Low-Carbohydrate Diets and All-Cause Mortality:

[Sid Bonkers]

Table 13. Apologies, it's 93.1% that aren't getting the 6.5% HbA1c target, not 94%. This table is for Type 1s in England only, for Wales it's worse. There is a complete breakdown in the audit of diabetes performance across the UK for both types. Pretty reputable source if you ask me.

LOL, thats not what you said at all and you know it isnt, you didnt state you were talking about T1's and you still havent stated the NICE recommendations which I believe are 7% or 7.5% something not 6.5% at all.

And further more that same study actually stated that 60% plus of T2 diabetics were reaching NICE recommended levels so your figure of 94% of diabetics is totally wrong which ever way you look at it. Just as I pointed out already.

@superchip Im not even going to bother answer you as your reply is just rude, aggressive, confrontational and totaly against forum rules. But I will report it seeing as no moderator has removed it.

 

[hanadr]

Yet again an ill informed comment about Doctor Atkins. He was an eminent cardiologist, who devised his diet for his heart patients. His patients certainly benefitted. His own death has had any number of fictional stories told about it. What is certain is that in his 70s,he was walking to his surgery in New York in snowy weather and slipped on ice and hit his head. His death resulted from the head injury although he lingeredd on life=support for some days.
He was NOT a MISTER ATKINS who wrote a book to make money.
Hana

 

[Andy12345]

Ok I don't understand most of this but until someone says it's bad for me for sure ill carry on losing weight and enjoying great bg counts

 

[SamJB]

Sid, as you can see from my first post in the topic I did state that the statistic was for Type 1s. For the sake of brevity and assuming people have read my posts before replying to them, I later referred to the statistic being for "diabetics". Perhaps we were both mistaken in this regard?

The 6.5% target was set largely from from the results of the DCCT trial. This found that at an HbA1c of 6.5% the risk of complications reaches unity with the non-diabetic population. Presumably this was why the National Diabetes Audit, commissioned by the NHS (and others) set the target of 6.5%. Incidentally, this is also the target set by Diabetes UK who also commissioned the audit.

I'm very pleased that 60% of Type 2s are reaching the HbA1c target - great news. Although this still leaves hundreds of thousands not reaching the target. Not great news for Type 1s though, unfortunately.

Surely you can agree that 93.1% (of Type 1s) is completely unacceptable and implies that something is fundamentally wrong?

I can see the way this thread is descending, perhaps we should agree to disagree? Based on my experiences and the evidence I've read, I think low carbing is efficacious and low risk compared to the status quo of carbohydrate advice. You differ. Fair doos, everyone's entitled to an opinion!

 

[WhitbyJet]

Oh dear me, does anyone really take any of the studies seriously? I have yet to find one study that doesnt have flaws.

I am type 2, no meds, this is my 6th year of following the low carb lifestyle, Hb1ac consistently at non-diabetic levels, CKD stage 2 stable (reversed from stage 3-4), cholesterol/trigs no issues, no inflammation markers;
most of my carbs come from vegetables and berries, occasionally other fruit, I dont overdo it on protein, I eat the good fats and I dont ever miss bread, pasta, rice, potatoes.
I have a good balance of work, exercise, relaxation, socialising, solitude, friends, family, pets and heaps of love, fun and laughter in my life, so where's the problem?

Do what works for YOU, listen to your body, test your bg, use common sense and you cant go far wrong.

 

[SamJB]

Wonderful post WhitbyJet.

Do what works for YOU

Precisely, whether this is with carbs or without it!

 

[Cinderella]

I was only diagnosed Type 2 in December 2012 so do not have much experience and all those statistics make my head spin! I guess each individual has to decide for themselves what diet they think is most beneficial for them. I have been trying to follow the low carb route and my first HBA1C since being diagnosed was 7.2 which I am relatively pleased with. Diabetes is a strange disease and we all just have to do the best we can. I'm not sure about basing anything on statistics I just go with what works for me.

Cinderella

 

[mrman]

Just to add my opinion. Type 1 and eat a healthy diet including carbs. I eat 2~300 carbs a day which is my recomended intake of carbs if I was not diabetic. I have simply modified my insulin to suit my carb intake. Last hba1c was 5.6, achieved by using a pump. No way would I of achieved it on mdi. Diets In my opinion are good short term to achieve a goal but don't think good for the long term. I think it is the lack of support and advice given that lead to people not achieving hba1c targets eating carbs so end up low carbing instead.

As for type 2, can't really comment as obviously some can't cover food with insulin, but, are then given poor advice on the type of carbs to include.

Also a final thought is some type 2, low carb to avoid going to insulin. Personally, I would rather have the insulin and have a normal healthy diet. That is only personally my thoughts.

Sent from my GT-S5360 using DCUK Forum mobile app

 

[Sid Bonkers]

The 6.5% target was set largely from from the results of the DCCT trial. This found that at an HbA1c of 6.5% the risk of complications reaches unity with the non-diabetic population. Presumably this was why the National Diabetes Audit, commissioned by the NHS (and others) set the target of 6.5%. Incidentally, this is also the target set by Diabetes UK who also commissioned the audit.

Perhaps you can supply a link to this study as I think you may be mistaken as I thought it was two HbA1c's over 6.5% that is used to diagnose diabetes in the first place!!.

I can think of one study done a few years ago that came to the conclusion that HbA1c's under 6.5% where if fact dangerous for T1 diabetics and led to earlier mortality, but searching Google for the DCCT Trial all I can find is information about is a study about reductions in retinopaphy CVD not a stated level of HbA1c for T1's or T2's although of course I may have missed it.

And of course this thread is about a study into whether low carb diets are safe in the long term not about levels of safe HbA1c for T1's or T2's. As a T1 I would consider the best levels to be the ones that the individual is happy with although the NICE recommendations which are used by the NHS and stated quite clearly here on this site here: http://www.diabetes.co.uk/diabetes_care ... anges.html

Are:
What is a good blood glucose level?

NICE recommended target blood glucose level ranges Target Levels
by Type............................Before meals (pre prandial).........2 hours after meals (post prandial)
Non-diabetic............................4.0 to 5.9 mmol/L....................under 7.8 mmol/L
Type 2 diabetes........................4 to 7 mmol/L.........................under 8.5 mmol/L
Type 1 diabetes........................4 to 7 mmol/L.........................under 9 mmol/L
Children w/ type 1 diabetes.........4 to 8 mmol/L.........................under 10 mmol/L

So quite where your figure of 6.5% comes from escape me. As no figure of 6.5% has been set by anyone as far as I can see. It is NICE who set recommendations for use in this country, they have just been reduced from 7.5 to 7 mmol/L for T1 & T2 pre meal but as far as I am aware no % has been recommended in fact the DCCT percentages have now been binned in favour of the newer IFCC (International Federation of Clinical Chemistry) units of showing the HbA1c results.

Non of which has got much to do with a thread that simply posted a report of a study that stated that the long term use of low carb diets may not be good for general health, I think we all know that reduced carbs are a good way to control bg levels, I dont think that is in question but up till this moment in time there have been no studies into their long term safety which I think would be a good idea, and probably more so for those who eat a very low carb diet but it seems that some people would rather not see any research done into the possible safety aspects of their chosen diet, and in fact choose to ignore any studies that report any negative aspects at all.

 

[SamJB]

Here's a link discussing the results of the DCCT trial:

http://www.medscape.org/viewarticle/473744

So quite where your figure of 6.5% comes from escape me.

I've been told by my care team to aim for 6.5%. Several studies suggest that this is the target. Plus this is the figure recommended by Diabetes UK:

http://www.diabetes.org.uk/Guide-to-dia ... ctosamine/

This is all getting a bit academic now and admit we are digressing. So, in summary, here's my argument:

The mortality risks quoted in the study you presented are lower than the mortality and complication risks from having elevated sugar levels. So if you can low carb and not have elevated sugar levels then you are better off.

I am in complete agreement with you when you say that more research is needed into both the negative and positive effects of low carbing, couldn't agree more.

 

[PhilT]

http://rawfoodsos.com/2010/09/08/brand- ... in-trouble and others have issues with the original study - not least things like the "low carb" groups having levels of carbohydrate way above what anyone sensible would call low carb.

Then there's the meat eaters group having lots of smokers and obese people. So is meat a cause or a co-related factor ?

Epidemiology sucks.

 

[hanadr]

NICE used to have 7% HbA1c as their target for diabetic control. They revised it down to 6.5% not too long ago. For those who work in the new units, that's 53 revised down to 48.
To achieve HbA1c of 7%, you average around 9.6 mmol/l bg for 6.5% Hba1c it's 8.6.
Since non-diabetric numbera are about hbA1c 4.5% or an average of 4.6mmol/l Blood glucose,
I can see even 6.5% as much too high.
What we need is for everyone to understand the difference between blood glucose as a dynamic thing [ constantly changing] and measured in milimoles of glucose per litre of blood and Hb A1c as a measure of how much glucose has stuck ireversibly to the haemoglobin of the erythrocytes over a period of about 100 days, or the life of the aforementioned corpuscles.
Every now and again, I explain the definitions of some of the terms and their units and some of the chemistry involved.
Blood glucose values taken by finger-sticks and hb A1c measured in venous blood [taken by the phlebotomist] are NOT directly equivalent.
Hana

 

[hanadr]

All Cause Mortality includes road traffic accidents and ferry sinkings.
In low carbers, Cardiovascular disease is unlikely to be a acause since our CVD risks are usually low.
However
150/ 200g carb per day is NOT low.
Hana

 

[Geocacher]

Statistics can tell us everything and they can tell us nothing. All cause mortality is a catch all, it doesn't tell us that anyone on a low-carb diet has perished from a cause directly related to the diet. It just tells us that people have died and some of them happened to have claimed to be on a low carb diet. No doubt a majority of those people who died also claim to be christian, does that mean religion kills? They also probably used an escalator rather than stairs once in the week before they died, does that mean that if we don't use stairs we are more likely to die?

What is more likely telling us is that people who follow a low carb diet are more active and therefore more likely to get run over by a bus when they are out jogging, or get knocked off of their bicycle, or hit at a zebra crossing when they are out walking.

What's unfortunate is that scaremongers like Dr. Oz and the Natural News so often glom onto meaningless statistics like this and turn them into a reason for the unenlightened to buy books and/or products that do them no real good.

If you can't understand the data behind it, if it isn't from a reliable source, or if it seems too strange to be true, then don't believe it until you have all the facts.

 

[IanD]

The OP report does not consider low carb diet in relation to diabetes, where "we" have found considerable benefit in terms of BG control. Further, the assumption is the a low carb diet is high protein. The fat in the diet was not assessed.

My diet is low carb, high fat. My protein consumption is similar to my wife, who has a heart problem, but is not diabetic. We have a substantial consumption of vegetables & fruit. Nuts form a significant part of my diet.

12 years ago, on diagnosis, I was given a diet that amounted to about 300 g carb daily, & was told that diabetes was progressive, even if I followed the diet carefully. I did. 7 1/2 years on the complications were debilitating. With advice from this forum I switched to low carb. 3 months of low carb & I was fit & well. After 5 years of low carb I am free of all complications.

The TRUTH is that the high carb diet advised by the NHS & DUK causes serious health problems & ensures that T2 is progressive. A low carb diet potentially reverses diabetic complications.

I would not DARE to revert to the NHS/DUK high carb diet. I have too much to lose.

The 6.5% target was set largely from from the results of the DCCT trial. This found that at an HbA1c of 6.5% the risk of complications reaches unity with the non-diabetic population. Presumably this was why the National Diabetes Audit, commissioned by the NHS (and others) set the target of 6.5%. Incidentally, this is also the target set by Diabetes UK who also commissioned the audit.

.......
And of course this thread is about a study into whether low carb diets are safe in the long term not about levels of safe HbA1c for T1's or T2's. As a T1 I would consider the best levels to be the ones that the individual is happy with although the NICE recommendations which are used by the NHS and stated quite clearly here on this site here: http://www.diabetes.co.uk/diabetes_care ... anges.html

What is a good blood glucose level?

NICE recommended target blood glucose level ranges Target Levels
by Type............................Before meals (pre prandial).........2 hours after meals (post prandial)
Non-diabetic............................4.0 to 5.9 mmol/L....................under 7.8 mmol/L
Type 2 diabetes........................4 to 7 mmol/L.........................under 8.5 mmol/L
Type 1 diabetes........................4 to 7 mmol/L.........................under 9 mmol/L
Children w/ type 1 diabetes.........4 to 8 mmol/L.........................under 10 mmol/L

So quite where your figure of 6.5% comes from escape me.

Sid, those readings are the test strip readings we make, which will vary considerably through the day & night. The 6.5% is the HbA1c which is in effect an average reading over 2-3 months based on the cell glucose. HbA1c is a measure used by the HPs to assess the progress of our condition.

......
Non of which has got much to do with a thread that simply posted a report of a study that stated that the long term use of low carb diets may not be good for general health, I think we all know that reduced carbs are a good way to control bg levels, I dont think that is in question but up till this moment in time there have been no studies into their long term safety which I think would be a good idea, and probably more so for those who eat a very low carb diet but it seems that some people would rather not see any research done into the possible safety aspects of their chosen diet, and in fact choose to ignore any studies that report any negative aspects at all.

Have there been NO long term studies? And is the cited report an assessment of valid long term studies?

The July-August 2003 "Balance" (P34-) printed an article "Starchy & Husk" investigating the truth behind a low carb diet, particularly Atkins. The article expressed concerns about increased risks of: heart disease, cancers, bowel disorders, osteoporosis, kidney disease....

The article concludes: "Research into the long-term effects of low-carb diets is now required ... DUK is funding such research." 10 years on we are still waiting. DUK's "Position Statment - Low-carbohydrate diets for people with Type 2 diabetes" :

Diabetes UK has reviewed the evidence from 1998–2009 relating to low-carbohydrate diets, weight control, blood glucose management and Type 2 diabetes. 
....
Diabetes UK has concluded that:
Evidence exists suggesting that low-carbohydrate diets can lead to improvements in HbA1c and reductions in body weight in the short term (less than 1 year).
Weight loss from a low-carbohydrate diet may be due to a reduced calorie intake and not specifically as a result of the carbohydrate reduction associated with this diet.
Despite the short term benefit there is a lack of evidence related to long term safety and benefit of following this diet

.....
A review of low- and reduced-carbohydrate diets in 200816 reported no deleterious effect on glycaemic control or cardiovascular risk factors, and again reported that these findings should be interpreted with caution because the majority of studies lacked a control group and were of short duration. 
.....
In conclusion, low carbohydrate diets may be effective in facilitating weight loss in people with Type 2 diabetes in the short term, but there is no evidence that this approach is more successful in the long term than any other approach9. More research is needed to assess the effectiveness of varying degrees of low-carbohydrate diet on weight, glycaemic control, hypertension and lipid profile in people with Type 2 diabetes18 as well as to investigate the long term effects of these diets9.

So, a review of 11 years of reports has only found benefits for a low carb diet - expressed in negative terms "no deleterious effect on glycaemic control or cardiovascular risk factors".

I have studied the citations & note that they include a 44 month Swedish study - NOT "short duration" especially as some of the control, high carb group switched to low carb when they saw the benefits.

Quoting from the OP report:

.... Most of the studies included in the systematic review were conducted in the US and European countries and their follow-up durations were long enough for the outcomes to occur. Although the majority of the enrolled subjects were middle-aged and free of such chronic comorbidities as diabetes and coronary heart disease, healthcare professionals dominated in the US cohorts, who may not truly represented the average population in the community.
....
Some studies suggested that low-carbohydrate diets might increase the risk of mortality and CVD in animal-based dietary patterns whereas they might decrease the risk in plant-based diets. [7], [9], [30].

The estimates in all the other analyses using either score were non-significant and none of these studies revealed that low-carbohydrate diets were associated with a significantly decreased risk of these outcomes.
....
With regards to external validity, it is also important to realize that the participants of the studies may not represent general populations most likely because the majority of the studies were done in Western countries and healthcare professionals dominated. It remains unclear if these diets exert a similar influence on the clinical outcome in diabetic patients.

 

[hanadr]

I keep coming back to this thread, because my scientist brain sees it as a bit of very bad science. I also fear that so many people who could benefit from controlling their carbs will be scared away by the nonsense of it.
I know it's anaecdotal, but I'm sure Ian D would agree. Either of us would meet up with anyone scared of low carbing. we're not young, but very fit low-carbers.[ we do know each other personally].
I've looked again at the paper that sparked everything off. It specifies low carb High Protein, but doesn't give actual levels. i also couldn't find what the actual causes of death were in the studies quoted. It does however state that CVD risks were low in the low carb cohort.
The best long term study that I know of on the subject is the Jorgen Neilson[ spelling?] Swedish study, which is very important because the data is so good. although the numbers of people involved was small. this sudy continued for 4 years and shows the benefits of low carb very clearly.
I have also seen the tragic consequences of poor control of diabetes. Until I managed to persuade my husband to reduce his carb intake [he's a long term T1], His health was going down the drain fast, with 2 Charcot feet, needing NHS shoes, but so far no amputations, the loss of sight in one eye down to a failed attempt at a vitrectomy by our local hospital and serious kidney failure. Since he reduced his carbs [ still not truly low] all this has stabilised. He's been free of foot ulcers for several months, not needed any further laser for his eyes and kidneys haven't got worse in a couple of years. just increasing his insulin MIGHT have done the same, but somehow I doubt it. Oh and he lost 2 stone!
Other than that, I meet many diabetics during the course of my campaigning activities, I've met quite a few amputees, including a former work colleague who eventually died after his last operation, first a few toes on each foot and then the whole forefeet.[ aged in his 60s.T1 from a toddler] Lots whose sight is severely impaired, even more confined to wheelchairs and even a couple of kidney transplant survivors.
Hana

 

[Yorksman]

More information here http://www.plosone.org/article/info%3Ad ... ne.0055030

Its long been said that the effectiveness of low carb diets are only beneficial in the short term, somewhere between 6 months to 1 year. Lets hope that more long term trials are undertaken to prove this one way or the other or some diabetics could find themselves doing more harm than good.

Thanks for the link to the study. My wife and I did a zero carb diet back the early 1980s and it did work, but it was not very pleasant. Before Atkins, it was called a protein only diet. However, it was only meant to be taken in three stages, each lasting 10 days. We had to supplement it with a vitamin pill, which was sugar coated and our reserves were so low, we craved it. It was OK the first session, difficult the second session and awful the third and final session. Definitely not a lifestyle choice.

Personally I would worry about the high fat element of a low carb high fat diet. My trigs have more than halved but I am not sure that would not have been case if I didn't watch my fat intake, although I do know that sugars elevate trigs. I don't cut all fat out, just cut down on it, cut it off bacon, spread butter more thinly and so on. Same with carbs, avoid the refined stuff, moderate the medium GI but fill up on low GI.

 

[jddukes]

This study is certainly interesting to bring up and should certainly be given some thought, but to my mind quickly appears the limitations of such studies. There are several problems I have with this study, and those similar.

- There is no context of what we are concerned with.
I.e. we are diabetics trying to reduce our complications, with a read-out of BG levels and ultimately HbA1c. We know that a reduction in both those readings (to a point) will improve our long-term outcome and mortality rate, as that is very well established. This study (as already mentioned) does not approach the subject of low-carb from a diabetic point of view. Therefore it is very difficult to actually relate any of these findings to people who are already predisposed to a higher mortality rate, which is true of all diabetics (you have a greater chance of dying as a diabetic than a healthy individual).

- The risk adjustments seem incomplete.
If you look at the tables that describe the trials and risk adjustments, in fact only 2 of the trials I believe out of them all adjusted for diabetes. This is even more pertinent when low carb diets are of particular interest to those of a diabetic nature (both Types) and a concern. These are large studies whereby we see many 1000s of people taking part. Diabetes for say, type 1 is about 1% of the population if my memory serves me correctly (and perhaps 10% for Type 2???!) so therefore at least for every 1000 participants you would expect 10 type 1's etc. That doesn't sound like much but when you are dealing with rates of mortality, 1 person in 1000 makes a huge difference as we are dealing with very low %ages.

- Comparability of trials is not fully assessed.
To truly do a meaningful analysis there have to be similar levels of carbs and other nutritional components. The definition of "low carb" is very tricky with regards to this and makes a study like this to be taken very cautiously.

- The very nature of the subject invokes an inherent problem with the study
There are 2 aspects to this. The first is why would someone go on a low carb diet in the first place. Although this study included RCTs, it clearly states in the methods of selection that RCTs were not a limiting criteria in study inclusion: "or observational studies of at least one year’s follow-up period." Therefore you always have to consider that there is an unaccounted for predisposition towards people who may be more (or even less) at risk of all-cause mortality or CVD mortality purely as you skew a population by looking at people who choose a particular diet. For example, if you stand outside a gay nightclub and do a survey on everyone who walks by and find that 40/100 people are gay, this does not mean that in the real world 40% of people are gay, it means that your location of survey skewed the results due to preselection bias.

The second aspect to this is that diets are notoriously hard to do large studies on. In the case of drug RCTs or double-blind placebo controlled drug studies, it is much easier to spot drop-out rates and those that deviate from the protocol and thus should be considered in a different light (read, NOT EXCLUDED, as the reason for drop-out for example could be due to drug toxicity and this must be assessed and considered in a trial - another trick of pharma companies, but I digress...), when compared with diets. Diets rely on self-reporting accuracies, they rely on people's psychological approach to food to be of a straightforward manner. A low carb diet may be particularly more dangerous if occasionally someone gorges on carbs in day of weakness and this can throw the results. Remember, when we are talking about 1000s of people there are literally just a couple of people needed to potentially make a significant difference. The very nature of diets make such studies extremely hard to be as scientifically rigorous as perhaps a drug trial.


I would personally say that this study poses no issue to the diabetic looking to improve their glycaemic control and markers through use of a low carb diet, both type 1 and 2 diets. If we remember that many diabetics will have:
- hypercholesterolaemia
- dislipidaemia
- hypertension
- haemoglobin hyperglycosylation

All of these are very large CVD and mortality risk factors. One thing we do see in the literature of late especially, is that low carb-high fat diets reduce:
- diastolic and systolic blood pressure
- blood triglycerides
- blood glucose levels and standard deviation
- HbA1c levels
They also have been shown to increase:
- HDL

Therefore the conclusion is from what we know being in the position of a diabetic, if you can improve all of those factors with a particular diet, that has no conclusive negative impact on health, then you will actually reduce your mortality risk. Whether you do that through low carbs or high carbs it does not matter - the point is that you DO reduce those figures. Now when you talk about personal experience you will see people on both ends of the spectrum for improvement of this with various diets, but there is growing evidence and increased publication around low-carb diets being beneficial for both type 2 and type 1 diabetics in improving those markers. Therefore to dismiss a reduction in carbs (and subsequent increase in fats) as risky based on a study like this, in my opinion would be quite unwise. This study should not be a cause for concern if you are a diabetic wishing to adopt a low-carb approach.

It is also worth mentioning that I suspect much of the worry about low-carb diets among NICE and other health organisations that make recommendations come from large studies done on mice and rats, which you could quite easily argue in fact are irrelevant to humans as these animals react very differently to dietary changes than humans do, that is certainly clear.

Don't get me wrong, meta-studies are good and I applaud very much so the efforts of the Cochrane collaboration and institute for instigating far more of these, but they must be used appropriately and there is still a level of human need to determine inclusion criteria from the vast number of studies, and this is what should be scrutinised the greatest.

J

 

[Yorksman]

I don't see how anyone can sensibly comment on this paper without referencing the cited papers in 'Table 2. Methodological assessments of the included studies', and 'Fig 2, Adjusted risk ratios for all-cause mortality associated with low-carbohydrate diets' for the details of what is meant by all cause mortality, low carbohydrate score or low carbohydrate high protein score.

One of the cited studies, Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. Fung et al 2010 (PubMed) concludes:

"A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates."

People shouldn't be so willing to dismiss peer science or the peer review process. Peer science is open to peer review and if other researchers wish to question or challenge any aspect of the published research, those challenges too are published. Sometimes this initiates a response from the original researchers.

Fung above is co-author to de Koning et al the following year in 'Low-carbohydrate diet scores and risk of type 2 diabetes in men. (2011 PubMed). It throws further light on the conclusion of Fung et al 2011 with the conclusion:

"A score representing a low-carbohydrate diet high in animal protein and fat was positively associated with the risk of T2D in men. Low-carbohydrate diets should obtain protein and fat from foods other than red and processed meat."

Cheese, fish, olive oil, chicken fat etc. are all better than red meat fats. Or, as the french say, the softer the fat, the better it is for you.

 

[Paul_c]

All Cause Mortality includes road traffic accidents and ferry sinkings.
In low carbers, Cardiovascular disease is unlikely to be a acause since our CVD risks are usually low.
However
150/ 200g carb per day is NOT low.
Hana

but it is "low" when you consider that the RDA for carbs is a gob-smacking 300 grams per day

http://www.netrition.com/rdi_page.html

what they call low-carb is against that 300 grams per day, what we call low carb is to get into or close to ketosis and requires far less than 130 grams a day.