Consultation : ‘Lower carbohydrate diets for adults with type 2 diabetes’

britishpub · Mar 5, 2020

The Scientific Advisory Committee on Nutrition (SACN) consultation on its draft report, Lower carbohydrate diets for adults with type 2 diabetes, is open for scientific comment. You are invited to submit comments relating to the scientific content of the draft report. You are also invited to draw the Committee’s attention to any evidence that it may have missed.

https://www.gov.uk/government/consu...ign=govuk-notifications&utm_content=immediate

Indy51 · Mar 5, 2020

I'm hoping the UK Type 2 LCHFers will inundate them with "n=1" anecdotes. We tried hard with the West Australian Parliamentary Committee, not that it got us too far, but hopefully it will pay off eventually. Go for it!

Brunneria · Mar 5, 2020

They won't take the slightest bit of notice of any n=1 results.
I suspect that any such contributions will be immediately discarded.
All they are interested in is feedback on their analysis of the very carefully selected studies.

I haven't read the full doc, just skipped to p74 and onwards.
Interesting outcome. Looks like the general conclusion is basically 'we looked really really really hard for something to prove LC is harmful, and we can't find it, but we are still going to mutter cautionary speculation about long term dangers'.

Here are the last two paragraphs

In general, no adverse events were reported with lower carbohydrate diets, but study duration did not extend beyond 12 months in the majority of primary RCTs. The effect of lower carbohydrate diets over several years in adults with T2D are unknown.

Several gaps were identified in the evidence base. No trials provided information about the type of carbohydrate consumed (for example, those with differing free sugar or fibre content, wholegrains compared to refined starch) or considered how this could affect the outcomes of interest. In addition, few trials assessed longer-term effects (beyond 12 months) of lower carbohydrate diets, and none considered hard endpoints such as diabetes complications, CVD events or mortality.

bulkbiker · Mar 5, 2020

Brunneria said:
They won't take the slightest bit of notice of any n=1 results.
I suspect that any such contributions will be immediately discarded.
All they are interested in is feedback on their analysis of the very carefully selected studies.

I haven't read the full doc, just skipped to p74 and onwards.
Interesting outcome. Looks like the general conclusion is basically 'we looked really really really hard for something to prove LC is harmful, and we can't find it, but we are still going to mutter cautionary speculation about long term dangers'.

Here are the last two paragraphs

In general, no adverse events were reported with lower carbohydrate diets, but study duration did not extend beyond 12 months in the majority of primary RCTs. The effect of lower carbohydrate diets over several years in adults with T2D are unknown.

Several gaps were identified in the evidence base. No trials provided information about the type of carbohydrate consumed (for example, those with differing free sugar or fibre content, wholegrains compared to refined starch) or considered how this could affect the outcomes of interest. In addition, few trials assessed longer-term effects (beyond 12 months) of lower carbohydrate diets, and none considered hard endpoints such as diabetes complications, CVD events or mortality.

Looking at the make up of the working group it doesn't surprise me tho.. worse luck..

Deleted member 475901 · Mar 5, 2020

I have written a fairly strongly worded response about their decision to ignore the published multiple case study analyses. They cherry-picked Dr Unwin's work.
In challenging the study criteria I included the fact that I am a retired Senior Statistician.
Not sure it will carry much more weight than the n=1 responses with that team, but may influence other people who read the published responses.

Member496333 · Mar 5, 2020

Brunneria said:
In general, no adverse events were reported with lower carbohydrate diets, but study duration did not extend beyond 12 months in the majority of primary RCTs. The effect of lower carbohydrate diets over several years in adults with T2D are unknown.

Several gaps were identified in the evidence base. No trials provided information about the type of carbohydrate consumed (for example, those with differing free sugar or fibre content, wholegrains compared to refined starch) or considered how this could affect the outcomes of interest. In addition, few trials assessed longer-term effects (beyond 12 months) of lower carbohydrate diets, and none considered hard endpoints such as diabetes complications, CVD events or mortality.

And meanwhile;

"We have never had any evidence whatsoever that low fat, healthy whole grain diets are safe for humans, yet we continue to espouse this approach even after fifty years of misery and death."

Ricky · Mar 5, 2020

At last- now how do I let them know that I have been on a low carb diet for about 17 years with no ill effects (and no meds - just!!)

HSSS · Mar 5, 2020

Page 77

“Limitations in the evidence base

There were several limitations in the quality of the evidence base.

One of the most important limitations was the lack of an agreed definition for a low carbohydrate diet......

Estimated mean achieved carbohydrate intakes in the lower carbohydrate groups ranged between 13 to 47% TE and, in most studies, were above the definition of a low carbohydrate diet according to categories of carbohydrate intake (>10 to <26% TE or >50 to <130 g/day).
Out of 27 RCTs that reported achieved mean intakes of carbohydrates, the highest number of comparisons (14 RCTs) were between moderate versus high carbohydrate intakes; only 3 RCTs compared low versus high carbohydrate intakes.”

So having discarded studies that used actual low carb diets they admit they are basing this report on studies that aren’t actually low carb.

Divia · Mar 8, 2020

Sorry for the stupid question, but what is n=1?

Is it short for an experiment with only one subject?

Thank you!

DCUKMod · Mar 8, 2020

Divia said:
Sorry for the stupid question, but what is n=1?

Is it short for an experiment with only one subject?

Thank you!

Divia - One here, people often use this to describe how they themselves have fared doing, x, y or z. Relating to research, the "n" tells us us the sample size involved. So n-1 means a sample of one, so you're pretty spot on.

Shakkers · Mar 8, 2020

There is plenty of evidence in support of the benefits of a low carb high fat diet for T2 diabetics. This forum is a gold mine of evidence along with every bit of data that Dr David Unwin has at his disposal. It may not be in classic form but it is evidence all the same. Every T2 on this forum that has had success with lchf has been a guinea pig. That data just needs bringing together and published. In this country we are pretty strict when it comes to clinical studies and that is playing into the hands of the powers that be right now but in some other countries the requirements are not so stringent.

Diabetes.co.uk have the means to conduct a study based on the data of the members of this forum and have the capacity to then draw reasonable conclusions on the data before them. Publish that data and at the very least it would pave the way for a more stringent study in this country and possibly even be enough to convince the authorities in other countries across the globe.

The very first claims that the world was round were anecdotal. No scientific study was conducted. Anecdotal evidence under the right conditions is good enough.

Diabetes.co.uk, do not hide your light under a bushel and get cracking with what needs to be done.

Shakkers · Mar 8, 2020

HSSS said:
Page 77

“Limitations in the evidence base

There were several limitations in the quality of the evidence base.

One of the most important limitations was the lack of an agreed definition for a low carbohydrate diet......

Estimated mean achieved carbohydrate intakes in the lower carbohydrate groups ranged between 13 to 47% TE and, in most studies, were above the definition of a low carbohydrate diet according to categories of carbohydrate intake (>10 to <26% TE or >50 to <130 g/day).
Out of 27 RCTs that reported achieved mean intakes of carbohydrates, the highest number of comparisons (14 RCTs) were between moderate versus high carbohydrate intakes; only 3 RCTs compared low versus high carbohydrate intakes.”

So having discarded studies that used actual low carb diets they admit they are basing this report on studies that aren’t actually low carb.

Lack of agreed definition. You can say that again. We don’t help ourselves when we squabble over that definition either. Or how to manage it best.

Brunneria · Mar 8, 2020

Shakkers said:
There is plenty of evidence in support of the benefits of a low carb high fat diet for T2 diabetics. This forum is a gold mine of evidence along with every bit of data that Dr David Unwin has at his disposal. It may not be in classic form but it is evidence all the same. Every T2 on this forum that has had success with lchf has been a guinea pig. That data just needs bringing together and published. In this country we are pretty strict when it comes to clinical studies and that is playing into the hands of the powers that be right now but in some other countries the requirements are not so stringent.

Diabetes.co.uk have the means to conduct a study based on the data of the members of this forum and have the capacity to then draw reasonable conclusions on the data before them. Publish that data and at the very least it would pave the way for a more stringent study in this country and possibly even be enough to convince the authorities in other countries across the globe.

The very first claims that the world was round were anecdotal. No scientific study was conducted. Anecdotal evidence under the right conditions is good enough.

Diabetes.co.uk, do not hide your light under a bushel and get cracking with what needs to be done.

Hi and welcome @Shakkers

You may want to look into the diabetes.co.uk Low Carb Program.
The stats, success stories, are widely available, including you tube videos of conference presentations and other reports. Diabetes.co.uk ‘s LCP has been so successful, and offers sufficient evidence, that it is now available on the NHS and is receiving international acclaim.

Shakkers · Mar 8, 2020

Brunneria said:
Hi and welcome @Shakkers

You may want to look into the diabetes.co.uk Low Carb Program.
The stats, success stories, are widely available, including you tube videos of conference presentations and other reports. Diabetes.co.uk ‘s LCP has been so successful, and offers sufficient evidence, that it is now available on the NHS and is receiving international acclaim.

If it is so successful then why isn’t it being prescribed or recommended at every surgery across the country?

Brunneria · Mar 8, 2020

Shakkers said:
If it is so successful then why isn’t it being prescribed or recommended at every surgery across the country?

You would have to ask each individual doctor that question, since they are the ones choosing what information to hand out to their patients.

Member496333 · Mar 8, 2020

Shakkers said:
In this country we are pretty strict when it comes to clinical studies..

Except when it comes to drawing up calamitous nutritional guidelines, where a tenuous hypothesis will suffice

Shakkers · Mar 8, 2020

Brunneria said:
You would have to ask each individual doctor that question, since they are the ones choosing what information to hand out to their patients.

So you would have to agree that it isn’t successful (for whatever reason), except maybe in occasional instances.

Brunneria · Mar 8, 2020

Shakkers said:
So you would have to agree that it isn’t successful (for whatever reason), except maybe in occasional instances.

You should educate yourself on the LCP before commenting further. It would help you to avoid forming mistaken impressions.

Shakkers · Mar 8, 2020

Brunneria said:
You should educate yourself on the LCP before commenting further. It would help you to avoid forming mistaken impressions.

It seems very few surgeries effectively offer it. It is of little use therefore except to the lucky few. How many surgeries across the land offer it as an alternative to a progressive outcome or as an alternative to medication? Do you know? Fantastic solution yes. But in many cases it doesn’t get as far as the people who need it.

bulkbiker · Mar 8, 2020

Shakkers said:
It seems very few surgeries effectively offer it. It is of little use therefore except to the lucky few. How many surgeries across the land offer it as an alternative to a progressive outcome or as an alternative to medication? Do you know? Fantastic solution yes. But in many cases it doesn’t get as far as the people who need it.

Possibly true but I'm afraid that is the way the NHS is run. GP surgeries are for the most part independent institutions who are supposed to follow "guidelines" but with no penalties for not doing so. They have autonomy.

This leads to the postcode lottery of some GP's being well educated and up to date and others being antediluvian in their outlook and the poor patients left floundering between the two. So much for "our" NHS.

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