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Low-Carbohydrate Diets and All-Cause Mortality:

I wish I was as considerably smart as you two ! It's great reading very long words when short ones will do lol ! I think the next, and possibly winning post, should be in Latin ;-)
Then it can finish ! And we can all be diabetic friends :-)


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lo us filli carbas muchos dominus asas comparious ass mossas ne fearious potious. !
 
hanadr said:
the definitions of things like "Low Carbohydrate" are not clear through the whole of this argument.
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You have to look at the individual studies and they don't give it in terms of grammes, they give it in 'scores'.

For example, the scoring system in 'Low carbohydrate–high protein diet and mortality in a cohort of Swedish women' Lagiou et al in Table 2 uses the following scoring system:


"Women were assigned a score from 1 (very low protein intake) to 10 (very high protein intake), according to their decile of energy-adjusted total protein intake. An inverse score, from 1 (very high carbohydrate intake) to 10 (very low carbohydrate intake) was also assigned according to the woman’s decile of energy- adjusted total carbohydrate intake. The scores were
studied both separately and after being added creating a composite additive score simultaneously assessing the position of each subject in terms of protein and carbohydrate intake. Thus, a woman with a score of 2 is one with very high consumption of carbohydrates and very low consumption of proteins, whereas a woman with a score of 20 is one with very low con-
sumption of carbohydrates and very high consumption of proteins."

To find out the how the bands are differentiated, you either refer to the Supplementary Data or contact the author.
 
I am - supposedly - on a low carb diet .I`m an overweight ,62 year old Type 1 currently taking 20 units of Levemir and 12 units of Victoza per day. I was diagnosed only 2 years ago but know that I have been diabetic for at least 15 years - my Mum and her siblings were all Type 1 and I recognised the symptoms.

Unfortunately I had a rotten G.P. who flatly refused to test my bloods - "all in the imagination !!" I am certainly paying the price for his attitude.

I know I do not get enough exercise - this is due to a degenerative spinal condition which makes even walking very hard - at times impossible.

I`m really struggling with this low carb diet,do not think I have lost much - if any - weight yet I watch what I eat like a hawk.

It would be much easier if I could have a pre-printed diet sheet like my Mum used to have.When I search for recipes all I seem to find are ones containing weird and wonderful ingredients.I am juggling ,trying to live on a low carb diet whilst trying to feed up my terminally ill husband.

Has anyone else found that stress affects their bloods - sometimes I am almost within limits 5 and then - for no apparent reason I`m up at 19/20.These increases do seem to appear when my husband has been exceptionally poorly,I am nursing him at home with help from Carers and the Palliative Team - but I am slowly going under !

Has anyone got any diet sheets please - just easy,quickly prepared food because as sure as eggs are eggs hubby is ill when I sit down to eat !

All/any advice gratefully received :?
 
Ian

The thread is moving on and you are contributing to that. I do not see why the contributions of others who are also moving the thread on should be off topic and need a fresh thread. The forum would be deluged with tiny, half discussed threads if we took that line.

Hoping you understand.

Doug
 
i really didn't want to get involved in this, but its actually really interesting.

"Heart diseases and stroke are the No. 1 causes of death and disability among people with type 2 diabetes. In fact, at least 65 percent of people with diabetes die from some form of heart disease or stroke.
Adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes.
The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease."

that's from heart.org.
the problem with that study is it shows low carb diets in THE GENERAL POPULATION. who have a much lower risk of CVD than diabetics. MUCH lower, like, loads! (exact values depend on far to many variables to give a proper estimate)

now, "if" by using a low carb diet we could lower our risk of CVD to the same level as in this study?
fantastic! because it would be lower than our risk of CVD as diabetics! (mostly i admit overweight T2s with bad glucose control, but still)
what we need, is a proper study of the effects of a low carb diet on DIABETICS.
:P

and i do mean a proper study, no number of personal success stories of low carb diets on this website is ever going to persuade ANY serious organisation to change its policy on diets.
EVER

its fine for you to say how much success you have had at lowering your BG readings by cutting out carbs, but your personal experiences count for absolutely diddly squat scientifically. and you "CANNOT" claim that your diet is "SAFE" and that everyone should follow it, without proper scientific proof. which you DO NOT HAVE...

now, as an aside, i do follow a low carb diet, not as low as some of you, but certainly less than 20% of my intake. and I've found it fantastic.
 
Yorksman said:
jddukes said:
I am not here to argue with anyone
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That's all you do. You don't seek information nor do you provide any. All you do is make posts written in the tones of a Dickensian schoolmaster.
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Pot. Kettle. Black.

If I apparently do not add any information nor seek information then I must contribute nothing to this forum nor benefit and that raises the point of being here at all. I will therefore let you get on with your superior contributions as I do not wish to be drawn into making personal judgements or negative comments about other members on here as forums are not the place for such behaviour in my humble (but apparently useless) opinion.

All the best and regards.
J
 
ilnar said:
"if" by using a low carb diet we could lower our risk of CVD to the same level as in this study?
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Few people here doubt that reducing carb intake or changing type of carb is an expedient but 'low carb' on its own says little. How low is low and what does one supplement it with? As stated in the introduction, "low-carbohydrate diets tend to result in reduced intake of fiber and fruits, and increased intake of protein from animal sources, cholesterol and saturated fat, all of which are risk factors for mortality and CVD." But that doesn't mean it is inevitable, it's just a question of what else one combines the low carb element with.

The study is actually a statistical review of many previous studies. Unfortunately those studies use different methologies. One of them which I looked at, 'Low carbohydrate–high protein diet and mortality in a cohort of Swedish women' Lagiou et al. used a score system with 19 combinations of varying levels of carbohydrate and protein ranging from a score of 2, with very high consumption of carbohydrates and very low consumption of proteins to 20, one with very low consumption of carbohydrates and very high consumption of proteins.

The problem with vague terms like low carbohydrate high fat is that neither the amounts are specified nor are the types; animal fats, vegetable fats, fish oils, dairy fats for example. Each type of fat has its own risk associations. Nor are other supplementary nutrients such as soluable fibre, useful for preventing the build up of deposits on the inner walls of blood vessels even mentioned. Consequently, I would not place too much faith in these vague terms. They are simply not informative.
 
Yorksman said:
ilnar said:
"if" by using a low carb diet we could lower our risk of CVD to the same level as in this study?
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"snip"

The problem with vague terms like low carbohydrate high fat is that neither the amounts are specified nor are the types; animal fats, vegetable fats, fish oils, dairy fats for example. Each type of fat has its own risk associations. Nor are other supplementary nutrients such as soluable fibre, useful for preventing the build up of deposits on the inner walls of blood vessels even mentioned. Consequently, I would not place too much faith in these vague terms. They are simply not informative.
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not arguing any particular point,
as i said earlier, we need a decent comprehensive study of the effects of a low carb diet on diabeteics, which, by definition, would include a range of carbohydrate intakes, and a variety of replacements, as well as long and short term health effects of everything!
sadly, given the COMPLETE lack of funding for such a project, since no one stands to directly profit from it, (even the NHS since there is no guarantee of a saving) unless DiabetesUK decide to fund it, it is unlikely to happen.
 
ilnar said:
sadly, given the COMPLETE lack of funding for such a project, since no one stands to directly profit from it, (even the NHS since there is no guarantee of a saving) unless DiabetesUK decide to fund it, it is unlikely to happen.
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When it comes to nutrition and diabetes the USA recommend Medical Nutrition Therapy, "Because of the direct correlation between diet and diabetes management, medical nutrition therapy (MNT) provided by a registered dietitian is a key complement to traditional medical interventions in diabetes treatment." This is the bit the NHS won't invest any real money in and advice is given in very general terms, often by non specialist staff. I went on a Desmond course and the entire afternoon was spent talking about foods but, when people asked what the recommendations were, they were simply told, 'we don't advise on any specific diet'. Looking at a plastic model of a fried egg and rasher of bacon was as good as it got.

Research isn't what the NHS is about. Organisations like the Wellcome Trust do that, http://www.wellcome.ac.uk and they are well funded. In addition there are individual academic institutions. You may have heard of the Counterpoint Study at Newcastle University, Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol which was diet based and done in collaboration with DUK and the Wellcome Trust.

I know the Wellcome Trust for their work in genetics but they do have a project devoted to nutrition, Researching health and disease: Nutritional studies, http://www.wellcome.ac.uk/Education-res ... 031529.htm

The European Prospective Investigation into Cancer and Nutrition or EPIC project also has a team dedicated to diabetes based in Cambridge, the The EPIC Europe Diabetes Study, http://www.mrc-epid.cam.ac.uk/Research/ ... betes.html Their study areas are listed here: http://www.mrc-epid.cam.ac.uk/Research/Programmes/
 
http://www.nhs.uk/Conditions/Clinical-t ... ction.aspx

the NHS do LOADS of research and clinical trials! it actually is a big part of the NHS, just not one that people see often
if there were an organisation better set up for long term studies on diabetics i have no idea what it would be!
we already have 3-6 monthly check up with (hopefully) knowledgeable clinicians, (blood)-tested, poked and prodded.
seriously, it would be disgustingly easy to set up diet studies, especially in the better CCGs like Portsmouth.

*shrugs*

its one of the things my company is pushing for at the moment, but sadly funding is rather lacking. especially among academic institutions, mainly because of the stigma prevalent around diabetes, its "our fault" so why should other people have to pay for it.
 
It seems to me that we are left with the message that low carb may be bad for us or it may be good for us. I low carb but not to a serious degree. This is not because I have concerns about it but rather that I just like some carbs. My own experience has been very positive and I am quite happy to continue on this path until or if there is hard evidence stating it has detrimental effects.

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ilnar said:
the NHS do LOADS of research and clinical trials! it actually is a big part of the NHS,
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I didn't say that the NHS didn't do research, I said that research isn't what the NHS are about. The NHS are about delivery of healthcare. Research is now handled by the National Institute for Health Research.

Direct spending on research is less than 1% of the NHS budget. Most major industries spend about 5% of their turnover and pharmaceutical companies account for 25% of all UK R&D spend.

The NIHR Office for Clinical Research Infrastructure, NOCRI, set out its 5-year Research and Development Strategy for the NHS in England in Best Research for Best Health: http://www.nihr.ac.uk/files/pdfs/Implem ... PDF%29.pdf

Far from research being a big part of the NHS, it is so small it doesn't make the overall figures:

60% staff, 20% drugs and medical supplies, 20% buildings, equipment, training, medical equipment, catering and cleaning.

ilnar said:
we already have 3-6 monthly check up with (hopefully) knowledgeable clinicians, (blood)-tested, poked and prodded. seriously, it would be disgustingly easy to set up diet studies
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My wife is a biomedical scientist working in the haematology lab in the Path Labs Dept in the local hospital. Although what you suggest sounds reasonable, the healthcare trust would not take on even the clerical staff for such an exercise. The local healthcare trust wouldn't fund it. To the contrary they are already attempting to shed entire laboratories, eg the microbiology lab in Huddersfield and the microbiology lab in Halifax get merged and then they transfer the entire funtion over to Oldham. Remote monitoring is the new mantra. Why do you think Leeds are trying to get rid of their child heart unit?
 
Lots of research going on , not a lot of diet trials specifically concerning diabetes but there have been some.

DUK research project directory
http://www.diabetes.org.uk/Research/Cur ... directory/
Register of past and on going studies in the UK
http://public.ukcrn.org.uk/Search/Portf ... x?Level1=3
Diabetes research network (can be cross referenced with the the above register.
http://www.ukdrn.org/lrn/sites-and-studies.aspx

Big long term studies are very expensive. There is at present a study looking primarily at diet and cancer but also other conditions/causes of death.
It is a European wide study with 69,000 people in the UK alone It is the largest detailed study of diet and health ever undertaken. It started in 1993 and follow up continues until 2025.
It is purely observational ie no intervention. (like the studies used in the meta analysis in the OP.
It will look at the association (if any) between various types of diets on mortality/cancer and other diseases.
http://www.epic-oxford.org/home/
The study has already produced a lot of publications including several on diabetes . (People with diabetes form a subset of the study population)
and perhaps relevantly to this discussion:

Fibre and carbohydrate intake, mortality and diabetes: (haven't read it yet so am just quoting from the results)

Dietary fiber was inversely associated with all-cause mortality risk (adjusted HR per SD increase, 0.83 [95% CI, 0.75-0.91]) and CVD mortality risk (0.76[0.64-0.89]). No significant associations were observed for glycemic load, glycemic index, carbohydrate, sugar, or starch.
Glycemic load (1.42[1.07-1.88]), carbohydrate (1.67[1.18-2.37]) and sugar intake (1.53[1.12-2.09]) were associated with an increased total mortality risk among normal weight individuals (BMI≤25 kg/m(2); 22% of study population) but not among overweight individuals (P interaction≤0.04). These associations became stronger after exclusion of energy misreporters
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.
http://www.plosone.org/article/info%3Ad ... ne.0043127

Shorter controlled trials won't tell us much about long term outcomes. They usually use various markers , weight loss, glucose control nefore and after, fasting levels, insulin levels, medication reduction, lipid levels and more recently more direct measurements of arterial thickness , arterial blood flow etc

The big problem with randomised diet trials is compliance. Quite frequently the low carbers end up eating more carbs when the trial goes beyond about 6 months. The low fat people end up eating higher fat so that by the end there isn't much difference between the two. Nevertheless there have been such studies (even funded by DUK!) . The reference I gave earlier is a review
It was only published last month so at the very least gives people references to the relevant research to follow up . It covers

High Protein diets,Very Low Carbohydrate, High Fat diets, High Carbohydrate, High Fibre diets and 'Mediterranean' type diets. http://dvd.sagepub.com/content/13/2/60.full.pdf+html

One last long term study that did record diet in terms of carb/fat intake was the DCCT.(T1) In that study there was a certain amount of education about 'healthy eating' but the major concern was control. It wasn't a test of diet. Nevertheless researchers have looked at the association between fat/carb intake and Hba1c in the study.
http://ajcn.nutrition.org/content/89/2/518.full
The differences weren't huge. The researchers say that
Higher insulin dose, lower carbohydrate intake, and higher saturated, monounsaturated, and total fat intakes were associated with higher Hb A1c concentrations at year 5. In age- and sex-adjusted multivariate macronutrient models, substitution of fat for carbohydrate was associated with higher Hb A1c concentrations (P = 0.01); this relation remained significant after adjustment for exercise level, serum triglycerides, and BMI (P = 0.02) but was no longer significant (P = 0.1) after adjustment for baseline Hb A1c and concurrent insulin dose
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phoenix said:
Lots of research going on , not a lot of diet trials specifically concerning diabetes but there have been some.

It will look at the association (if any) between various types of diets on mortality/cancer and other diseases.
http://www.epic-oxford.org/home/
Click to expand...

EPIC do research into diabetes and nutrition. I found this on the link that you kindly provided:

Carbohydrate intake and risk of type 2 diabetes
http://www.epic-oxford.org/publications ... 2-diabetes

but it is subscription only. Maybe you have access?
 
Phoenix:

The big problem with randomised diet trials is compliance. Quite frequently the low carbers end up eating more carbs when the trial goes beyond about 6 months. The low fat people end up eating higher fat so that by the end there isn't much difference between the two. Nevertheless there have been such studies (even funded by DUK!) . The reference I gave earlier is a review
It was only published last month so at the very least gives people references to the relevant research to follow up . It covers

High Protein diets,Very Low Carbohydrate, High Fat diets, High Carbohydrate, High Fibre diets and 'Mediterranean' type diets. http://dvd.sagepub.com/content/13/2/60.full.pdf+html
Click to expand...
That study concludes:
Is there an optimal diet for patients with type 2 diabetes? Yes, the one that works for them!
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I have commented on that report already. How do we implement that advice? We have a chronic condition that usually progresses slowly, over a matter of years, so personal experiments, even comparing the NHS/DUK, Mediterranean & LCHF diets could take a minimum of 3 years, with one year for each. Close monitoring with say 3-monthly HbA1c & at least daily BG tests, preferably assessing different foods will be necessary.

In my case, I trusted the NHS/DUK advice & followed it carefully for over 7 years. I did experience an rapid improvement in BG & HbA1c, (8.6 down to 6.5) so I accepted that the diet was working. After 7 years debilitating complications set in. As I was in my 60s, I assumed that ageing contributed to the progression. Only then did I try low carb, with immediate improvement in BG (7 down to 6) with relief from the complications within 3 months. That was 5 years ago. I don't anticipate further experiments in diet, or consider further improvement practicable. I am fit & well, & free from complications.

To quote again:
Is there an optimal diet for patients with type 2 diabetes? Yes, the one that works for them!
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Why then are all newly diagnosed T2 diabetics given a single diet - high starchy carb, low fat, low sugar? We are NOT given the option of trying different possible diets, nor the information needed to assess different diets. Many contributors here are not allowed test strips & are advised that testing is unnecessary.

Why are we told that however well we follow that diet, the disease will inevitably progress? And why is T2D becoming an epidemic in spite of the "healthy eating" advice we are all given?
 
I read a lot and study a lot on the human body. With diabetes I look for logical things to help me. I found a man called Joel Furmon . I believe. He wrote a book called "Eat to Live" It is a whole foods healthy way that we are supposed to go by to achieve a long life. America is riddled with cheap bad food and to expensive good food. Anyone ever wonder why in a study of over 100,000 americans to 100,000 Asians that not one. not one Asian died from stroke, heart attack, or had any form of unhealthy reading. America,,,, well you can guess almost everyone had some form of heart disease, high BP, High cholestrol. I suffer myself with High BP and High CHL> I have been having this since mid 20's. I am not obese. I am 5'7 185. I am slightly overweight. It is a fact that living off the land of whole foods, fish, and teas can almost make you live over 100. I personally do not want to be 100 but some do. They are even now marketing a pill from Asians straight to us on T.V. that promises us longevity. Really? It all bows down to living like a rabbit but living life. You can cure cancer or stop it in it's tracks. More people prefer whole foods over chemo because there is a higher rate of survival. These are proven facts. To all who worry about low carb. There is no need. It only helps in the long run. This was written with respect to everyone. Just looking for answers and suggestions. That is why I am here. For help. Thanks.
 
Rabherself

It would be helpful for you to give a link to the report on American v. Asians. Of course the terminology "Asians" does not necessarily mean the same to us Brits as it does in the USA so perhaps you can tell us the actual nationality of the Asians you are referring to.

I am pleased that you have found the secret of long life. Let's hope it helps with you blood pressure and cholesterol problems.

Take care

Doug
 
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