Low carb diets and Diabetes UK

douglas99 · Jan 21, 2014

Yorksman said:
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)

No, as above.

IanD · Jan 21, 2014

douglas99 said:
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 .

DUK deliberately confuse the defininition by stating in their Position statement on low carbohydrate:

For the purpose of this position statement, the term “low-carbohydrate” is used as a collective term to describe any amount of carbohydrate restriction which is less than the dietary reference value of 45% of total energy.

And DUK immediately issue an implied warning against even that:

What are the risks associated with low-carbohydrate diets?

Any contact with DUK regarding carb restriction is met with their "well researched" advice against it:

Nutrition adequacy of the diet needs to be assessed; one of the main side effects associated with a low carbohydrate diet is the risk of hypoglycaemia, which can be even greater during physical activity. It is therefore important to consider overall diabetes control and monitor blood glucose levels closely and adjust medication accordingly. Other reported side effects include headaches, lack of concentration and constipation.

How "well researched" is their position statement? Phoenix & Douglas have provided links that show a high level of confusion, not least with definitions that make a meta-analysis impossible.

So should we let DUK hide behind their's & others' meta-analysis, or should we pay more attention to the specific work by e.g. Dr Daly & the Swedes, who have defined their parameters.

Yorksman · Jan 21, 2014

douglas99 said:
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?

Tha study above used the following:

"The subjects assigned to the low-carbohydrate diet were instructed to restrict carbohydrate intake to 30 g per day or less."

Magilly666 · Jan 21, 2014

Some people are frightened for the jobs and positions , to change is difficult and painful , and do not forget litigations!

fatbird · Jan 21, 2014

What is a low carb diet? Just as ambiguous as a healthy balanced diet. The so called ‘healthy balanced diet’ lead to obesity and type two diabetes for me. Low carb diet for me is 50 grams of carb per day. Others see it differently. A good place to start is reduce carbohydrates and be guided by your blood glucose meter. When weight loss (if necessary) has been achieved-make up the calorie deficit with good quality fats.

FB

Daibell · Jan 21, 2014

So we have a Western diet full of carbs that is known to be unhealthy, yet the experts want to spend loads of time and money proving that a low-carb diet isn't unhealthy; this is stupid and bad science. I'm an engineer and have had to make many design trade-offs over the years. When presented with a proven bad route with an unproven bad route I know which way I would go (and have gone). Simples.

douglas99 · Jan 21, 2014

Yorksman said:
Tha study above used the following:

"The subjects assigned to the low-carbohydrate diet were instructed to restrict carbohydrate intake to 30 g per day or less."

Exactly. my point again.

So 30g per day.
So very low carb. not low carb by most definitions on here.

And what of the rest of the diet to supplement the carb deficiency?

No replacement - low calories diet

Replaced by fat
saturated, unsaturated?

Replaced by protein?

douglas99 · Jan 21, 2014

fatbird said:
What is a low carb diet? Just as ambiguous as a healthy balanced diet. The so called ‘healthy balanced diet’ lead to obesity and type two diabetes for me. Low carb diet for me is 50 grams of carb per day. Others see it differently. A good place to start is reduce carbohydrates and be guided by your blood glucose meter. When weight loss (if necessary) has been achieved-make up the calorie deficit with good quality fats.

FB

So you need to limit your evidence to studies that reflect your diet proposal, not shotgun every diet with the words "low carb" in it as proof, then it becomes a serious study, and one DUK can identify with it.

douglas99 · Jan 21, 2014

Daibell said:
So we have a Western diet full of carbs that is known to be unhealthy, yet the experts want to spend loads of time and money proving that a low-carb diet isn't unhealthy; this is stupid and bad science. I'm an engineer and have had to make many design trade-offs over the years. When presented with a proven bad route with an unproven bad route I know which way I would go (and have gone). Simples.

So an I, that's why you need a proper spec for the good route, a vague over that way" isn't good engineering.

Let's get a proper diet, and proper studies to prove that particular diet, as any engineer would.

douglas99 · Jan 21, 2014

Andy12345 said:
i have to assume you are on a wind up mate

Size of the steaks you have, you're low carb, medium fat, high protein mate.

IanD · Jan 21, 2014

Is there a role for low carbohydrate diets in the management of type 2 diabetes?

J. Worth1 and H. Soran2

Citation 18 in the DUK Position Statement includes the following paragraph:

In summary, low-CHO diets of 6–12 months duration have no adverse effect on CVD risk factors, and show no major adverse effects to preclude their use. Meaningful weight loss is achieved, but this does not appear to be sustained beyond 6 months. Long-term trials are required to assess their safety, and studies are awaited to define the role of such diets within patients with diabetes. In the study by Samaha et al., 39% had diabetes, and the mean fasting glucose level decreased more in the low-CHO group than in the low-fat group (−9 ± 19% vs. 2 ± 7%, p = 0.02) at 6 months.13 A 16-week pilot diet intervention trial also demonstrated that a low-CHO, ketogenic diet can improve glycaemic control in obese type 2 DM patients (mean BMI 42), such that diabetes medications were discontinued or reduced in 17 of the 21 participants.19 However, to date there has been no randomized controlled trial in type 2 DM patients and health care professionals remain wary of their use, particularly as standard dietary advice from Diabetes UK does not support this approach.7

The last sentence is telling:

However, to date there has been no randomized controlled trial in type 2 DM patients and health care professionals remain wary of their use, particularly as standard dietary advice from Diabetes UK does not support this approach.

Does that mean that LCHF (modified Atkins) is considered "unethical" bythe HCPs because of the attitude of DUK?

The authors refer to Dr Daly's work (funded by DUK) which I quoted earlier:

Until long-term safety data are obtained for low-CHO diets, a compromise may be appropriate, with the use of diets with lower CHO and modest protein intake. Such an approach has been trialled in a small-scale study led by the South-West Clinical Diabetes Research Group.23 Obese type 2 DM patients (n = 102) were recruited and randomly allocated to follow either a CHO restriction diet or a low-fat diet; 79 completed the 3 month study, with similar attrition rates in each group. Weight loss was greater in the low-CHO group (−3.55 ± 0.63 vs. −0.92 ± 0.40 kg) and cholesterol: HDL-cholesterol ratio improved (−0.48 ± 0.11 vs. −0.10 ± 0.10 kg), despite a diet containing more protein, saturated fat and less fibre. On the basis of this, a two-year randomized controlled study of CHO-restriction versus a prescribed energy deficit diet, in 300 obese type 2 DM patients has been funded by Diabetes UK. The study is due to report this year, and will provide information regarding the long-term efficacy and any potential side-effects of a low-CHO diet in patients with type 2 DM.

A six-month interim report (abstract only) based on 259 type 2 DM patients revealed greater weight loss in the low-CHO group (−3.77(0.46) vs. −1.34 (0.32), p < 0.0005) with no deleterious effect on glycaemic control, other risk factors or renal safety.

Dr Daly responded to my email query:

We have presented our results at 3 national and 1 international meetings. We found no serious adverse effects over 2 years but not everyone is as good at sticking to low carbohydrate diets as you – you’re certainly doing well to keep the tennis going well – I suspect you need extra carbs on tennis days?

We also found that the lower carb group lost more weight initially but the difference between the groups became less over time. Cholesterol and blood pressure were similar.

It is sad that a DUK funded 2-year project (Daly, ref.8) giving satisfactory results for low carb should not get a special mention in their Position Statement & is virtually dismissed:

There is evidence that low-carbohydrate diets lead to improvements in HbA1c and/or reductions in body weight, but this needs to be interpreted with caution (4, 5, 6, 7, 8). This benefit is mainly observed in short-term trials lasting six months or less.

tonyS54 · Jan 21, 2014

douglas99 said:
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.

The threads not intended to be about "low carb high fat diet for all type 1 and type 2 diabetics" it's just getting DUK to accept LC as a viable alternative to their guidelines.

From what I've gleaned from this thread DUK’s evidence based diet advice is anything but.

fatbird · Jan 21, 2014

Douglas said

"So you need to limit your evidence to studies that reflect your diet proposal, not shotgun every diet with the words "low carb" in it as proof, then it becomes a serious study, and one DUK can identify with it."

What is your diet? you have said you do not count carbs. You have said you drop in and out of medication. Do you actually know what you are doing from one day to the next. You sound like a very confused man to me.

FB

douglas99 · Jan 21, 2014

tonyS54 said:
The threads not intended to be about "low carb high fat diet for all type 1 and type 2 diabetics" it's just getting DUK to accept LC as a viable alternative to their guidelines.

From what I've gleaned from this thread DUK’s evidence based diet advice is anything but.

The whole point of my posts is there is no way to live on a low carb diet.

Low carb high fat diet, as a lot seem to think that's what low carb must be without any other option.
Or is it low carb high protein, or all the other versions like paleo, that are equally low carb?

They can't accept just LC, as it's a meaningless phrase, and needs to be defined.
Otherwise "low carb" is just as lacking in evidence.

fatbird · Jan 21, 2014

Douglas said

"The whole point of my posts is there is no way to live on a low carb diet."

FB

paul-1976 · Jan 21, 2014

douglas99 said:
The whole point of my posts is there is no way to live on a low carb diet.

Oh really?

douglas99 · Jan 21, 2014

FB[/quote]

paul-1976 said:
Oh really?

Define a low carb diet then.
And I'll give you ten to one you can't without using proteins or fat or calories.

fatbird · Jan 21, 2014

Douglas said

"Define a low carb diet then.And I'll give you ten to one you can't without using proteins or fat or calories."

I have been searching for a zero calorie diet for years-just think of the money we could save.

FB

mo1905 · Jan 21, 2014

Seems to be going round in circles here and getting nowhere fast. Nobody can catagorically state exactly what a low carb diet is. We all eat and like different food. We really should be trying to push and encourage reducing carbs, not defining the diet. How long is a piece of string ? How long should everybody exercise for exactly ? Is it 30g of carbs for someone who weighs 8stone as well as someone who weighs 28stone ? Pointless !

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shirty252 · Jan 21, 2014

I would imagine someone has a big law suite coming their way??

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Low carb diets and Diabetes UK

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