Govt Report (draft) on efficacy of low carb diets

[Tannith]

Low carb diets & diabetes

https://assets.publishing.service.g...nt_data/file/860659/Draft_diabetes_report.pdf
Lower carbohydrate diets for adults with type 2 diabetes SACN Jan 2020

The evidence considered for the following markers and clinical outcomes of T2D suggests that for adults with T2D:
• body weight — no difference between lower and higher carbohydrate diets in the longer term (shorter-term weight changes were not considered)
• HbA1c — lower carbohydrate diets have benefits over higher carbohydrate diets in the shorter term but evidence for longer-term effects are unclear
• fasting plasma glucose — lower carbohydrate diets have benefits over higher carbohydrate diets in the shorter term but there is insufficient evidence to assess longer-term effects
• serum total cholesterol — no difference between lower and higher carbohydrate diets in the shorter or longer term
• serum triacylglycerol — lower carbohydrate diets have benefits over higher carbohydrate diets in the shorter term but evidence for longer-term effects are inconsistent
• serum LDL cholesterol — no difference between lower and higher carbohydrate diets in the shorter term or longer term
• serum HDL cholesterol — evidence for shorter-term and longer-term effects is inconsistent
• serum total cholesterol:HDL cholesterol ratio — none of the SRs with MAs considered this outcome • medication use — lower carbohydrate diets may have a beneficial effect in reducing diabetes medication but the evidence is unclear because of inconsistencies in the reporting and measurement of diabetes medications across primary studies • diabetes-related symptoms — none of the SRs with MAs considered this outcome

 

[Oldvatr]

Low carb diets & diabetes

https://assets.publishing.service.g...nt_data/file/860659/Draft_diabetes_report.pdf
Lower carbohydrate diets for adults with type 2 diabetes SACN Jan 2020

The evidence considered for the following markers and clinical outcomes of T2D suggests that for adults with T2D:
• body weight — no difference between lower and higher carbohydrate diets in the longer term (shorter-term weight changes were not considered)
• HbA1c — lower carbohydrate diets have benefits over higher carbohydrate diets in the shorter term but evidence for longer-term effects are unclear
• fasting plasma glucose — lower carbohydrate diets have benefits over higher carbohydrate diets in the shorter term but there is insufficient evidence to assess longer-term effects
• serum total cholesterol — no difference between lower and higher carbohydrate diets in the shorter or longer term
• serum triacylglycerol — lower carbohydrate diets have benefits over higher carbohydrate diets in the shorter term but evidence for longer-term effects are inconsistent
• serum LDL cholesterol — no difference between lower and higher carbohydrate diets in the shorter term or longer term
• serum HDL cholesterol — evidence for shorter-term and longer-term effects is inconsistent
• serum total cholesterol:HDL cholesterol ratio — none of the SRs with MAs considered this outcome • medication use — lower carbohydrate diets may have a beneficial effect in reducing diabetes medication but the evidence is unclear because of inconsistencies in the reporting and measurement of diabetes medications across primary studies • diabetes-related symptoms — none of the SRs with MAs considered this outcome

I see Roy Taylor is one of the panel members. I also see that the Unwin studies were rejected from the outset as being unable to meet the SACN standards for evidence-based research. I see the Mike Lean/ Taylor study is given provenance, especially since DUK is also involved in the panel to a large degree. Do I see potential bias? Just a whiff.

I do not agree with the scientific description of carbohydrates in Section 2. Something is amiss there, and on first read through my hackles raised. It certainly reads like the old SACN mantra, especially here they identify most carbs as being starch and then go on to praise this with potatoes, grains and fruit.

They do not mention the effects of lactase, maltase, and other enzymes involved in breaking down the complex carbs, and their description of the fructose pathway seems to be muddling along with no real understanding. Their description of fermenting carbs being converted to lipids in the lower intestine is news to me too.

My head hurts. There is much from this report that does not seem to be fully in line with what the endocrinologists are modelling nowadays, and I see the panel has no endo's listed. Surprised they have anything positive to say for Low Carb, and it is obvious that they lack contact with any real reserch into this diet. They exclude short term effects, then say that they have no long term data. This is their way of casting aspersion on LC diets and undermining the claims,

I have not yet got down to the referenced studies that they did use, but I suspect that many of them call anything less than 200 g/ day, or even per meal, as classed as Low Carb, especially since I suspect they class any intake of less than 80g/meal as being starvtion and hence harmful and dangerous. I did note that their dictionary definition of carbohydrate also happens to cover fats and protiens since those are also chained carbon, hydrogen, and oxygen too.

Just a few thoughts en passant. Need a break

 

[bulkbiker]

Interesting in Section 5.9 they reject anything that shows that Low Carb might be effective yet earlier they specifically mention DiRECT which also would fail on the criteria they use to reject the other studies...
Odd eh?

 

[bulkbiker]

Not a single one of the 4 studies they based their finding on even looked at what they themselves describe as a Low Carb diet
Less than 26% TEI or 130g per day. Not one.

 

[Oldvatr]

Not a single one of the 4 studies they based their finding on even looked at what they themselves describe as a Low Carb diet
Less than 26% TEI or 130g per day. Not one.

sections 7.21 to 7.26 covers the 4 prime (SR+MA) candidates, but also the secondary RCT's

 

[OzBlossom]

When I look at the Register of Interests of SACN committee members and see Sainsbury's, Nestle, Agricultural Council, various Nutrition Panels and organisations, it gives me a sense that there is no way this report would have come out showing solid support for LC . This report does my head in particularly with - what seems to me - to be the fluffing of the boundary between LC and Higher Carb in terms of them reaching their conclusions about whether there was 'adequate, inadequate or inconsistent' evidence for each possible benefit. I see 'Lower Carb' was considered as consuming carbs from <10% up to 50% of total energy requirements (median 40%). Interesting that they did note the current UK guidelines for carb intake would be considered 'high'.

If they were looking at the 'benefit' of Low Carb as defined by up to 50%TE intake, compared with Higher Carb at, what 50% plus TE? - well that does not seem to have much value, so the results in this draft report are not surprising. It impresses me as a whole lot of obfuscation that has the outcome of not upsetting vested interests and puts forward the idea that you can't do LC without becoming deficient in essential nutrients. Humph.

A bastion of health advice here, and a favourite of my GP is The Baker Institute, that STILL has a fact sheet for diabetes listing:

Healthy carbohydrate choices:• Wholegrain bread, Crispbread• Wholegrain breakfast cereal• Grains such as Barley, Quinoa• Pasta, Noodles• Rice • Wholegrain flour, Wholemeal flour• Lentils, Legumes• Starchy vegetables including Potato, Sweet Potato and Corn• Fruit.

Yeah right, I know exactly what most of those would do to my blood sugar. Again I say HUMPH.

Even our own CSIRO here went from their last book on managing Type 2 Diabetes espousing 'moderate' carbohydrate intake to their latest book on the same topic that at the very start acknowledges the solid research supporting the benefits of (proper) LC eating in controlling and remitting Type 2.

I think I will be quite happy to stick with the information foundation assembled by my readings around e.g. Michael Mosely's collected info and Prof Roy Taylor. I feel like I am living the proof of the benefits of LC.

 

[bulkbiker]

I think I will be quite happy to stick with the information foundation assembled by my readings around e.g. Michael Mosely's collected info and Prof Roy Taylor. I feel like I am living the proof of the benefits of LC.

Oddly though neither of those two are particularly supportive of low carb eating.

 

[Oldvatr]

Oddly though neither of those two are particularly supportive of low carb eating.

Certainly, Roy is a Calorie restriction proponent and is closely associated with the FAST 800 diet which is a CICO shakes based marketing operation.

There is at least one genuine Low carb advocate in the panel Dr Pamela Dyson

 

[Member496333]

I gave up long ago on any expectation of governmental approval for low-carb eating. So long as money rules the world it will always be just one step away. One more study, one more excuse. Expecting otherwise while artificial food is more profitable than real food is just folly.

This will not change. Ever. Better to focus efforts on a ground-up approach and teach the ordinary man to ignore dietary guidelines.

 

[Dark Horse]

The authors are clear that they are not comparing 'low carbohydrate' to 'high carbohydrate' diets but, based on the evidence available to them, they had to compromise by comparing 'lower carbohydrate' to 'higher carbohydrate' diets:-

7.53 In considering the evidence, it was not possible to assess the impact of a low compared to a high carbohydrate diet on markers and clinical outcomes of T2D in adults with T2D. This was because: • the definition of a low carbohydrate diet varied widely across the primary RCTs, with prescribed carbohydrate intakes in the lower carbohydrate group ranging from 14 to 50% TE (median, 40% TE) • estimated mean achieved carbohydrate intakes reported in the lower carbohydrate groups ranged between 13 to 47% TE but were moderate (26 to 45% TE) in the majority of primary RCTs.
​

The authors also include this in the general limitations of the evidence base:-

6.62 An important limitation in consideration of the evidence was that the 4 prioritised SRs with MAs had different inclusion criteria for cut-offs used to define lower carbohydrate diets (see Table 6.1): • <40% TE (Korsmo-Haugen et al, 2018; van Zuuren et al, 2018) • <45% TE (Sainsbury et al, 2018) • no cut-off; low carbohydrate diet as stated by author; to be included, the low carbohydrate group must have achieved a lower carbohydrate intake than the control group (Huntriss et al, 2018).
​

The answer is that more high-quality research is needed.

 

[MrsA2]

I think Dr Unwin has a new report coming out soon, maybe this week

 

[OzBlossom]

Oddly though neither of those two are particularly supportive of low carb eating.

That is strictly true, perhaps I should have included more of my referencing choices to make things clearer. Yes, I think Roy Taylor said something like he wouldn't be fussed if people just did the weight loss on 2litres of skim milk per day. At the moment I'm using Taylor/Mosley information collation on calorie restriction research, coupled with other research to make my decision on keeping net carbs <20g per day, though it's difficult to see how you'd fit in many carbs on restricted calories (700-800) while simultaneously trying to get a reasonable amount of protein per day. I've maintained a mild to moderate ketosis for 3 months - would not necessarily expect high ketone levels by measure as pretty sure I'm burning up all available fuel.

The shakes mentioned by @Oldvatr are not available in Australia (though I think that's imminently changing) so I haven't been using theirs but have to say I have found it helpful to access a protein meal shake in this phase as the calorie budget is not a lot to play with and I do want to keep my protein up - don't fancy my hair falling out or my muscles wasting away!

I'm finding that there is plenty of interesting reading on Diet Doctor and elsewhere and I've also found lots of Youtube presentations quite interesting e.g. Dr Cywes and Dr Unwin. Will keep a look out for a new Unwin paper @MrsA2 - thanks for the heads up on that!

I suppose I am making my own synthesis out of all the research and certainly in the past 3 months I've seen massive changes and health benefits though admittedly I've tweaked the FAST800 program to aim for more of those lower calorie days and keeping the carbs down lower than their menu plan would have. My long term intention is to adhere to a ketogenic approach and I feel sufficiently convinced by the low-carb research pool out there to comfortably wander away from much of the SACN document.

 

[OzBlossom]

I gave up long ago on any expectation of governmental approval for low-carb eating. So long as money rules the world it will always be just one step away. One more study, one more excuse. Expecting otherwise while artificial food is more profitable than real food is just folly.

This will not change. Ever. Better to focus efforts on a ground-up approach and teach the ordinary man to ignore dietary guidelines.

Very good point. My father was diagnosed with high cholesterol in the 1970s, was told 'don't eat prawns or eggs, eat low fat, eat more wholegrains'. That advice has not aged well! He had a five-way bypass nearly 30 years ago and luckily is still happily active at 87years old.

 

[Tannith]

When I look at the Register of Interests of SACN committee members and see Sainsbury's, Nestle, Agricultural Council, various Nutrition Panels and organisations, it gives me a sense that there is no way this report would have come out showing solid support for LC . This report does my head in particularly with - what seems to me - to be the fluffing of the boundary between LC and Higher Carb in terms of them reaching their conclusions about whether there was 'adequate, inadequate or inconsistent' evidence for each possible benefit. I see 'Lower Carb' was considered as consuming carbs from <10% up to 50% of total energy requirements (median 40%). Interesting that they did note the current UK guidelines for carb intake would be considered 'high'.

If they were looking at the 'benefit' of Low Carb as defined by up to 50%TE intake, compared with Higher Carb at, what 50% plus TE? - well that does not seem to have much value, so the results in this draft report are not surprising. It impresses me as a whole lot of obfuscation that has the outcome of not upsetting vested interests and puts forward the idea that you can't do LC without becoming deficient in essential nutrients. Humph.

A bastion of health advice here, and a favourite of my GP is The Baker Institute, that STILL has a fact sheet for diabetes listing:

Healthy carbohydrate choices:• Wholegrain bread, Crispbread• Wholegrain breakfast cereal• Grains such as Barley, Quinoa• Pasta, Noodles• Rice • Wholegrain flour, Wholemeal flour• Lentils, Legumes• Starchy vegetables including Potato, Sweet Potato and Corn• Fruit.

Yeah right, I know exactly what most of those would do to my blood sugar. Again I say HUMPH.

Even our own CSIRO here went from their last book on managing Type 2 Diabetes espousing 'moderate' carbohydrate intake to their latest book on the same topic that at the very start acknowledges the solid research supporting the benefits of (proper) LC eating in controlling and remitting Type 2.

I think I will be quite happy to stick with the information foundation assembled by my readings around e.g. Michael Mosely's collected info and Prof Roy Taylor. I feel like I am living the proof of the benefits of LC.

"When I look at the Register of Interests of SACN committee members and see Sainsbury's, Nestle, Agricultural Council, various Nutrition Panels and organisations,"
I can find NONE of these in the register of interests of ANY members of the SACN committee in question studying low carb diets. ALL the members have nothing but respectable, honourable, highly professional academic and charitable interests in the general subjects of diabetes and diet. NONE have any financial interest beyond travel expenses to academic conferences etc, and in the case of Prof Taylor royalties from a book donated WHOLLY to charity. Perhaps you would care to direct me to the source of this information - which so far to me seems misleading and a slur on their characters?

 

[ChristieM]

My thinking on this could possibly be described as naive but, put simply: diabetics should avoid sugar in their system, all carbohydrates turn to sugar in your system, ergo avoid carbohydrates. Can’t see how you can disagree with this as the basis of a diabetic system of eating.

 

[OzBlossom]

"When I look at the Register of Interests of SACN committee members and see Sainsbury's, Nestle, Agricultural Council, various Nutrition Panels and organisations,"
I can find NONE of these in the register of interests of ANY members of the SACN committee in question studying low carb diets. ALL the members have nothing but respectable, honourable, highly professional academic and charitable interests in the general subjects of diabetes and diet. NONE have any financial interest beyond travel expenses to academic conferences etc, and in the case of Prof Taylor royalties from a book donated WHOLLY to charity. Perhaps you would care to direct me to the source of this information - which so far to me seems misleading and a slur on their characters?

The register of interests to which I referred was posted on their website and includes the part about Prof Taylor's book. I don't have any concerns about his interests and as I already noted I am following his research in guiding my own decisions. If you see the SACN document as helpful for you, that's fine. I see it differently.

 

[Antje77]

My thinking on this could possibly be described as naive but, put simply: diabetics should avoid sugar in their system, all carbohydrates turn to sugar in your system, ergo avoid carbohydrates. Can’t see how you can disagree with this as the basis of a diabetic system of eating.

Not all diabetics are the same. And any diabetic on glucose-lowering medication will need sugar sometimes to treat hypo's. Sugar and slower acting carbs can be a life saving medicine for all diabetics on insulin or sulfonylurea.

I also think many diet controlled diabetics do not need to avoid all carbs. There are many T2's maintaining perfectly healthy bg's without resorting to a pure carnivore diet, which is the only diet left if you want to avoid carbohydrates altogether.

And then there are the T1's and T3C's. Why would they avoid sugar in their system, provided they can dose for them? Personally I prefer eating somewhat lower carb compared to the average carb intake, but the statement "diabetics should avoid sugar in their system, all carbohydrates turn to sugar in your system, ergo avoid carbohydrates." implies that every diabetic who doesn't adhere to this is doing it wrong.

Even besides the T1's, there are plenty of non medicated T2's who are consistently seeing non diabetic numbers while still eating carbs; some can only eat 20 grams of carbs a day to achieve this, others 150 grams. Why would you tell those people to stop following a diet they enjoy and which keeps their BG at healthy levels? A no carb diet is very restrictive.

 

[Mr_Pot]

My thinking on this could possibly be described as naive but, put simply: diabetics should avoid sugar in their system, all carbohydrates turn to sugar in your system, ergo avoid carbohydrates. Can’t see how you can disagree with this as the basis of a diabetic system of eating.

I wouldn't disagree personally but I think the reasoning the medical profession use is as follows:

Doctors must prevent people dying.
Diabetics die from cardiovascular problems.
Eating less fat helps avoid cardiovascular problems. (false)
If patients are to eat less fat they need to eat more carbohydrate.
Therefore carbohydrates are good for diabetics.

 

[ChristieM]

Not all diabetics are the same. And any diabetic on glucose-lowering medication will need sugar sometimes to treat hypo's. Sugar and slower acting carbs can be a life saving medicine for all diabetics on insulin or sulfonylurea.

I also think many diet controlled diabetics do not need to avoid all carbs. There are many T2's maintaining perfectly healthy bg's without resorting to a pure carnivore diet, which is the only diet left if you want to avoid carbohydrates altogether.

And then there are the T1's and T3C's. Why would they avoid sugar in their system, provided they can dose for them? Personally I prefer eating somewhat lower carb compared to the average carb intake, but the statement "diabetics should avoid sugar in their system, all carbohydrates turn to sugar in your system, ergo avoid carbohydrates." implies that every diabetic who doesn't adhere to this is doing it wrong.

Even besides the T1's, there are plenty of non medicated T2's who are consistently seeing non diabetic numbers while still eating carbs; some can only eat 20 grams of carbs a day to achieve this, others 150 grams. Why would you tell those people to stop following a diet they enjoy and which keeps their BG at healthy levels? A no carb diet is very restrictive.

Rushed my response. Quite agree with you Antje77. Should have said ‘restrict’ not ‘avoid’ and by restrict I mean to a level that works for you. I’m in Metformin and I keep to less than 130g a day and this works for me but may not for other people.

 

[Antje77]

Rushed my response. Quite agree with you Antje77. Should have said ‘restrict’ not ‘avoid’ and by restrict I mean to a level that works for you. I’m in Metformin and I keep to less than 130g a day and this works for me but may not for other people.

Thanks for your elaboration.