Low carb diets and Diabetes UK

[xyzzy]

My thought has always been to bypass DUK entirely by going directly to the front line gps who have the direct responsibility for people's care. If gps were persuaded that the advice they hand out is out of date and that more modern techniques will save them hard cash on their drugs bills then DUK would soon be bypassed.

When I was first diagnosed I got my own den and subsequently my gp interested in how I was successfully managing T2 by providing them with loads of printouts of various stuff. My gp set up an after hours appointment with me so I could tell him more. Both he and my dsn have continued to actively support me since then. I even persuaded him to prescribe a reasonable amount of test strips.

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[ClumberQuean]

Its worth looking at what the people actually ate on the 2 diets.
The people on the 'paleolithic' diet actually ate fewer calories than those on the consensus Med diet. (1344v1795)
Both groups ate about the same amount of protein
Those in the P diet ate about 134 g of carb compared to 231 in the 'Med' group
Those in the P diet ate 42g of fat compared with 50 in the Med group.
So the P diet in this case was lowish carb, lowish fat and hence low calorie. The 'Med like' diet was higher carb, higher fat and higher calorie.
There is no justification to say that the P diet was somehow better than a low fat diet since it was actually lower in fat than the diet eaten by the other group.

There are some surprising differences in the 2 groups as to types of food eaten. For example those in the P group ate almost double the amount of fruit to those in the Med group, they ate a third more veg and 20% more fish and more nuts. Those in the P diet even drank more wine!(the 'Med' group seemed to drink 'lite' beer.)
As you can probably gather I don't think that this is anything like a Med diet as described by most people. http://oldwayspt.org/resources/heritage-pyramids/mediterranean-diet-pyramid/traditional-med-diet so I don't think that it really compares the 'P' diet it to a Med diet There are a lot of studies that show good results from more truly 'Med like' diets

Nevertheless the diet worked well (though only a few subjects and a short time) However, there is no consensus on what a Paleo diet really is (except for avoiding grains and dairy) You will find lots of people claiming they are eating paleo with very different proportions of protein/fat/carbs to the ones this diet uses.
This is the website of Cordain, who is the so called founder of the Paleo diet... His diet is high-protein, high-fruit and veggie diet with moderate to higher amounts of fat, http://thepaleodiet.com/paleo-diet-faq/

Thank you Phoenix your observations are most useful and helpful! I shall look into your links: the med diet in particular ! One more - perhaps silly - question: have you any idea why (in this particular trial) the Paleo diet was more effective in lowering BG levels than the "med" diet?

 

[mpe]

DUK seems to be getting more and more out of date and out of touch with reality. In previous years their position statements have essentially followed those of the ADA however there now seems to be some large differences in approach. Obvious ones seem to be the ADA now recommend restricting carbs per day to around 40g per meal and have downgraded GI to a secondary technique and recommends simply reducing daily total carbohydrate (some form of carb counting) as the primary method. DUK's position statement still has the starchy carbs with every meal nonsense and advocates GI as a primary means of BG control.

It's dangerous nonsense especially considering that many people don't appear to know what starch actually is. Is the ADA's figure a maximum or a minimum?
The obvious problems with GI include it varying between individuals and there being no simple way to deal with meals made up of multiple foods. About the only practical form of GI appears to be "eat to your meter".

 

[IanD]

It's dangerous nonsense especially considering that many people don't appear to know what starch actually is. Is the ADA's figure a maximum or a minimum?
The obvious problems with GI include it varying between individuals and there being no simple way to deal with meals made up of multiple foods. About the only practical form of GI appears to be "eat to your meter".

I've just signed up for the DUK "Type 2 diabetes & me" course. The healthy eating module advises:

Carbohydrates:
Bread, rice, potatoes and pasta all contain carbohydrates. Carbohydrates are broken down into glucose and used by the body's cells as fuel. Starchy foods are naturally low in fat and high fibre varieties (like wholegrain bread and brown rice) help to keep your bowels regular. Choose carbohydrates that are absorbed slowly, helping to keep glucose levels stable.

Eat five to fourteen portions of starchy foods every day. This should make up one-third of your diet, so try to include them in every day.

One portion is:

• 2-4 tablespoons of cereal
• 1 slice of bread
• 2-3 tablespoons of rice, pasta, couscous, noodles or mashed potato
• 2 new potatoes or half a baked potato
• Half a small chapatti
• 2-3 crispbreads or crackers

I'm a fan of Pete Seeger "When will they ever learn .....?"

 

[IanD]

Low-carbohydrate diets for people with Type 2 diabetes (Mar 2011)

Low-carbohydrate diets have been a subject of discussion for over two decades. They have attracted attention as a means of losing weight and optimising blood glucose control, particularly in people with Type 2 diabetes. However, debate has arisen about whether this approach is both safe and effective.

Please read this - including the references! I quoted these in a previous post, & I have looked up a lot of the others.

8 Daly M, Paisey P, Millwards B, Eccles C, Williams K, Hammersley S, Macleod K and Gale T (2006). Short-term effects of severe dietary carbohydrate-restriction advice in type 2 diabetes – a randomized controlled trial. Diabetic Medicine 23; 15–20

13 Nielsen J and Joensson E (2008). Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycaemic control during 44 months follow up. Nutrition and Metabolism 5; 14

 

[IanD]

This is the most up-date recommendation fom DUK: It gives teh link to: evidence-based recommendations for the practical implementation of nutrition advice in the UK.

Food, nutrition & lifestyle

Consumption of carbohydrate in people with diabetes (Mar 2012)

 

[Yorksman]

The link to the full article works - I am a language person, not science but without fully understanding all the tables and diagrams it seems to make good sense ... Anybody tried this?

http://www.staffanlindeberg.com/DiabetesStudy.html

You could just follow the advice of quoted at the end:

"If you want to prevent or treat diabetes type 2, it may be more efficient to avoid some of our modern foods than to count calories or carbohydrate"

 

[phoenix]

So what does the longer term data tell us?
Presumably that's what DUK looks at and what presumably Sam tried to show them . However they do have to evaluate all of it.
Here is a comprehensive list of studies for anyone who wants to look them up for themselves.
http://www.bda.uk.com/BDAlive/Paul McCardle Handout 2.pdf

There is as far as I know only one meta analysis of randomised controlled trials for T2 2diabetes diets. (ie pooling the results from the available smaller studies)

This was published last year but is unfortunately still behind a pay wall. However, there is a review of the paper in the Univ of York data base. It included those trials that looked at glycemic control and weight loss, lipids and included those that lasted over 6 months. They used the Cochrane criteria for selection. It included trials of low carb, vegan , low fat, high fibre, low GI, Mediterranean, high protein etc etc

The results and methodology of the various trials showed a lot of variability ie they weren't consistent . They were able to include. 20 trials with 3073 subjects..
Results : (as far as they went because of the trial variability)
Glycemic control
Diets that showed a significant drop in HbA1c compared with the control diet
( I've put the average HbA1c reduction and the number of trials in bold and left in the confidence intervals for those that want to see them)
low-carbohydrate ( reduction of -0.12%, 95% CI -0.24 to -0.00; eight RCTs; Ι²=75%);
low-GI (-0.14%, 95% CI -0.24 to -0.03; three RCTs; Ι²=80%);
Mediterranean (-0.41%, 95% CI -0.58 to -0.24; three RCTs; Ι²=82%);
high-protein (-0.28%, 95% CI -0.38 to -0.18; two RCTs; Ι²=60%).
Weight loss
figures not given in the review
'The Mediterranean diet led to greater weight loss than control diets; -1.84 kg (95% CI -2.54 to -1.15).
There was no statistically significant difference in weight loss with low-carbohydrate, low-GI and high-protein diets compared with control diets'
Lipids
HDL was increased with the low-carbohydrate, low-GI and Mediterranean diets, compared with control diets, but not with the high-protein diet. The Mediterranean diet also significantly reduced triglycerides.
Authors Conclusion
Low-carbohydrate, low-GI, Mediterranean and high-protein diets were effective at improving various markers of cardiovascular risk in people with diabetes

The review points out lots of possible flaws in both the analysis and methodology of many of the trials. (they always do this. I think the problem is that doing well controlled diet trials is difficult (people are very variable and don't respond predictably like lab rats) No wonder there are difficulties and controversies when evaluating the evidence) None of the results show magnificent results . I think that's mainly because most long term trials show a lot of people don't stick to their allocated diets and at the end of the trial both the controls and the test subjects end up eating similar diets.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?ID=12013016138#.Ut5L9ppwZjo

 

[douglas99]

The only flaw in meta analysis is that all the results are preselected, so anything that doesn't fit is excluded automatically.
Hence all results usually fit the required conclusions already.

Again, with the study above, they consider long term greater than 6 months, whereas others consider it greater than 10 years.

 

[catherinecherub]

The only flaw in meta analysis is that all the results are preselected, so anything that doesn't fit is excluded automatically.
Hence all results usually fit the required conclusions already.

Again, with the study above, they consider long term greater than 6 months, whereas others consider it greater than 10 years.

I have been following this thread and notice whatever anyone says or no matter how many studies are put forward you still cannot accept anything else other than your own opinion..
You stated earlier that you would like the Newcastle Diet for Type 2s as it was your preferred option after I had posted a link showing that DUK were funding a five year follow up on this diet but you ignored the link. Depending on this study costing over £2million it may become an option.
Might be an idea to give it a rest now, this thread is going nowhere fast and is miles away from the original post.

 

[douglas99]

I have been following this thread and notice whatever anyone says or no matter how many studies are put forward you still cannot accept anything else other than your own opinion..
You stated earlier that you would like the Newcastle Diet for Type 2s as it was your preferred option after I had posted a link showing that DUK were funding a five year follow up on this diet but you ignored the link. Depending on this study costing over £2million it may become an option.
Might be an idea to give it a rest now, this thread is going nowhere fast and is miles away from the original post.

No I read the link.
Indeed, it's the point I made.
What I am saying is if DUK state that there are no long term studies being presented, It's a pointless argument to keep using 6 month studies to provide data to them.
No matter how convinced we are, if the information they want isn't provided, merely providing something they keep saying they don't want isn't going to work.

Also the thrust of the meta analysis isn't that low carbing isn't the only solution, many varied diets seemed to produce the same effect.

 

[douglas99]

The presentation that goes with the summary pdf is more interesting

http://www.bda.uk.com/BDAlive/Paul McArdle .pdf

The summary -


"There is a need for high quality
research, including RDs, using clearly
defined approaches."

The BDA also had a presentation on protein

http://www.bda.uk.com/BDAlive/Azmina Govindji Rick Miller.pdf

full list here

http://www.bda.uk.com/BDAlive/

 

[fatbird]

I have been following this thread and notice whatever anyone says or no matter how many studies are put forward you still cannot accept anything else other than your own opinion..
You stated earlier that you would like the Newcastle Diet for Type 2s as it was your preferred option after I had posted a link showing that DUK were funding a five year follow up on this diet but you ignored the link. Depending on this study costing over £2million it may become an option.
Might be an idea to give it a rest now, this thread is going nowhere fast and is miles away from the original post.

Well said but lets keep the thread open and stick to the OP topic.

FB

 

[douglas99]

Well said but lets keep the thread open and stick to the OP topic.

FB

I'll await your good news.

"Diabetes UK advice low carb high fat diet for all type 1 and type 2 diabetics"

but I think the DBA presentation results may sway them more.

 

[IanD]

The presentation that goes with the summary pdf is more interesting

http://www.bda.uk.com/BDAlive/Paul McArdle .pdf

The summary -


"There is a need for high quality
research, including RDs, using clearly
defined approaches."

The BDA also had a presentation on protein

http://www.bda.uk.com/BDAlive/Azmina Govindji Rick Miller.pdf

full list here

http://www.bda.uk.com/BDAlive/

Thanks for finding those, Douglas,
They indicate that the whole carb situation is officially in a state of confusion. How can DUK can make clear recommendations, while warning against low carb when the data is so confused??

It increases the importance of this thread.

 

[douglas99]

Thanks for finding those, Douglas,
They indicate that the whole carb situation is officially in a state of confusion. How can DUK can make clear recommendations, while warning against low carb when the data is so confused??

It increases the importance of this thread.

My point exactly.
There is no such beast as a "low carb diet"

If there was that would be a start, and studies made of that particular diet .

 

[fatbird]

"My point exactly. There is no such beast as a "low carb diet"

Good grief

FB

 

[Yorksman]

My point exactly.
There is no such beast as a "low carb diet"

If there was that would be a start, and studies made of that particular diet .

Well there are studies into Low Carbohydrate diets but do you mean no studies into the long term effects of a Low Carbohydrate diet? This is the sort of caveat one often sees in these studies: "Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed." (A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity)

 

[Andy12345]

"My point exactly. There is no such beast as a "low carb diet"

Good grief

FB

i have to assume you are on a wind up mate

 

[douglas99]

"My point exactly. There is no such beast as a "low carb diet"

Good grief

FB

You're probably one of the worst offenders.
Low carb diet -

You've put up paleo, low carb high protein, low carb reduced fat Mediterranean portion controlled, reduced carb reduced fat, vegetarian low carb, vegetable fat, and claimed them all to provide positive proof low carb high fat is the way to go.

Instead of banging your head on a wall, now, just tell me exactly what a "low carb diet" is.

And not the buzzword LCHF, exactly how much carbs, protein, and fat is in a low carb diet?

Then we'll have a peg in the ground.