No belittling
Just truth,
The people on here are a 'few ' people on a forum. Frequent posters are a tiny number of the actual members, they are people who have had a measure of success and find themselves well supported, others though are less supported and unsurprisingly they don't stay. This is not a representative sample. Moreover all have lost weight fairly recently so cannot be compared with what happened over a period of 11 years.
What I object to is the way this topic was introduced : First a statement from a blogger with as far as I know no 'inside knowledge ( A British vet)
There is some speculation among bloggers that the trial was halted because more people died in the intervention group than in the usual care group:
http://high-fat-nutrition.blogspot.co.u ... opped.html
However the massive omission, from the quick look I've managed, is of any intention to report the all cause mortality. It seems very likely to me that more people died in the intervention group than in the usual care group, but p was > 0.05.
Call me a cynic, but I think they stopped the trial because they could see where that p number was heading. Has anyone seen a body count from anywhere in the trial?
followed by this next statement
This is more excellent evidence against the idiotic (diabetic killing) dietary advice handed out by the NHS and DUK. It demonstrates the inefficacy of both low-calore + exercise and high-carb as a method of treating T2 diabetes
Sounds scary, people dying. Perhaps it's not surprising that another poster wrote
The people who took part in this trial, possibly knew nothing about a low carb diet and diabetes, so will have gone into this trial thinking it may help them, when as we can see 11.5 years later, there is a body count. There is not a shread of doubt in my mind, had these people trialed a low carbohydrate diet, many would still be alive, AND healthy.
There weren't large numbers of deaths: that was actually the problem.
The trial was originally scheduled for 10.5 years. Two years in they realised that the study didn't have enough power to detect any differences. Simple reason there were not enough 'cardiac events' a rate of 0.7% rather than the 3.125% expected. Far too few too detect any difference between groups.
(quite probably at this stage they should have given up)
They were given permission to both extend the study by 2 years and to increase the number of endpoints (ie what they counted as a CVD event).
http://www.ncbi.nlm.nih.gov/pubmed/22334468
This obviously was insufficient so the trial was stopped because it patently hadn't enough power to demonstrate anything. There were far fewer CVD event in this trial than any other previous diabetes trial . I would suggest shows that demonstrates the 'usual care is much better than it was at the time of the other big studies such as the UKPDs where there were a large number of cardiac events from the early stages'
Another plausible reason for there being so few deaths is that the participants were excluded from the trial if they didn't do well on the Graded Exercise Test thus excluding participants most likely to develop CVD.
The other problem is that the weight loss intervention was not successful. It isn't that low calorie diets don't work. They do, lots of evidence for that and so do other diets.
The big problem is maintaining that loss.
I have an idea that some people approaching their intervention meetings would be very human; being good before the meetings and weigh ins, relaxing a bit after. (I'm sure those of you who have attended slimming clubs would recognise this behaviour, some people do similar things for HbA1c) . Not so bad when the meetings were very regular but more significant when the number was reduced as it was after year one and again after year 4.
I don't know of any trials that demonstrate maintenance of a big weight loss over a long time and 11 years is a long time. I wonder how it worked out with individuals. I doubt individual plots would sow a weight loss followed by a slight regain and then a plateau (final 5%) ; some would have lost a lot, some would have yo yoed , some would have gained.
The only data I know concerning people who have managed to keep weight off is from the Weight Loss registry and those people are (just like the people on this forum) self selected, perhaps very motivated.
In real life I think it's very clear ( been then, done it) that people can lose weight but find it very difficult to maintain it.
many people are recidivists at the various slimming clubs.
It's no different with 'low carb' Many find it very difficult to maintain their losses. Jimmy Moore was mentioned in another thread linked to this one as a good example of the weight that can be lost on a low carb diet. He's actually a very good example of how difficult it is to maintain weight loss , loosing 170lbs on a low calorie diet, 180lbs on Atkins, 50lbs on his recent venture (and lot's of other big losses in between).
I'm absolutely not surprised in the results of this trial but as I said in the first post think it will be interesting to see the subgroup effects. It may be that those who lost larger amounts , became fitter etc were even less likely to have a CVD event , improved markers etc. It would be good news for those who have lost and been able to maintain a large weight loss over periods of a decade or more.... We won't know until they publish and going on how long it took to publish early results it will be a long wait.
(and sorry for another epic post, I shan't return to this subject ... since I still think it's a storm in a rather expensive teapot)