Dietary And Nutritional Approaches For Prevention And Management Of Type 2 Diabetes

[DCUKMod]

This was published in this week's BMJ.

https://www.bmj.com/content/361/bmj.k2234

 

[bulkbiker]

Quite a depressing read.. still going on about sat fat and CVD... still mealy mouthed about low carb..

 

[DCUKMod]

Quite a depressing read.. still going on about sat fat and CVD... still mealy mouthed about low carb..

Having heard the lead author speak a few months ago, I wasn't too surprised by the stance.

 

[Rachox]

This was published in this week's BMJ.

https://www.bmj.com/content/361/bmj.k2234

Where’s the dislike button when you need it?!

 

[DCUKMod]

Where’s the dislike button when you need it?!

The article isn't saying anywhere that carbs are essential, or any of the morre extreme statements we have all read in the past. There is also a recognition in the article that medics don't know too much about nutrition, and maybe struggle forr time to explain what they do understand.

There's also talk, recognising remission. That was unheard of reltively recently.

The positives I took from it were the admissions that "they" know they don't know a lot. Perhaps the dogma is softening.

Turning a cruise ship doesn't happen on its own footprint.

 

[Mr_Pot]

Conclusion
Despite the challenges of nutritional research, considerable progress has been made in formulating evidence based dietary guidance and some common principles can be agreed that should be helpful to clinicians, patients, and the public.

Despite reading it twice I am still not sure what the progress was or what the agreed common principle are?

 

[Rachox]

The article isn't saying anywhere that carrbs are essential, or any of the morre extreme statements we have all read in the past. There is also a recognition in the article that medics don't know too much about nutrition, and maybe struggle forr time to explain what they do understand.

There's also talk, recognising remission. That was unheard of reltively recently.

The positives I took from it were the admissions that "they" know they don't know a lot. Perhaps the dogma is softening.

Turning a cruise ship doesn't happen on its own footprint.

Oh I agree there is progress, maybe I’m being impatient, it just seems so clear to me that low carb is the way to go!

 

[bulkbiker]

Some better news here

http://www.pulsetoday.co.uk/clinica...atients/20037092.article#.W04E5_N4CJw.twitter

 

[dawnmc]

Don't know why the online course is aimed at doctors, I've never seen one in 6 yrs about my diabetes.

 

[DCUKMod]

Don't know why the online course is aimed at doctors, I've never seen one in 6 yrs about my diabetes.

I've only seen a nurse twice. Once, litererally at diagnosis, and the other a few months later, when I requested it (long story, I'll spare you), but since then, I have only ever had diabetes related conversations with GPs.

To be honest, dawnmc, many of the diabetes nurses folks see are practise nurses who are lumbered with dealing with T2s, just as they are probably lumbered with the asthma, COPD and whatever else clinics. I feel positive much of the messaging they deliver comes from their management line - the GPs, so GPs do need to know, as a first priority, in my view.

 

[Oldvatr]

Useful reference library. Thank you for posting. I liked the snide remarks at the beginning that there may have been conflicts of interest when deciding on current treatment practices based on so called evidenced studies.

I am not surprised they are siting on the fence over low cal/high cal vs low carb/high carb and low fat/high fat.

I was surprised when they started a section with expressing 'concerns', but when reading what followed they were not as anti as I would have expected. So there was a pro new age bias creeping in , even if you feel that they were toting the old mantras. they were not, and they have at least tried to understand the latest research with some success. They DO raise some areas where there are concerns over the long term implications of some of the new diets, and are correct to identify that further quality research is needed. This is needed considering their target audiences, since this article is not purely for benefit of T2D, but needs to inform the HCP's and those that fund them. We are priviledged to be able to read this Open Access posting and bring our knowledge and first hand experience to bear. We are also guilty of the same token of bringing our own agendas to the table, and if you do not find agreement with any of it, then I am sorry. I thought it was better than I expected and in line with the current trend as opposed to supporting Eatwell as the way forward like NICE and ADA and BHF etc do. After all, SACN are the authors and champions of Eatwell, and they are declared in the conflict of interests as having input to this report - that is encouraging IMHO

 

[Lampman]

I've only seen a nurse twice. Once, litererally at diagnosis, and the other a few months later, when I requested it (long story, I'll spare you), but since then, I have only ever had diabetes related conversations with GPs.

To be honest, dawnmc, many of the diabetes nurses folks see are practise nurses who are lumbered with dealing with T2s, just as they are probably lumbered with the asthma, COPD and whatever else clinics. I feel positive much of the messaging they deliver comes from their management line - the GPs, so GPs do need to know, as a first priority, in my view.

I have seen a nurse, once. She gave me my flu shot last year. She asked why I was there, and I told her it was because I was diabetic. She seemed quite surprised she had not seen me before, as she was the diabetic nurse. The doctor I see regularly is the practise diabetic specialist, and she is very keen to ask me what I have been doing to improve my situation and she even takes notes! On our first meeting, I told her what I proposed to do with changing my diet to a low carb one, and making my own food from basic ingredients so I could control it directly. She then gave me the URL of this site, not "the other one." I take from that the thought that we need to encourage GP's to be interested, just as much as they need to encourage us. It must be a soul destroying experience for them to dispense good advice only to see it ignored, as much as it is for us to meet a rushed and disillusioned doctor. Nurses must be equally likely to be struggling with what can often be a complex set of problems. All of this with unsympathetic time and cost constraints. Isn't life fun?

 

[HSSS]

I’m actually quite pleased. Whilst it doesn’t do what some here seem to want (ie advocate unequivocally low carb/keto) it does clearly question the historical inconsistent advice against newer evidence based outcomes (frequently identified as low carb).

It says whilst it can’t be advocated right now there is sufficient anecdotal and small scale studies (time,quantity) to warrant better larger longer studies and a consensus of definitions. I for one read that as they (medical guideline formulators) realise there’s a lot to low carb but as it’s not sufficiently evidenced yet they are edging towards it cautiously and seeking that evidence and best practice guidelines. So progress. It’s never going to happen overnight.

Also the main issues with low carb seem to be based around compliance and long term achieability. I suspect many on this forum by the very nature of seeking information here are well motivated and thus succeed. Those with less information or motivation could well squew the success figures downwards compared to us here thus cause the hesitation in the officials.

 

[Guzzler]

I know this is wrong but I started reading the piece and within minutes all my brain was getting was blah, blah, blah. If the piece was alluding to the recent Swiss Re Conference then it seemed to me that there was little consensus and quite a bit of bias with regard to upsetting the status quo. And as to proof of sustainability and long term studies into particular diets then where are said studies into Eatwell or CICO or Low Fat Diets?

On my darkest days (today is looking like it may be one) I sometimes think that these people would rather hold onto to their dogma at the cost of n=1s quality of life rather than admit that their guidelines simply do not bear scrutiny thus putting their reputations (and careers?) In jeopardy. But I am in a low, glass half empty mood.

 

[HSSS]

I know this is wrong but I started reading the piece and within minutes all my brain was getting was blah, blah, blah. If the piece was alluding to the recent Swiss Re Conference then it seemed to me that there was little consensus and quite a bit of bias with regard to upsetting the status quo. And as to proof of sustainability and long term studies into particular diets then where are said studies into Eatwell or CICO or Low Fat Diets?

On my darkest days (today is looking like it may be one) I sometimes think that these people would rather hold onto to their dogma at the cost of n=1s quality of life rather than admit that their guidelines simply do not bear scrutiny thus putting their reputations (and careers?) In jeopardy. But I am in a low, glass half empty mood.

I guess it is half glass syndrome here and mine today appears half full. I read it was admitting to a limited degree of consensus because of the lack of evidence (low carb and eatwell and low fat etc etc). And seeking to go get the evidence it lacks. Though a fair amount of the consensus did include the fact the low carb has had positive results, without trashing the current guidelines I know. The establishment will always be slow to change the status quo, but at least they are questioning it rather than complete denial. Slowly.

 

[Guzzler]

I guess it is half glass syndrome here and mine today appears half full. I read it was admitting to a limited degree of consensus because of the lack of evidence (low carb and eatwell and low fat etc etc). And seeking to go get the evidence it lacks. Though a fair amount of the consensus did include the fact the low carb has had positive results, without trashing the current guidelines I know. The establishment will always be slow to change the status quo, but at least they are questioning it rather than complete denial. Slowly.

It is their seemingly complete removal from the plight of millions of sufferers that gets me. They are so wrapped up in their numbers that they could be accused of forgetting that each and every number is a living breathing, person. And still on the question of numbers, John Ionnides presentation at Swiss Re although jaw droppingly enlightening left me with a feeling of sheer loss in that if I can't trust the data and I feel ignored by the boffins analysing and writing guidelines based on that data where then do I turn for truth and advice?

I feel like giving it all up as a bad job.

 

[kokhongw]

Also the main issues with low carb seem to be based around compliance and long term achieability. I suspect many on this forum by the very nature of seeking information here are well motivated and thus succeed. Those with less information or motivation could well squew the success figures downwards compared to us here thus cause the hesitation in the officials.

It is simply too convenient to blame the victim for non-compliance...

 

[DCUKMod]

I know this is wrong but I started reading the piece and within minutes all my brain was getting was blah, blah, blah. If the piece was alluding to the recent Swiss Re Conference then it seemed to me that there was little consensus and quite a bit of bias with regard to upsetting the status quo. And as to proof of sustainability and long term studies into particular diets then where are said studies into Eatwell or CICO or Low Fat Diets?

On my darkest days (today is looking like it may be one) I sometimes think that these people would rather hold onto to their dogma at the cost of n=1s quality of life rather than admit that their guidelines simply do not bear scrutiny thus putting their reputations (and careers?) In jeopardy. But I am in a low, glass half empty mood.

Bearing in mind the process to put such a paper together, then the Peer review process etc., the Swiss Re conference was way, way to recent too have impacted on this piece in any way.

 

[Guzzler]

Bearing in mind the process to put such a paper together, then the Peer review process etc., the Swiss Re conference was way, way to recent to have impacted on this piece in any way.

Jumping the gun, sorry. One of the authors spoke at the SR conference and I did the old 2+2=5 trick.

 

[HSSS]

It is simply too convenient to blame the victim for non-compliance...

I’m doing no such thing.

Lack of education or information, an historical faith in drs just because they are doctors, a non questioning view of current advice, a fatalist outlook, poverty, lack of support, other lifestyle and medical issues all affect non compliance and motivation. It’s the reality of life.

And trying to deflect by saying I’m victim blaming is frankly either over sensitive or defensive. Those who genuinely can’t be bothered are a minority of unsuccessful people imo.