stages of insulin response, Stage 1 is the anylase response which is fast acting, but limited duration, and this may explain the initial drop in bgl. Stage 2 is the basal response which is long lasting and normally closed loop as the blood sugar approaches the basal level (FBG), Most T2D have a condition that shows both responses are badly affected by the disease, and for most the Stage 1 response is usually very poor or non existant. But some retain a good first response. So the initial dip is part of the process and valid, but it does affect the calculation since it represents glucose that should be there but is being quickly diverted into storage instead so IMHO the missing sugar should be added back in since it did get converted silently in the process.

The other thing about the 2 stage response is that simple carbs like sugar, glucose, trigger the amylase reaction in the mouth during mastication, which is the signal to trigger insulin release. But other carbs and especially in the presence of fat do not cause the Stage 1 release. So a super ripe banana may or may not trigger, but the OGTT glucose beverage most certainly should. This is why the pure GI value or carb content could be misleading the Reporter in his study. It is also why the GI . GL concept is not generally accepted as fact, and does indeed call into question the numeric equivalence shown in the infographics. If the calculations had been based on actual OGTT results for a random sample of the population then that might have been a firmer foundation.

The last observation I make is that diabetics will show different results than the general population anyway, and it is not clear which cohort the infographics are supposed to illustrate. To a general reader such as a MoS reader or Reporter or NICE they need the data to show how a normal person would react, but a person reading a book on diabetes would probably expect to see how they might react.

 

[pdmjoker]

Sadly the GI and GL concepts are as much an anathema to SACN and NICE as Low Carb is; They do not accept that it can be calculated like that, and is therefore an artifice and obviously 'quack'. It is not based on scientific evidence and cannot be proven by RCT trials. It is in their mind blogger material to sell books, not suitable for serious consideration. EATWELL is not based on such false premises.

That is my jaundiced and cynical view of it anyway. Your last paragraph rings very true to my mind. It is akin to the parables of the Bible that some fervently believe to be totally true stories from history (so immutable fact), but others hold as being simple stories to demonstrate a moral point or two so that they are easily assimilated by children and can be easily handed down verbally through the generations or down the pub.

Helpful, thank you. In other words it wasn't hard to find some senior medical people who would disagree with the infographics and say they are unscientific etc...