High Carb T2 Diabetes Trial Ends in Failure

[xyzzy]

It seems to me that the experiment is so badly flawed that it would be very hard to draw any solid conclusions from it. It is a huge waste of time and money. I doubt if the experiment will ever get published in a reputable journal because the design of the experiment is so poor, and so it will not get through peer review.

I do hope it will get published and like others I don't accept that the experiment was flawed. In fact it has produced results entirely inline with what many of us who have successfully controlled our T2 would expect. The trouble is people like us are never asked how do we control our conditions successfully.

If you are newly diagnosed then in most cases controlling your T2 is quite straightforward just cut out most sugar and cut down on starchy carbs (rice, pasta, bread, potatoes, cereals and other flour based products) and replace with extra meat, fish, cheese eggs and especially green veg. A lot of T2's end up finding the control point is somewhere between a 10% and 30% carbohydrate diet depending on how much insulin resistance they have and how much pancreatic function remains. Get and use a meter to work out your personal tolerance. It's not rocket science and certainly doesn't cost $200m and 11 years to prove.

 

[hanadr]

This failed study, has shown that their partcular recommended lifestyle modification doesn't work, However it's still a HUGE leap to the humility needed to look at a controlled carb lifestyle.
Of course, the fact that exercise doesn't do much for weight has been known for decades and they still peddle it as an answer.
Even more useless is "moderate" exercise! Extreme exercise does affect weight.
Hana
PS who's going to send the reference to DUK. I'm just off away for a few days.

 

[Defren]

I hope they publish the body counts.

It's this kind of thing that really concerns me. Not that you wonder if they will publish a body count Stephen, but the fact there will be one. Posters here know that now and again we have television programs come along and ask us if we would be willing to take part in a new show they have in the planning. I always refuse, simply because I have worked out what suits me, so why would I change that for a diet that could possibly harm me.

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.

While we all accept things are only found out by trials etc, the high carb low fat diet has been shown over and over not to work, so why the need to through 220 million at it? My GP wants to do a trial of low carb diabetics, he is certainly not asking for anything near £220 million, but I will lay odds he won't get a penny!!

 

[xyzzy]

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.

Excellent point Jo +1 and all that

 

[borofergie]

It's this kind of thing that really concerns me. Not that you wonder if they will publish a body count Stephen, but the fact there will be one.

Well to be fair, in any trial of this magnitude people will die. That's kinda the point, these trials are body counting exercises (to prove that the intervention kills more people than the control group). To be fair to the researchers, they thought they had designed an intervention that would save lives, and their sense of disappointed is almost tangible from the quotes that they made in the press.

However, we all know, that the mortality rate would have been much lower, had the intervention been a supported low-carb diet.

We'll get there in the end.

 

[IanD]

I complete 12 years as a T2 diabetic. I'm now 73 & fit, well & active.

During those 12 years I have personally conducted 2 diet/exercise routines:
DUK high starchy carb/low fat-sugar-salt, with regular exercise - mainly tennis. 8 years of that & I was becoming crippled & could not exercise. My active life was over - it was a painful struggle to get out of bed.

Then I found this forum, & switched to low carb, with fats as they come. 3 months & I was out of pain & playing tennis again, & 4 years on I am fit & well, & playing tennis at club standard still.

I have no intention of abandoning my low carb diet & exercise programme.

Ealing Hospital have a cardio rehab exercise class - 2 sessions a week intended to benefit cardio patients (I go with my wife who had a heart attack 10 years ago.) We have progressed from simple circuit training to include table tennis & badminton. That exercise is certainly beneficial, with a friendly club atmosphere. Everybody's fitness is visibly enhanced.

 

[xyzzy]

A bit more of the original announcement can be seen here

http://webcache.googleusercontent.c...rt.org/article/1458351.do+&cd=1&hl=en&ct=clnk

Of great interest is the main thing that didn't change between the group that were on the low fat, high carb exercise regime and those who weren't was the fact that BOTH groups had similarly bad LDL cholesterol levels after the 11 years.

The only cardiovascular risk factor that remained unchanged with treatment was LDL-cholesterol levels.

What is even more galling is they've wasted 11 years and 200m replicating results that were already known. See a posters comments lower down the page.

This is not new, we saw it in MR FIT in 1982 found no significant CV benefit and no overall benefit from intensive lifestyle intervention. The Goteborg Study published in 1986 also demonstrated no benefit.

I would suggest that from this it implies a low fat, high carb with exercise regime raises your bad cholesterol levels but I'm sure that must be wrong :shock: :wink:

As someone who adopted a low fat high carb diet with exercise regime for many years prior to diagnosis of T2D and screwing his LDL level I can agree with that finding...

 

[borofergie]

Hah - got there at the same time as BlindDog:

The Action for Health Diabetes (Look AHEAD) study, a trial comparing an intensive lifestyle-intervention program aimed at achieving and maintaining weight loss and fitness in patients with type 2 diabetes, has been stopped for futility.

A large cardiovascular-outcomes study funded by the National Institutes of Health that included 5145 adults with diabetes and a body mass index >25 kg/m2, Look AHEAD failed to show a difference in the rate of nonfatal MI, nonfatal stroke, death, or hospitalization for angina among patients randomized to an intensive lifestyle intervention and those randomized to a control arm consisting of education alone.

Despite significant reductions in weight and improvements in physical-fitness levels among patients with diabetes, investigators concluded that the intervention arm, which included individual sessions with a nutritionist and/or personal trainer, as well as group sessions and refresher courses, failed to provide any benefit in terms of cardiovascular outcomes.

Here is the earlier report which mentions the unchanged LDL levels:
http://care.diabetesjournals.org/content/34/7/1481.full

The improvement in HbA1c was marginal too:

Only those that approached 15% weight loss got anywhere near reducing their HbA1c by 1%, most were nearer to 0.5%. By comparison, I achieved a 5.7% reduction in HbA1c (for 10.6% to 4.9%) by low-carbing.

 

[xyzzy]

Hah - got there at the same time as BlindDog:

Here is the earlier report which mentions the unchanged LDL levels:
Only those that approached 15% weight loss got anywhere near reducing their HbA1c by 1%, most were nearer to 0.5%. By comparison, I achieved a 5.7% reduction in HbA1c (for 10.6% to 4.9%) by low-carbing.

Thanks for the links Stephen appreciated.

As you say 0.5% in 11 years - wow what a result - not :thumbdown:

It's not difficult is it?

I did 11.3% to 5.3% or a 6% drop in 3 months by adopting a low carb higher fat diet .
I went from a just under 6 on statins total cholesterol to a 3.9 off statins result by adopting a low carb higher fat diet.
I went from a BP of 145/95 to 115/75 by adopting a low carb higher fat diet.
I lost 3 stone in 6 months on a low carb higher fat diet.

Unlike yourself (no criticism at all) I did it all by doing no more exercise than I had been doing prior to diagnosis.

Low carb boring? I don't think so. Mrs xyzzy's latest. Low carb pasta made from Soya flour and Vital Wheat Gluten. The plateful is uncooked and is less than 20g of carbs in total.

 

[phoenix]

The trial was about losing weight, and whether that would result in fewer incidences of CVD. Some lost weigh but not I would suggest enough. There are other trials showing greater weight loss initially, though very few over a long period.

I think the trial shows the problem of trying to change a large number of peoples weight and whether in fact it will make a difference!

Would they have done better on a different type of diet; who knows? It is not sensible to try to compare them with a few people on a forum .
I can tell you of a few individuals who have had CVD 'events' heart attacks or the necessity for stents and a couple who have died on this and other forums (including those who adopted very low carb diets and those who haven't ). I could personalise as so many have done (cholesterol decreased from over 8mmol/l at diagnosis, regression in plaque and greater blood flow rate at seven years ) but important as this is to us as individuals it isn't hard data.
There are so many people that don't continue to post ,we don't know their outcomes over a year; let alone 11 years.

I think the very small 44 month non-randomised low carb trial actually showed an increase in weight at 44 months but haven't checked, is there a longer one? There were CVD events in that trial too.


Jaminet may have blogged about it but he also (subsequently or before he wrote) seems to agree that we don't have enough info

Paul JaminetOctober 22, 2012 11:39 AM
Good point about the change in weight vs outcomes, that would be interesting. Hard to say anything about this trial based on the press releases and news stories. I haven't seen any useful data yet

http://carbsanity.blogspot.fr/2012/10/t ... mment-form

Just realised that she has written a second post about it, I haven't read that yet.
Well, I've skimmed it now, you might want to read both posts. and comments,
This is one from Guyenet. I find it interesting that he says that there were fewer events than expected.

Stephan GuyenetOctober 23, 2012 12:46 PM
A 5% weight loss can be clinically significant even if it's not aesthetically significant. The DPP and related trials had similar weight losses and they prevented diabetes incidence by up to 60%. This was basically a follow-up study to DPP and there was every reason to believe the intervention would be effective based on previous trials.

The reason Look AHEAD was terminated early is that it was hopelessly underpowered. The event rate was nearly 4X lower than expected. It's still possible that the intervention would have been highly successful, but we'll never know because the study design turned out to be inadequate. Still, they found improvements in several secondary endpoints.
http://www.drsharma.ca/looking-back-at-look-ahead.htm

and the Sharma link gives more details .

This reduction in body weight was accompanied by significant improvements in glycemic control and numerous other health benefits (e.g. decreased sleep apnea, improved mobility and quality of life)

given a remarkably low incidence of ‘hard’ endpoints in both the interventions and control groups, it became evident the the study would stand little chance of demonstrating superiority of the lifestyle intervention in terms of preventing cardiovascular complications.

Nevertheless, according to the recommendations of the Data Monitoring Board, the study should be continued (without the intervention) to determine the long-term outcomes in the participants.

and a suggestion:

Not only may future studies have to enrol a substantially greater number of participants but such studies may also need to substantially enrich the study population with higher risk individuals to increase event rates (i.e. EOSS Stage 3 rather than just EOSS Stage 2 patients).

Storm in a very expensive tea cup?

 

[xyzzy]

Would they have done better on a different type of diet; who knows? It is not sensible to try to compare them with a few people on a forum .

Well a few in my use of the English language usually means around 5. So how many people have there been on this forum over the years its been online who have successfully stated they have controlled their T2 by using some form of low carb diet, 100+, 200+ probably even more than that. Starting to be a decent sized sample set wouldn't you say? Surely they are not all making it up or are sock puppet accounts?

To say it's just "a few forum members" belittles the hard work and effort ALL those people put into controlling their condition.

 

[borofergie]

You're right of course, we need bigger trials with more people and more support (including more nutritionalists and more personal trainers) to be able to demonstrate the positive health benefits of a high-carb / low-fat diet. We also need to include patients with even higher degrees of morbid obesity and worse diabetic control (because bog standard obese T2s aren't at high enough risk).

So how about a billion dollar trial, involving 2500 very sick diabetics, with even closer supervision? That should be enough to prove the health benefits (in terms of CV mortality or weight loss) of a low-fat high-carb diet.

Or maybe we just accept that the benefit of a high-carb low-fat diet is so small (if it exists at all) that we just can't measure it in an experimental trial.

(I'm loving the Carbsane desperate post-hoc-rationalization. Do you think that she'd have been criticising the study if it had proved the hypothesis. It's good for me though, all the desperate blog writing has left the door open for me to overtake her in the PaleoHacks all time reputation charts. Yay).

 

[Defren]

Would they have done better on a different type of diet; who knows? It is not sensible to try to compare them with a few people on a forum .

Well a few in my use of the English language usually means around 5. So how many people have there been on this forum over the years its been online who have successfully stated they have controlled their T2 by using some form of low carb diet, 100+, 200+ probably even more than that. Starting to be a decent sized sample set wouldn't you say? Surely they are not all making it up or are sock puppet accounts?

To say it's just "a few forum members" belittles the hard work and effort ALL those people put into controlling their condition.

Well, yes it does actually Steve. I have worked damned hard, and I am by no means the only one, and I don't appreciate that effort belittled!!

 

[phoenix]

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)

 

[Paul_c]

they should be doing a trial of the standard NHS 50% carb type diet + exercise versus a low-carb diet with ad-libitum consumption of fat and proteins on those diagnosed as having impaired glucose tolerance (ie pre-diabetic) and see how many or each group go on to develop full blown diabetes after several years on the diet...

 

[borofergie]

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?

Yeah, I took this straight from (and linked to) Paul Jaminet, who I'm sure you'll agree, is hardly the internet's biggest shock blogger. I agree that it's speculation, but I don't think that it's completely unfair. Other commentators have also questioned why the trial ended early.

Who do you think is the most objective and rational blogger, geeky Paul Jaminet, or Evelyn Carbsane who you quoted?

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.

Object all you like, but if you're going to do so please try and back it up with some hard evidence. I stand by this position 100%. The NHS recommended advice is killing T2 diabetics, and this trial demonstrated that an intensive NHS type intervention (50% by carb) was no more effective than a control group who just received lifestyle counselling.

Do you honestly think that the standard NHS advice on diet is effective?

Percentage of registered Type 1 patients in England
HbA1c >= 6.5% (48 mmol/mol) = 93.1%
HbA1c > 7.5% (58 mmol/mol) = 71.7%
HbA1c > 10.0% (86 mmol/mol) = 17.5%

Percentage of registered Type 1 patients in Wales
HbA1c >= 6.5% (48 mmol/mol) = 94.9%
HbA1c > 7.5% (58 mmol/mol) = 75.3%
HbA1c > 10.0% (86 mmol/mol) = 20.1%

The Look AHEAD study demonstrated that the standard dietary and exercise advice given by the AHA and DUK and NHS:

1. Only delivers modest weight losses
2. Delivers a small but significant improvements in Diabetes markers other than LDL-C.
3. That modest weight loss itself doesn't influence CV outcomes

More than this, the outcomes are modest in spite of relatively intensive support given in the early stages of the programme. How can we expect NHS patients, who get similar advice and very little support, to get better outcomes than this group of people? The answer is that we can't, and it is likely that the standard NHS patient will do much worse.

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.

That's because there are no long term trials of low-carbohydrate diets, which leaves us speculating about anecdotal results of low-carbers on forums such as these. I agree that anecdotal evidence is worth very little, but since no-one has bothered to invest in properly constructed low-carb trial, speculation is all we can do. It's difficult to imagine that a low-carb diet would have faired any worse that the low-fat/high-carb diet used in Look AHEAD.

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).

So we're not allowed to play "n=1" but you're allowed to play "n=Jimmy". If we're going to play "n=Jimmy" let's be accurate about it: the guy has gone from 410lbs in 2003 to 255lb in 2012.

Here is Jimmy in 2003

Here is Jummy in 2012

Losing almost 40% of your bodyweight in 9 years is an absolute validation of the low-carb diet, even including a bounce back up to 300lbs at one stage. I think that it's pretty clear than Jimmy Moore has lost large amounts of weight, albeit not in a linear fashion. No-one loses weight in a linear fashion.

(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)

No, I probably wouldn't if I were you either.

Conversely, I think that Look AHEAD has further exposed the inefficacy of high-carb diets when used to treat T2 diabetics and the obese. The trial demonstrates (that even with intensive support) the NHS/AHA/DUK diet is not better than doing nothing. No amount of hand waving is going to make that go away.

 

[Sid Bonkers]

So we're not allowed to play "n=1" but you're allowed to play "n=Jimmy". If we're going to play "n=Jimmy" let's be accurate about it: the guy has gone from 410lbs in 2003 to 255lb in 2012.

Yes he has but he has also repeatedly put that weight back on, if you read his blog you will know that he is a yo yo dieter, every year he takes another diet and looses weight then goes back to his usual eating habits and puts the weight back on.

As I said in another thread loosing weight is not that hard if you are competed and most diets will work in the short term, the trick though is to keep the weight off as that requires a lifestyle change not just a diet every year as yo yo dieting is known to be bad for your health.


@ phoenix, great post phoenix, as usual.

 

[phoenix]

No, I probably wouldn't if I were you either.

Sorry to disappoint you. My prerogative to change my mind.

I will add that I've just returned to Jaminet's post and looked at the comments. He (unlike you) seems to have moderated his views in his comments and responses to both Guyenet (too much/many to quote) and to Evelyn.

Hi Evelyn,
1200 and 1300 are about the same. Jaybird was pretty much 100% in accord with our recommendations.
Thanks for the info about Ebbeling, I basically agree with your posts on Look Ahead. It looks like an ineffective intervention, behavior of the controls was pretty similar to the intervention group, plus they selected unusually healthy diabetics for the trial so they had low event rates and we can’t infer anything from the difference in event rates between study participants and the general population.
Counting calories will probably bring everyone closer to a target, but I doubt it completely suppresses a tendency to eat more calories on a 50% carb diet than on a 30% carb diet. I agree that increased protein intake tends to suppress appetite and calorie intake

I think that is very much what I have been saying. (certainly what I've been trying to say)
viz a viz Jimmy, it was you that mentioned his recent weight loss to demonstrate the superiority of what he could do contra the Look ahead trial. My point i remains that he can't maintain. You can find pictures on his blog looking very slim and other later ones looking much larger.
He's not alone in that, as I said.I know from personal experience. I also 'work hard' to maintain my weight, I have always gained very easily so am now extremely careful, if I start gaining I now do something about it. (I eat less and move more; still have to take the insulin though) If it were easy then the slimming clubs/books market wouldn't be so profitable if it were easy and I wouldn't have a series of books dating back to 1976 including an ancient Atkins.
I doubt it was any easier for the people in the study.

I discounted the WLR but I could have linked to stories of people who have managed to both lose lots of weight and maintain it

Incidentally, my reference to Carbsane's blog . was to comments , not what Evelyn herself said I referenced Guyenet who in turn referred to Sharma. As Guyenet is an obesity researcher at Washington and Sharma holds the Chair in Obesity Research and Management at Alberta, I would think they were more than qualified to comment. .

 

[borofergie]

No, I probably wouldn't if I were you either.

Sorry to disappoint you. My prerogative to change my mind.

I will add that I've just returned to Jaminet's post and looked at the comments. He (unlike you) seems to have moderated his views in his comments and responses to both Guyenet (too much/many to quote) and to Evelyn.

I've read all of both blogs, including all the comments. I haven't moderated my opinion because, unlike Jaminet, Guyenet, and Carbsane, my perspective is as a T2 diabetic. I don't really care about the experiment's stated purpose of "the influence of moderate weight loss and CV outcomes", but I am interested in the diet as a test of AHA / NHS / DUK type diets on diabetic outcomes.

So it seems from Carbasane et al the, possibilities are:

1. The study was underpowered (despite over 5000 participants and $200m cost).
2. The diabetics in the trial were unusually healthy.
3. The control group did much better than expected.
4. The diet and exercise programme was too difficult for the participants to follow.

Of course it couldn't possibly be the case that:
5. the hypothesis was wrong, and the trial couldn't demonstrate any benefit from the intervention.
6. there is a benefit from the intervention, but it is so small that it couldn't be demonstrated in any reasonable sized study.

I'm sorry, but this isn't science. Instead of accepting that we couldn't falsify our null hypothesis, we invent any number of excuses to why the experiment failed. The hypothesis can't be wrong because, before we know that the effect that we are trying to demonstrate is real, and if we can't show it, it must be because the experiment was wrong.

This is exactly how false consensuses are established. We never get to test an alternative hypothesis (maybe that T2 diabetics might have better outcomes on a low-carb diet), because we spend all of our time and money trying to prove that the original hypothesis was right, in more and more expensive and elaborate ways.

Here's the rub, there is no science that suggests that a 50% carbohydrate diet is an effective prescription for T2 diabetics. You can quite rightly say that "there is no science that says a low-carb diet is effective for T2 diabetics", and I'd have to agree (but I'd note that no-one ever does the experiment). You'll also reject my n=many anecdotal examples of T2s that have a put their diabetes into remission using a low-carb diet as being "n=few". Fair enough.

But Occum's razor, plus n=many, tells me that (5) or (6) are much more likely than (1)-(4). We did the science on the AHA/NHS/DUK diet (with intensive support) and the result came back negative. The best you can say is that there were slight improvements in diabetic markers and weight. This is not good enough. The kind of improvement demonstrated in this experiment will not prevent complications at in the larger diabetic population (who get the same type of advice with much less support). We need to look at alternatives. Low-carb, GI, and GL would all be good candidates.

I also think that the premise of the experiment is wrong. I agree that body fat has an influence on glycemic control, but it is less important that carbohydrate intake. I (and n=many others) were able to control our diabetes before getting our weight under control. Like Jaminet, I think that the results of this experiment demonstrate that weight is a symptom of glycemic control, not the cause.

Incidently the "not everyone is as informed and motivated as the people here" argument doesn't rub. If that's the case, we need to find ways to inform and motivate them. The alternative in Therapeutic Nihilism, which is explicitly prohibited by the Hypocratic Oath.

Might write more later, but if I don't go and paint some ceilings, I'll probably die of "wife cutting off my balls" complications.

 

[xyzzy]

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.

That is still constructively avoiding the point I was trying to impart in my opinion.

The following should be read in the context of T2 posters only.

At any particular time on this forum there have been a number of frequent posters. If you look back one year there were a set of frequent posters, two years another set of frequent posters, three years more frequent posters, four years a further set etc. Some have remained posters but many, the majority even, have come and gone. Also at any particular time there have been less frequent posters notably people who arrive on the forum then ask for advice, get that advice, do the advice then leave as mostly satisfied customers. It's what the T2 sections of this forum do best in my opinion.

The overwhelming vast majority of those posters over the years have reported that low carb works. They may have argued that this kind of low carb was better than that kind of low carb and even been at each others throats over which method is best. Some have said said lchf, some have said vlc, some have said lclf, some have argued for gi, some have argued for gl and others portion control with an effective carb control element. Do you know what? I don't give a **** what they use and I'll try and support every last one of them even if they are using a different method than me because they all share a common underlying theme which is generically low carb works and has been reported to have worked by hundreds of members over the time the forum has existed.

Denying that simple fact is absurd and trying to make out the low carb success story in all its forms is only a recent thing being pushed by the likes of me and a few other posters is just as absurd.

You state "and a measure of success and find themselves well supported". That's the point they are being supported by being given low carb advice by members on this forum. I'm glad you finally admit that low carb advice given by me and many, many other members over the years leads to success. :clap: Perhaps if they were given similar low carb support by the NHS it too would begin to reap the benefits.

I'm actually amazed that someone with your very apparent interest and respect of science and as someone who is obviously a gifted amateur (for want of a better phrase) that you appear to be in denial about both the implications of the failure of the AHEAD Trail and the evidence before your eyes in the form of all those real people who have passed in front of you reporting their low carb success on this forum over the years you've been a member.