Radio Four - lunchtime today

[alaska]

I found it a shame that Dr Briffa's point about ketosis not being a process that must be excluded wasn't discussed further on the show.

 

[catherinecherub]

The problem there was that Briffa seemed to intimidate the Dietitian who was ill prepared to discuss the points raised. Briffa's agenda was well thought out and left the Dietitian floundering.
I would have liked to see a Dietitian who could have presented themselves better so that it was a meeting of equals on different sides of the fence.

 

[borofergie]

The problem there was that Briffa seemed to intimidate the Dietitian who was ill prepared to discuss the points raised. Briffa's agenda was well thought out and left the Dietitian floundering.
I would have liked to see a Dietitian who could have presented themselves better so that it was a meeting of equals on different sides of the fence.

I agree that the Dietician was ill-prepared. However, to be fair to her, she was being asked to defend the indefensible. I'd also be very interested to here a compotent dietician who could explain why Diabetes UK is push a carb heavy diet (see post above about latest issue of Balance magazine).

 

[noblehead]

I don't low-carb and eat around 150g of carbs a day

Isn't that splitting hairs Nigel? Compared to what Diabetes UK is recommending 150g is a low carb diet.


All depends Stephen, in the March/April issue of Balance the advice on how much starchy carbs a day is: '' 7-14 portions. One-third of your diet should be made up of these foods, so you should include them in all meals''. Therefore working on the basis of one slice of bread this could be 83g of carbs at the lower figure (7 portions) if you were eating Burgen for example, and on the upper level (14 portions) this would be 166g of carbs.

A bit more clarity would be beneficial in what they call a portion, for example they say 2 new potatoes are one portion (but what size?) as a type 1 being taught about carbohydrate counting a portion was 10g of carbs, on DAFNE this is the same but is called a CP (carbohydrate portion) so some clarity is needed here.

Part of the problem is that the term "low-carb" tends to be very emotive. If we talked about a managed or controlled carbohydrate diet, then maybe people would listen more.

It's only emotive to those who want it to be, as we know we have members on here who consume carbs anywhere between 30 - 200+ a day and control it quite successfully, like you I'd rather the term low-carb wasn't used as it is ambiguous and the true meaning has been lost in translation along the way, terms like 'moderate' seem much more appealing and covers all options IMHO

 

[Unbeliever]

What do they actually do? Apart from churn out harmful and wrong advice? Have they been active in campaigning to get T2s strips? Or are they just a vehicle for selling carb filled cornflakes?

They won't get a penny of my hard earned cash.

Here's a clue to where some of their money is spent Stephen:

http://www.diabetes.org.uk/Research/Current-research/


I've been a supporting member since 1982 when it was the BDA, I'll continue to support the good work they do in providing help & support to diabetics via their support line, research funding....but most importantly the good work they do in providing help, support and funding into Juvenile diabetes.

All these charities seem to run into an identity crisis at some point. Inevitable I suppose. Naturally the original onjective is to help people but this praiseworthy objective sometimes - nay often - gets lost or bogged down in the necessity for the charity to compete with others for our money . They are businesses- often big business and behave like any other business. They often appear to lose their way and lose sight of their original purpose in trying to please sponsors or
interest groups. I know hat a lot of this is supposed to be "for the greaer good" but there often comes a point at which they must take stock if they wish to be taken seriously by those hey purport to represent or assist.

In the case of DUK, as Nigel has pointed out they deserve support for their research programme and who could dispute the
necessiy for any help in juvenile diabees.

Regarding their helpline- I have atempted o use it twice and quite frankly found it UN-helpful and others have said the same.
Worse, ithe unhelpfulness appeared to be based on some PC agenda , ewly diagnosed I asked a quesion about metformin.
Quite innocuous , mentioned no names or personalities , the sort of question you migh see here in the newbie forum any day of the week. I was asked to re-phrase my question. Couldn't understand why. Asked again same reply. Told them I didn't understand here was no other way o pu the simple question. Got owhere . Gave up. A while laer ried again. Different question, different person, similar reply. I can only assume that hey are terrified that they will answer in a way which might upset an HCP if repeated to them
When I look at the site I wonder who the arget audience is. I don't wan o run the Three peaks or camp on Mt Everest.
Good luck and well done to those who do but...

I do wonder very much about the motivation for their pushing the high carb diet. They are ot taking a neutral stance hey are positively pushing it. I can understand their not pushing a low carb diet but they are waiting for research to be concluded on that. Where is the reserch on the high carb ? And to name certain cereals??

I am sure they must find invitations to advise government and being quoted by doctors as if they were the last word on diabetes, very satisfying but to me , this puts a greaer onus on them to be very sure and very careful about the advice they dispense and the items they publish. Just saying...........

Please excuse any wore than ormal typos. Had angiogram on eyes today and the effec of the drops still hasnt worn off though with my eyes its difficult to tell.

 

[Etty]

The problem there was that Briffa seemed to intimidate the Dietitian who was ill prepared to discuss the points raised. ...

I don't think she is unprepared, after all she's been a spokesperson for DUK for some time, and a "clinical adviser". She was just sticking to what the website says, and didn't have any good counter arguments to the points put to her. Her/their attitude seems to be summed up by her saying "let's face it, carbohydrate is an important part of the diet, everybody eats it"!
As for the position statement, it seems to include all diets with less than 45% carbohydrate as low carb diets. No wonder they don't find clear support for low carb eating.

 

[IanD]

She was obviously desperate by the end - wasting time by explained the difference between T1 & T2.

And that "Position Statement" is worthless & has been totally disregarded by the mindless repetition of the high carb diet in the Balance.

 

[IanD]

I remembered I had posted this in April 2011 when DUK brought out their "Position Statement"

I came across the July/August 2003 Balance, which had an article "investigating the truth behind a low carb diet."

I won't bore you with warnings of the dangers of "breakdown of vital muscle & body tissues" or "increased risk of heart disease, cancers & bowel disorders" or "the risk of kidney disease." Such a diet may be "suitable ... with medical supervision & with guidance from a state-registered dietitian."

A key paragraph is: "Research into the long-term effects of low-carb diets is now required. And in response to this, Diabetes UK is funding such research."

I presume the results of that research are seen in D UK's Position statement (after 2009) Low-carbohydrate diets for people with Type 2 diabetes which concludes with:

"More research is needed to assess the effectiveness of varying degrees of low-carbohydrate diet on weight, glycaemic control, hypertension and lipid profile in people with Type 2 diabetes (18) as well as to investigate the long term effects of these diets."

I can't wait for yet more long term studies - I've too much to lose. I followed their "healthy diet" for 7 years & was crippled by the complications. My low-carb diet started in May 2008. The complications disappeared in 3 months. Three years on I am well & active. There is no hint of any adverse effects in my experience. My Drs are happy with my level of health & all my blood test results.

 

[Daibell]

Hi IanD. I think you just posted on Biffra's site; yes 42 tablespoons of mashed potato would equate to DUK's maximum daily carb intake. My wife almost fell off her chair! One of the problems is the quoted people who are 'OK' on high-carb diets, which to me sounds unlikely scientifically but, of course, it could be true. I would like to understand the stats more fully. I have a friend who is 'T2', whose GP said have plenty of carbs and he says his sugars are fine with that. However he also said he was prescribed Gliclazide as well as Metformin (due to the carbs??) and went hypo on one 80gm tablet so no lack of insulin and he is underweight. My question would be what level of diabetes does he have? I'm on full dose Gliclazide plus Sitagliptin and had a BS of between 11 and 12 on the last 2 nights 2 hours after an average carb meal. Tonight it was only 6.7 with a very low-carb dinner. There is such a big difference within T2s on BS control and I'm convinced that for those of us who are struggling, high carb is certainly not an option at all.

 

[xyzzy]

Ian, Stephen well we tried our best on their FB page but as far as I can see all we achieved was to maybe begin to convince one lady who already was a closet convert already! No one else seemed to give a ****.

Likewise their forum seems similarly lemming like, a real Stepford Wives kind of place full of compliance and obedience, makes me shudder.

So I think I'm just going to try and continue to help the people who end up over here as it's far more rewarding.

 

[xyzzy]

Ian saw your FB post this a.m. Good move with the link, tempt them over here

 

[hanadr]

I've written to D uk [not for the first time!] and pointed out tha EVIDENCE shows clealy that low carb diets suit diabetics best and citing my source as well as reminding them that I put a copy of the relevant study into their hands personally about 3 years ago.
the D uk dietician could not cite any references. That's what Ifind whenever this question is raised. I have also written to Sense about science. There's an article about asking for evidence in the current issue of "Balance",[ the Duk magazine], which is supported by Sense about Science.
Unfortunately the "Authorities least likely to be questioned[ the medical folks] are those who WON'T/CAN'T give it. Our local diabetes clinic, which I've never attended as a patient, because only insulin users see them, told myT1 husband that they are an "evidence based "facility. However, they don't offer to show that evidence.

 

[borofergie]

All depends Stephen, in the March/April issue of Balance the advice on how much starchy carbs a day is: '' 7-14 portions. One-third of your diet should be made up of these foods, so you should include them in all meals''.

It depends what they mean by one third of my diet doesn't it?

If they mean one third of my calories by energy then thats 2500kcal/3=813kg/4= 210g of carb per day...
If they mean that one third of your food by weight, then obviously that'd be quite a lot more (since carbs are less energy dense than fat).

It's only emotive to those who want it to be, as we know we have members on here who consume carbs anywhere between 30 - 200+ a day and control it quite successfully, like you I'd rather the term low-carb wasn't used as it is ambiguous and the true meaning has been lost in translation along the way, terms like 'moderate' seem much more appealing and covers all options IMHO

Well it's the ones that want it to be emotive that cause the problems and turn any thread that mentions carb-control into some personal vendetta for or against ultra low-carb diets. I do think that we are all agreed that carbohydrate control is the best way forward. If some people can cope with 200g a day, then that's brilliant (wish I could).

Another problem is that it's very different for those of us who aren't on insulin compared with those of you that are. I do believe that some sort of carb control is necessary for all of us who are on diet and metformi (I'd be interested in hearing from any diet/metformin T2s that do well on 200g of carb...)

It's much more complex for insulin users who can both adjust their dose to account for more carbs, and need to be careful to avoid hypos. I think that DUK needs to split it's advice accordingly.

 

[phoenix]

Here is some very recent evidence , a review of the studies since 2002. It is not clear at all that there is one diet that suits people with diabetes best.
http://care.diabetesjournals.org/content/35/2/434.full
There are studies for and against different diets and the individual components (fruit, veg , whole grains etc)
Unfortuately many of them are of poor quality. Those that looked at low carb were often " small, of short duration, and in some cases were not randomized or had high dropout rates." This sort of trial is frequently not considered valid by proponents of evidence based medicine.
The reviewers asked the billion dollar question
Question 3: Is there an optimal macronutrient ratio for glycemic management and cardiovascular risk reduction in people with diabetes?

and answered.

Variability in study methodology, including measurement of dietary intake, retention rates, and confounding by weight loss, limits comparisons as to how macronutrient distribution independent of weight loss affects outcomes of interest. Although in many instances there were not statistically significant differences between dietary approaches, improvements were often seen from baseline to follow-up in both intervention groups supporting the idea that several different macronutrient distributions may lead to improvements in glycemic and/or CVD risk factors (Supplementary Table 1)

(my underlining)

For those who haven't the energy to plough through the review here is a plain language summary of it
http://www.diabetesdaily.com/edelman/20 ... -research/

 

[noblehead]

Well it's the ones that want it to be emotive that cause the problems and turn any thread that mentions carb-control into some personal vendetta for or against ultra low-carb diets. I do think that we are all agreed that carbohydrate control is the best way forward. If some people can cope with 200g a day, then that's brilliant (wish I could).

To some extent we are all controlling our carb intake be it on 30g a day or 200g, it doesn't really matter how many carbs someone consumes as long as they are maintaining good bg. The arguments begin when someone dictates that there is only one diet that diabetics should follow and anything else just will not do, if we all respected our dietary choices then such quibbles wouldn't take place.

Another problem is that it's very different for those of us who aren't on insulin compared with those of you that are. I do believe that some sort of carb control is necessary for all of us who are on diet and metformi (I'd be interested in hearing from any diet/metformin T2s that do well on 200g of carb...)

As we know Grazer is diet controlled and does remarkably well on 150-180g a day.... but I would imagine he is the exception to the norm. Yes you cannot compare someone who injects insulin to someone who is diet controlled and this always needs to be taken into considedration, this is why very few type 1's follow a ultra low-carb diet.

It's much more complex for insulin users who can both adjust their dose to account for more carbs, and need to be careful to avoid hypos. I think that DUK needs to split it's advice accordingly.

That is something that DUK needs to address, as I said before I'm a long-term supporter of DUK and will continue to be having had some helpful advice from them over the years, they are not perfect by any means and I sincerely hope in time that they may recognise that carb control is the way forward for type 2 diabetics.

 

[borofergie]

Agree 100% Nigel.

 

[Christinelh]

Hi to bigfatpaulie I come from that town and all my family are still there that is where I was diagnosed and wrongly. I must say it sounds very interesting the low carb diet I was on holiday in November last year on a cruise and joaana hall gave lectures and said it was good to do a meal once a day with no carbs being type 1 it seems I am unable to do this due to the. Insulin but I do try not to eat too many carbs as the more you eat the more insulin you take f

 

[Christinelh]

Hi to bigfatpaulie I come from that town and all my family are still there that is where I was diagnosed and wrongly. I must say it sounds very interesting the low carb diet I was on holiday in November last year on a cruise and joaana hall gave lectures and said it was good to do a meal once a day with no carbs being type 1 it seems I am unable to do this due to the. Insulin but I do try not to eat too many carbs as the more you eat the more insulin you take f

 

[londoner]

Just heard the discussion. The Diab UK dietician was not very persuasive and did not seem to mention that some type 2 diabetics take insulin.

Dr Briffa comments made a lot of sense - we don't all need so many carbohydrates. At last someone seems to understand the relationship between to many carbs and raised blood glucose levels plus weight.

It will be interesting to see if Diab UK eating advice is updated.

 

[Bluenosesol]

Diagnosed nearly 3 years ago with HBA1C 10.3% and over 17 stone. I very quickly determined that low carb was the way to go. I lost 4 stones, came off the metformin and have been on diet and exercise now for 2 1/2 years and HBA1C in the 5's for same period. Only time I have brief hiccups (weight gain and BG temporary gains) is when I increase carb intake. I received my Balance magasine from DUK this week. They have a recipe for Spaghetti with crab and radish. There is a traffic light system to highlight suitability for diabetics, whereby green is good. The carbs are not included as they are obviously deemed to be safe at any level as we all need our starchy carbs. The sugar content is 4.4grams, whilst the carb content is 87.5 grams :shock: :shock: :shock:
What planet are these people on ??- My DUK subscription cancellation is in the post!!

All the Best - Steve