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DUK's new position statement on Low carbing.

Discussion in 'Diabetes Discussions' started by sugarless sue, Apr 14, 2011.

  1. catherinecherub

    catherinecherub · Guest

  2. sugarless sue

    sugarless sue · Master

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    It should be noted that the protocol link is for HCP's only.
     
  3. IanD

    IanD Type 2 · Well-Known Member

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    I did note, but the link is bad anyway. I've asked Ally if she has seen it.
     
  4. cugila

    cugila · Master

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  5. ally5555

    ally5555 · Well-Known Member

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    Hi Ian

    I had not seen that link but I have requested a copy of the results so will let you know!

    I have in the past spoken to a member of the team and what I was told was:-
    1) The low carb group were asked to consume 70g CHO and completed food diaries that were analysed.
    2) the control group were on a calorie deficit intake.
    3) Overall there was not a significant difference in any results - HBA1c , weight, cholesterol etc.
    4) The low carbers lost weight faster at first - that is not suprising as other studies have shown that low carb = lower calorie intake.
    5) Sustaining the low carb intake was a problem for some - I do not know how many.

    I do think that there is not a consensus on what is low carb - the problem is that it would vary according to indiviual energy requirements - something that Bernstein , Atkins etc do not seem to grasp at all.

    Anecdotal evidence will never be accepted - it cannot be validated.

    The difference here is that if there are any nutritional deficiencies in the low carb group that would be addressed as qualified dietitians are involved.

    I will let you know what I find out.

    Ally
     
  6. viviennem

    viviennem Type 2 · Well-Known Member

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    Being an experienced calorie-controlled dieter, and having been brainwashed by the 'low fat' brigade for years, I checked my calorie intake for a month when I first did Atkins.

    Over that period my calorie intake was never lower than 1500 per day, and never over 2000. Usually about 1800, I would say, which is more than any other type of diet advised I should be eating.

    I still have all that info, plus weight loss and BP charts, on another PC, but unfortunately in WordPerfect which my current PC won't support. However, I shall be rigging it up to get hold of that fairly shortly, so it will be available.

    I have never felt more energised in my life than on that diet, and was walking the Wolfhound at least 25 miles per week without any fatigue, hunger or cravings at all.

    Back on it now, it's working more slowly, but it is working. I'm having trouble with increasing my exercise because of mobility problems (which are getting worse as I lose weight, not better) but I shall persevere with that.

    Now I KNOW that this is all anecdotal and has no value as evidence at all. But it's what happened to me. Maybe someone could organise a trial after talking to experienced long-term low-carbers - or even do a trial WITH experienced long-term low-carbers, to see how healthy they (me too, soon) are.

    As far as describing my diet to known hostile HCPs, and all unknowns - I use the term 'controlled carbohydrate' which usually slips past unchallenged! If there are further questions, they get it like it is.

    I'm seeing our PCT dietitian for the first time next Tuesday - should be fun! :twisted: I'll keep you posted.

    Viv 8)
     
  7. ally5555

    ally5555 · Well-Known Member

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    Hi Viv

    Your calorie intake on atkins or similar is higher than I find in practice. I also analysed quite a number of the low carbers diets on here about a year ago and tbh the results were very similar. In fact it highlighted the reservations I have - there were alot who had quite deficient intakes of vits and minerals. In fact alot of the low carbers had low fat intakes - that did not suprise me as fat is more difficult to add in !

    If you want to low carb that is fine by me but I always emphasise that you need to be sure your diet is not lacking in essential nutrients.

    The BBC diet trials published in the BMJ also found the atkins type dieters were consuming less than 1000 calories a day.

    My own approach in practice is to use moderate carbs - around 40 %.
    I get good results - I am auditing at the moment and I have pts with HBA1 c in the 5s and 6s but no real problems with sustainability - except for those who will not follow anything!

    Allyx
     
  8. viviennem

    viviennem Type 2 · Well-Known Member

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    Hi Allyx

    What a lot of people miss with Atkins is that, on the induction phase, you must eat 14 ounces of the allowed vegetables every day with your protein and fat. He also insists on exercise if you can physically do it.

    He's a very bad writer and I think people have trouble searching through to find the core advice within all the "case studies". It's all too easy for people who aren't nutritionally aware (and I mean 'O' level biology level aware, not trained) to think - oh, meat and cheese - and forget the veg - and they are probably used to restricting food intake so do that too.

    From my own experience (anecdotal again, of course! :wink: ) it's possible to eat very little and not lose any weight at all! This from my student days, when a friend and I ate only one cup of soup per day for two weeks. I lost 2lbs! Fortunately we saw sense, and survived!

    Though how anyone can follow Atkins and come in under 1000 calories beats me - they are not "doing" Atkins properly if that's the case!

    I do agree with you that fat can be difficult to add in - how do you eat butter if you're not doing toast, potatoes and pasta? Some people cannot force themselves to eat fatty meat (the brainwashing again - I found it difficult at first, and still don't like beef fat) and some people physically cannot tolerate what I would call 'normal' levels of fats (such as our beloved leader Cugila!)

    Just out of interest, have you looked at my basic Atkins-derived diet, on the Low-carb Forum under the thread 'Viv's Diet'? Or I could PM it to you. It's only a couple of sheets of A4. You have much better things to do with your time, but I'd value your opinion!

    We need you properly-qualified people to help and advise us!

    Viv 8)
     
  9. ally5555

    ally5555 · Well-Known Member

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    hi viv

    I have looked at it of course and not really had time to analyse it. I have had no time over recent weeks to do anything - have been on Jury service for a while!

    If I get a mo I will - be a few weeks or so .

    I am not against people low carbing if they want to but it has it drawbacks and I have helped people correct them. However in practice my pts have as good results with a mod amount of carbs, It is documented on here that I have had words with DMUK about their stance on carbs and their meal plans!

    Allyx
     
  10. viviennem

    viviennem Type 2 · Well-Known Member

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    I think the main thing, really, is information and education. If only we could persuade everyone to take the time to inform themselves about what they are doing (eating or dieting or lifestyle) and not just leap on the the latest fad that is only half-understood!

    At present I doubt if I ever eat more than 75g carb a day, except on my very rare 'treat' days such as the 'Great Fish and Chip Experiment' which is going to happen this coming week :lol: . Sometimes I can be as low as 20g carb per day. And I feel really well on it.

    "Education, education, education" - who said that, I wonder?

    I've never been asked to do jury service, and it's almost too late - and I now have the time to do it! Where's the emoticon for 'miffed'?

    I'll be grateful for your comments on the diet - in your own time - it would be great to have your frank pinion. Don't pull your punches! - not that you would.

    Viv 8)
     
  11. ally5555

    ally5555 · Well-Known Member

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    Hi Viv

    I will have a good look - I have an analysis package on my laptop .

    There are so many people who will not do anything to help themselves and for me that is very frustrating but as HCP I have to accept that you can't help some people.

    Allyx
     
  12. IanD

    IanD Type 2 · Well-Known Member

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    Thanks. Have done - see what they say.
     
  13. cugila

    cugila · Master

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    That's good Ian. I think many of us would be interested to see the methodology and the outcome of the research ?

    It does seem mighty suspicious that it isn't freely available after all this time.... :roll:
     
  14. viviennem

    viviennem Type 2 · Well-Known Member

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    I had my first session with our PCT's dietitian today. She was pushing the party line and advising 'check the sugar content'! - the DUK position does not seem to have filtered through!

    She had been forewarned that I am a low-carber, and I tried not to be too disruptive of the session, though I had to intervene on sugars v total carbs! Most of the other people there were older than me and had obviously not done any internet research or found this forum, so I didn't want to confuse things too much.

    I did see her afterwards and discussed my Atkins-based diet with her, and found her much more in favour of low-carb than she had come across with during the session. So once the DUK news does filter through, I think we can confidently expect a few changes in our area.

    Viv 8)
     
  15. ally5555

    ally5555 · Well-Known Member

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    Viv - tbh I am not sure whether this was a group thing or an individual consulation.

    If you have a group the advice will be very general and has to be very simplistic . I can get where she was coming from - talking to a group of people is very difficult you just do not know anything about them !
    You are assuming people can tell carbs from sugar!

    I am quite honestly sick of the negativity about HCP - I only started posting here a few years ago when I read some awful things - you never see the positives. I have asked some of my own pts to post here and they are afraid to as they have a positive experience - not just from me but the nurses and others and they feel they will get shouted at.

    HCP are really putting themselves on the line posting here - I am and quite honestly think is it worth it ? I cannot give people individual advice and never have but the fact that I see real people counts for absolutely nothing.

    As far as Exeter is concerned they are not hiding anything - they may be waiting to publish - I have spoken to them and they were very open. If their results are not what you want I can understand the anger!

    Allyx
     
  16. sugarless sue

    sugarless sue · Master

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    Sorry Ally but I don't agree !

    This 'dumbing down' of diabetic education is damaging to our health. By not educating diabetics about carbs and concentrating on the word sugar the lay- Diabetic is being given the wrong information.

    Similarly rounding up the NICE guidelines to 10 instead of 8.5 is damaging our health. What we need is the proper information, this could save lives. It should never be assumed that every Diabetic will not understand and respond to the correct information.
     
  17. ally5555

    ally5555 · Well-Known Member

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    thing is Sue it is not Dietitians dumbing it down - they know they need to be in there.

    The problem is that people are not equal - I have pts who can't read or write and those who do not have the internet and those who couldn;t care so putting all of these together in a group is a recipe for disaster.

    How can you run a group when you have such a mix. I do diabetes education sessions and they are different every time I do them !

    I think one to ones are better but that is expensive!
     
  18. Daibell

    Daibell LADA · Master

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    Ally

    I can understand your point about having to generalise for groups of mixed people but I'm getting bored with reading articles in magazines and newspapers from several 'dietitions/nutritionists' advising one or other of 'eat starchy carbs', 'eat wholemeal bread' etc which show an inadequate level of education on how the body works at least with regard to diabetes. As well as not realising that sugar is just another high GI carb but that the value of wholemeal flour is the roughage content and it's GI value is not that much better than white bread. Also as most diabetics are on statins, if needed, then the importance of avoiding saturated fat is not as important as avoiding too many carbs. Yes, unsatured fat is always better. Are there some key training courses for dietitions that need reviewing?
     
  19. viviennem

    viviennem Type 2 · Well-Known Member

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    Allyx, I've replied to your query on Patch's Fat thread, so I won't duplicate it here.

    Just to say that I am always polite to HCPs, and respect their experience and training unless and until they give me good reason not to! I didn't go into today's session 'all guns blazing' because it's not the way I act anyway, and because it WAS a group session with a number of fairly newly diagnosed diabetics, older than me, who haven't had the advantage of my education and training in research etc. I would think a number of them probably left school at 15 and have never used the internet.

    The worst thing I could have done to the group as a whole was to argue with the dietitian every step of the way, so I didn't. I just raised a very few queries which she handled very well, and I hope I did it in such a way as to seed a few ideas in the others - particularly about testing.

    She was very good on the subjects of cholesterol and fibre, among other things, and I think once she is allowed to she will be advocating closer carbohydrate control too!

    Viv 8)
     
  20. Ka-Mon

    Ka-Mon · Well-Known Member

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    After reading so many damming reports about HCP's/Diaticians on this forum I am now asking myself if we are living in different countries in different times? :?

    Apart from one person who was just a learner at the time no one has ever told me to eat "loads of carbs", not my GP nor the dietician I saw a couple of months ago. I've always been told to watch the sugar and the carbs and only eat what my body can handle. Having said that, one diabetes nurse did try to tell me that maybe I cut down the carbs too much, because I want to eat all the time, and said that maybe I should take some other meds together with the Metformin but even she admitted that we are all different and we need to test and finsd out what and how much of it we can safely consume....mind you that was just after she said that Type2's only needed testing twice a week. :? I think she was a little confused and in the end decided to agree to let me decide what and how much I should eat.

    The dietician I saw though, was a very young, in her early 20's :?: , lady and she really was good. She explained the need for carbs but warned that I should test and see for myself how much I could consume without my BG going high.

    All in all I've had good experiences with all the HCP's I've met since diagnoses so I really can't understand why so many people complain. I can only assume that those who do complain are the ones that do not get the advice they expect or want. This really brings up a very, for me at least, important question....if people know what they want, why, willingly, go and get advice they know they are not going to get? :?

    PS: I hope I am not offending anyone with my above remarks, that's the last thing I want but I am just curious as to why people just don't stick to what they know works for them and go see a dietician/Diabetic Nurse only to get the wrong advice and get upset about it?
     
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