Diabetes UK & reduced carb (2)

IanD · Jan 22, 2014

The original thread started by SamJB degenerated & was becoming an argument. It is too important an issue to abandon - it would be helpful if we can have a constructive thread we can refer to DUK & other prefessionals for their comments.

I'll start by reposting the OP & add other comments from the other thread - most of which got lost without consideration.

SamJB said:
A few months ago I posted a request on this forum for low carb diet research papers in the attempt to persuade Diabetes UK to change its policy on low carb diets. I've presented these papers to a member of the Care Team at DUK. I don't know who, despite several requests for their name, they declined to give it.

The Care Team seem to be made up of a bunch of dieticians, so this was a tall order. In the end I managed to get their statement on low carb diets for Type 1s changed from, succinctly, "there is no published evidence that it works", to "there is no published evidence that it works, but we know some Type 1s use it to control their levels". I couldn't get anywhere with persuading them to change their advice on Type 2s. You can see the full statement here: http://www.diabetes.org.uk/About_us...tion-of-carbohydrate-in-people-with-diabetes/

Unfortunately, I don't think I'm going to get any further with them on this. I work in oncology clinical trials and have spent a decade in scientific research. I'm lucky that in my job, I am surrounded by high-calibre clinicians who will explore every avenue to improve efficacy (how well a treatment plan works). The person on the Care Team that I was dealing with is, regrettably, nowhere near the standards that I am used to. They have clearly deliberately chosen to only include negative references regarding low carb diets in their summary. It is the most bias scientific summary I have ever read. I have been quite candid with them on this, but like requests on the name of the person I was dealing with, I had no response from them on this.

To improve the results of the National Diabetes Audit, where only 7% of Type 1s and 25% of Type 2s achieve the HbA1c target of 6.5%, all efficacious treatment paths must be embraced. Consequently, I don't have any confidence that the Care Team will embrace such methods to improve efficacy.

I subsequently had a meeting with one of the directors of Diabetes UK, who agreed with me that potentially innovative and efficacious treatments must not be dismissed by the Care Team and should be followed up upon. She forwarded the papers I referenced onto the research director at DUK, but I'm yet to hear back.

The worst thing that a clinician, or group like Diabetes UK can do is to ignore patient experience, but that is what they are doing, in my opinion. I expect that we will be looking at the dreadful HbA1c statistics for many years to come.

IanD · Jan 22, 2014

For the purposes of this discussion, let us consider "Low Carb" to be a significant reduction of the consumption of the obvious carbs - potatoes, bread, rice, cereals, etc of all types (including so-called low GI), to below about 150 g per day, or half the amount recommended by DUK.

Where "high fat" is brought into the discussion, let us consider "high fat" to be eating naturally fatty foods in "normal" amounts - cheese, full-cream milk, meat, nuts, salad dressings, etc.

Also, vegetables should be included & moderate amounts of fruit.

Sweets, cakes & other sugary treats will not be included in such a diet.

Please do not argue about the precise definitions - as far as possible, try to keep to discussion of published data - we should attempt to make this an informed thread we can submit to DUK for their informed comments.

fatbird · Jan 22, 2014

"Where "high fat" is brought into the discussion, let us consider "high fat" to be eating naturally fatty foods in "normal" amounts - cheese, full-cream milk, meat, nuts, salad dressings, etc."

A point worth mentioning. Some think a low carb high fat diet involves eating blocks of lard . The high fat description only relates to the quantities of fat as a percentage of calorie daily input. It should be remembered fat has more than twice the calories of carb or protein. Our fat intake is not as high as some believe, especially in actual weight or volume of food consumed.

FB

SamJB · Jan 22, 2014

I think many of the well controlled carb counting Type 1s on here - Noblehead, Hale, ElyDave - are on low amounts of carbs (around the 150g mark) by your definition. That speaks volumes to me.

hale710 · Jan 22, 2014

I don't consider myself to low carb because I have not reduced my carb intake since becoming T1

However, as Sam said, I do average 120-150g per day. This is drastically less than many "normal" people, who would consider my diet low carb. This amount of carb means I take less insulin than many which results in less severe hypos than others may experience

I have also maintained the same level of far as before. I don't consider it to be high fat, but maybe it is. I don't directly monitor my fat intake.

I have little issue with my diabetes. Sure it needs tweaking, but it is essentially "fine". If my hbA1c rose and I struggled I would definitely try reducing my carbs somewhat to try and improve control. But until that day I'll continue as I am

Blogging at drivendiabetic.wordpress.com

pat-in-durham · Jan 22, 2014

As a thin T2 I have followed this &other previous thread with great interest. It is astonishing how uneasy DNs and clinic staff are around those of us that test our BGs and take control of our own condition. They have not been actually hostile but call me too obsessive. Having been a health professional and being married to a GP they do not intimidate me. I am being urged to eat more carbs!!!! My. BMI is too low admittedly, but I am very slowly gaining a little weight while trying to remain in control of by BGs, This forum has been a great support and I would welcome and work with anyone who is working to modify the recommended diet, Pat

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IanD · Jan 22, 2014

The confused situation with regard to (low) carb is clearly expressed in this presentation:

It does include papers I have cited, by Daly & Nielsen:

Daly, M. E., Paisey, R., Paisey, R., Millward, B. A., Eccles, C., Williams, K.,
Hammersley, S., MacLeod, K. M. and
Gale, T. J. (2006). Short term effects of severe dietary carbohydrate restriction advice in Type 2 diabetes
-- a randomized controlled trial.
Diabetic Medicine 23(1): 15 -20

Nielsen, J. V. and Joensson, E. A. (2008). Low carbohydrate diet in type 2 diabetes: stable improvement of
bodyweight and glycemic control during 44 months follow up.
Nutr Metab (Lond) 5: 14.

A particular point made by Nielsen was:

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 17-19] 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].

Summary: A reduced carbohydrate diet is effective in motivated patients and can be recommended for overweight patients with type 2 diabetes. There has been no sign of a negative cardiovascular effect.

Carbohydrate Advice inType 2 Diabetes: The ‘Hot Potato’ of Dietetics?

xyzzy · Jan 22, 2014

I suppose my fundamental point on this is the observation that while other countries (notably the Swedes and the Americans) are both now positively advocating reduction in total carbohydrate for T2 diabetics DUK does not. I'm sure both the Swedish government and the ADA used evidence based research so why does the UK continue to lag by not advocating that diabetes control is best practised by an individualised approach to treatment that includes a recognition that controlling or even reducing the total amount of carbohydrates consumed to below those levels advocated to the general population is advisable.

That one size fits all approach certainly contrasts with the latest ADA advice:

GI or Carbohydrate Counting?
There is no one diet or meal plan that works for everyone with diabetes. The important thing is to follow a meal plan that is tailored to personal preferences and lifestyle and helps achieve goals for blood glucose, cholesterol and triglycerides levels, blood pressure, and weight management.

Research shows that both the amount and the type of carbohydrate in food affect blood glucose levels. Studies also show that the total amount of carbohydrate in food, in general, is a stronger predictor of blood glucose response than the GI.

Based on the research, for most people with diabetes, the first tool for managing blood glucose is some type of carbohydrate counting.

Because the type of carbohydrate can affect blood glucose, using the GI may be helpful in "fine-tuning" blood glucose management. In other words, combined with carbohydrate counting, it may provide an additional benefit for achieving blood glucose goals for individuals who can and want to put extra effort into monitoring their food choices

- See more at: http://www.diabetes.org/food-and-fi...-index-and-diabetes.html#sthash.cVOlcBEy.dpuf

also taken from the ADA's 2014 position statement http://care.diabetesjournals.org/content/37/Supplement_1/S14.full.pdf+html

A variety of eating patterns have been shown to be effective in managing diabetes, including Mediterranean-style (144,146,169), Dietary Approaches to Stop Hypertension (DASH)-style (161), plant-based (vegan or vegetarian) (129), lower-fat (145), and lower-carbohydrate patterns (144,163).

The ADA now advocates total carbohydrate restriction through its policy that no more than 45 - 60g of carbs should be consumed in anyone meal. That is far less than the 33% starchy carbohydrate / 50% total carbohydrate regime advocated in the UK!

Thommothebear · Jan 22, 2014

pat-in-durham said:
As a thin T2 I have followed this &other previous thread with great interest. It is astonishing how uneasy DNs and clinic staff are around those of us that test our BGs and take control of our own condition. They have not been actually hostile but call me too obsessive. Having been a health professional and being married to a GP they do not intimidate me. I am being urged to eat more carbs!!!! My. BMI is too low admittedly, but I am very slowly gaining a little weight while trying to remain in control of by BGs, This forum has been a great support and I would welcome and work with anyone who is working to modify the recommended diet, Pat

Sent from the Diabetes Forum App

Actually I had my annual review yesterday and my DN, who is very clued up on diabetes and actually knows what she is talking about was very supportive of my low carb diet. We talked it through and sees no problem with it as a long term solution, especially as in my case it is very obviously working well.

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Thommothebear · Jan 22, 2014

For reference the ratios of carb/protein/fats in my diet have averaged 18/32/50% actual compared to the 20/35/45% targets I set myself initially. That may not be as low carb as many here would aim for.

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Johnroy · Jan 22, 2014

pat-in-durham said:
As a thin T2 I have followed this &other previous thread with great interest. It is astonishing how uneasy DNs and clinic staff are around those of us that test our BGs and take control of our own condition. They have not been actually hostile but call me too obsessive. Having been a health professional and being married to a GP they do not intimidate me. I am being urged to eat more carbs!!!! My. BMI is too low admittedly, but I am very slowly gaining a little weight while trying to remain in control of by BGs, This forum has been a great support and I would welcome and work with anyone who is working to modify the recommended diet, Pat

Sent from the Diabetes Forum App

Hi,
Like you I follow with interest as I also am type 2 and need to put some weight on. What have you been eating to help?
Thanks

ceejayblue · Jan 22, 2014

On the weightloss group I'm on the low carbers say you should only be having 20g of carbs a day! They are quite forceful in their promotion of this and make some people feel really bad if they don't achieve it. This to me is far too low for most people and someone on a recent Xpert course I was on who had been doing this had developed gout! I have gallstones and a hiatus hernia and must eat low fat so that I don't cause problems, now I'm intelligent enough to understand that if I eat too much of anything it has the potential to make me ill. Some people are not quite so canny and easily led and think that going low carb means eating more protein and high fat foods. Unfortunately, some of the evangelical very low carbers I know have confused and frightened some people who don't understand the essentials of a balanced diet in the first place and find it hard to believe that there is any other way.

My diabetic nurse is excellent and has given me great advice, including to lower my carb intake to 195g and to have 1500 cals a day. I have taken it on myself (and she's agreed) to aim for 50g per meal and this seems to be working for me. Any diet needs to suit the person and their medical history but if we all started from the stand point of everything in moderation, instead of people thinking that if they don't achieve the really low carb amounts that they will end up suffering from all the diabetic complications there are, then I'm sure it would be easier for people to get control. Just like not all Type 2's are overweight, even well controlled diabetics can end up with some complications as they get older.

fatbird · Jan 22, 2014

ceejayblue said

"On the weightloss group I'm on the low carbers say you should only be having 20g of carbs a day! They are quite forceful in their promotion of this and make some people feel really bad if they don't achieve it."

Please could you link to a post on this forum where 20 grams per day, has been forcefully promoted. Thank you. I am a low carb controlled diabetic and have never got close to 20 grams of carb per day.

Can we stick to facts on this thread rather than fiction. Even the low carb guru Dr Richard Bernstein does not go as low as 20 grams per day.

FB

Engineer88 · Jan 22, 2014

I'm a t1 of 23 years with (comparatively) poor control even though I've never been on more that 200g of carbs max a day.

I find that if I eat less that 80g of carbs I can control bg very easily. It's different for everyone *shrug*

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mo1905 · Jan 22, 2014

20g a day is not sustainable in my opinion. Extreme diets of any kind are very difficult and restrictive to live with. You need to find a balance and that will be very different for lots of people.

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Thommothebear · Jan 22, 2014

The 20 g per day is the amount promoted by the Atkins diet for the two week induction phase only. i did do this but I would find it incredibly difficult to do so for more than that inital two weeks, and the Atkins diet does not suggest this be continued.

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paul-1976 · Jan 22, 2014

ceejayblue said:
On the weightloss group I'm on the low carbers say you should only be having 20g of carbs a day! They are quite forceful in their promotion of this and make some people feel really bad if they don't achieve it. This to me is far too low for most people and someone on a recent Xpert course I was on who had been doing this had developed gout! I have gallstones and a hiatus hernia and must eat low fat so that I don't cause problems, now I'm intelligent enough to understand that if I eat too much of anything it has the potential to make me ill. Some people are not quite so canny and easily led and think that going low carb means eating more protein and high fat foods. Unfortunately, some of the evangelical very low carbers I know have confused and frightened some people who don't understand the essentials of a balanced diet in the first place and find it hard to believe that there is any other way.

My diabetic nurse is excellent and has given me great advice, including to lower my carb intake to 195g and to have 1500 cals a day. I have taken it on myself (and she's agreed) to aim for 50g per meal and this seems to be working for me. Any diet needs to suit the person and their medical history but if we all started from the stand point of everything in moderation, instead of people thinking that if they don't achieve the really low carb amounts that they will end up suffering from all the diabetic complications there are, then I'm sure it would be easier for people to get control. Just like not all Type 2's are overweight, even well controlled diabetics can end up with some complications as they get older.

Never heard of 20 grams a day being forced anywhere TBH-I eat 30 grams a day out of choice but I know many who eat double that with good control.

paul-1976 · Jan 22, 2014

Thommothebear said:
The 20 g per day is the amount promoted by the Atkins diet for the two week induction phase only. i did do this but I would find it incredibly difficult to do so for more than that inital two weeks, and the Atkins diet does not suggest this be continued.

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Ah-Could be that's what Ceejayblue meant but as you say it's an induction phase for 2 weeks only...not that I believe 20 grams a day is dangerous-just a bit limiting.

Thommothebear · Jan 22, 2014

paul-1976 said:
Ah-Could be that's what Ceejayblue meant but as you say it's an induction phase for 2 weeks only...not that I believe 20 grams a day is dangerous-just a bit limiting.

Exactly, there are a large number of people around who read the first part of Atkins and don't bother with the rest.

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fatbird · Jan 22, 2014

This thread is not about what people think of a low carb diet. It is about why the largest diabetes charity in the UK, does not recommend as an alternative, for the safe control of diabetes, a low carb diet. I have stated my thoughts and opinion on the other thread.

DUK do not recommend a low carb diet because it would cost their sponsors i.e. big pharma a huge amount of money. If DUK recommended a low carb diet they would lose many of their sponsors. DUK stick to established guidelines because it is safe and keeps away any chance of litigation. Their dietary advice is decades out of date and is contrary to so many of the members of this forums experience. The DUK dietary advice is wrong, dangerous, and scientifically illiterate.”

FB

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