Low-Carbohydrate Diets and All-Cause Mortality:

[Yorksman]

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.

Could you post details of that study as east asian populations are not immune to these diseases by any means.

Fllow this link for a larger version
http://circ.ahajournals.org/content/118 ... .large.jpg

There can be many factors involved, access to medical care, quality of drugs and preventative treatment etc. as well as different diets so one would have to read the study to find out what is going on.

 

[phoenix]

No Ian you haven't discussed the review, you've just repeated your experience which to a certain extent backs up the review in that you have been able to adhere to your chosen diet.
I'm not sure from your previous posts that you were indeed told to eat a higher carb and crucially higher fibre diet . That is the type of diet that was introduced in the 80s (following trials) when the previous advice to eat a low carb diet was found to be failing. The high fibre bit (which in many studies involved lots of pulses now known to be low in GI because of the resitant starch) seems to have got lost on the way .So much so that many people seem to think that the only carbohydrates are the starches to be found in flour/bread/potatoes. Personally the diet that was 'taught' to me and is the same advice as given to T2s was probably a cross between a low GI and a Mediterranean diet. It is one that sits very well in the food culture in this part of France so maybe that's why the hospital has good results with it's patients.


Rabherself1982
I suspect that you are referring to the Chinese in your post (in the UK we use the term Asian in a different way to the US), maybe your reference is to the China Study? https://en.wikipedia.org/wiki/The_China_Study

I also think perhaps you are talking about Dr Fuhrman (he wrote Eat to Live) His diet is a very high fibre, high carb diet , 90% comes from plant foods whilst '10% of the diet can contain small amounts of foods with lower nutrient to calorie ratios, such as animal products, sweets, and processed foods .' I think that is probably far nearer the diets used in the early higher carb trials for diabetess (particularly in India) than is often suggested today. Here is his pyramid
http://www.drfuhrman.com/library/foodpyramid.aspx
Again I it would be difficult to get people to adhere to this sort of diet if they don't like lots of veg and legumes (and being on a forum I've read of lots of people that say they hate vegetables) but I also have read of people using vegetarian diets with great success
Personally, I think it is potentially dangerous to make the sort of claims that you make for any sort of diet in respect to cancer. Fortunately there are many cancers against which which modern medical therapies have high success rates.
Actually, in the UK it remains illegal for anyone, anywhere to make such claims.
http://en.wikipedia.org/wiki/Cancer_Act_1939 .

 

[GraceK]

Well if a low carb diet is going to kill me then that's fine. At least my digestive system works better and is more comfortable on low carb, high fat and protein. My brain works better too - well sometimes! :lol:

 

[viviennem]

Well said, GraceK!

I've just read this whole thread in one gulp, and believe me it's pretty indigestible to a non-scientist. But very interesting.

There's one thing that has mildly amused me. All this talk of "increased risk of death".

My low-carb diet does not increase my chances of death. I am going to die. That is a 100% certainty. Life is a terminal condition, and none of us will survive it. No one knows when each individual will die.

If you told me that I could live to 70 (7 more years) but would continue until then in my present state of health - well, I'd think about it.

If you offered me as an alternative the chance to live to 90, but to get there disabled after a stroke, going blind, with kidney disease and missing the odd bit of limb - I know which I'd choose.

I believe, from my personal experience, that a low-carb higher fat diet suits me. I have lost weight on it, improved my blood pressure and lipid profile, and my Type 2 diabetes is under control. I feel well. I know that other people can achieve those same results on a higher carb intake than me, but I don't believe anyone with Type 2 diabetes can achieve them on 300g carb a day. Just my opinion - no science behind it.

I'm doing what suits me. I'd like to see much more research on diet and diabetes. I'd like to know the reasons (possibly genetic) why I get on so well with an Atkins-type diet.

But I'm still going to die. I just don't know when. And no amount of peer-reviewed papers, meta-studies and detailed analyses can tell me.

Viv 8)

 

[mo1905]

I think the last 2 posts sum up the thread perfectly ! Diabetes is not generic. Everyone is different. People react to different foods in different ways. There will never be a suit all diet. Also, some people are more concerned with longevity, others are more concerned with quality of life. I enjoy beer, junk food occasionally and have a bit of a sweet tooth. Ultimately, this may end up costing me a couple of years. Bit selfish, but I accept that. Each to their own !

 

[IanD]

No Ian you haven't discussed the review, you've just repeated your experience which to a certain extent backs up the review in that you have been able to adhere to your chosen diet.

From that report that considers a range of diets:

Is there an optimal diet for patients with type 2 diabetes? Yes, the one that works for them!

Now, please use your imagination: you're newly diagnosed, you've been warned of the consequences of uncontrolled diabetes - heart disease, stroke, amputation, blindness, kidney failure .... & you are panicking. "I've got the disease that will kill me." And you get that incredibly useless dietary advice: Is there an optimal diet for patients with type 2 diabetes? Yes, the one that works for them!

 

[Osidge]

I can accept the statement that the diet that works is the diet that works. It did for you, Ian, and that is excellent. I do not need to go down your path so why should I? The diet that works best for me is not the one that works for you, it's the one that works for me. You need to accept that and move on. By all means let people know what worked for you but there are other choices that will also work. If you really wanted people to make the best decision for them then you would not be making out that there is only one possibility.

Regards

Doug

 

[IanD]

I can accept the statement that the diet that works is the diet that works. It did for you, Ian, and that is excellent. I do not need to go down your path so why should I? The diet that works best for me is not the one that works for you, it's the one that works for me. You need to accept that and move on. By all means let people know what worked for you but there are other choices that will also work. If you really wanted people to make the best decision for them then you would not be making out that there is only one possibility.

Regards

Doug

Why then do DUK & the NHS only recommend one diet - for everybody, not just diabetics?

And how would YOU advise newly diagnosed T2Ds?

And how do they know what works for them when the HPs don't advise self monitoring?

And how useful is research that concludes: "the diet that works is the diet that works" ??????

 

[Osidge]

I was not talking about DUK and the NHS!!

The advice to newly diagnosed is that there are various ways of managing diabetes and the are...... You need to find the one that works for you and that is where the use of a blood glucose monitor assists. It enables you to know the effect of the foods that you eat on your blood sugar level so that you can make adjustments to your diet in the light if that knowledge. Of course I disagree with the view of some HCOs that using a blood glucose monitor is not necessary and I would advise all those with Type 2 diabetes to test.

All that and I have not made their diet decisions for them. A much better result. And of course the diet that works is the diet that works. As many people will attest, we are all different. It is not how we manage our diabetes that is the big issue it is making sure we do manage it!

Regards

Doug

 

[CollieBoy]

I was not talking about DUK and the NHS!!

The advice to newly diagnosed is that there are various ways of managing diabetes and the are...... You need to find the one that works for you and that is where the use of a blood glucose monitor assists. It enables you to know the effect of the foods that you eat on your blood sugar level so that you can make adjustments to your diet in the light if that knowledge. Of course I disagree with the view of some HCOs that using a blood glucose monitor is not necessary and I would advise all those with Type 2 diabetes to test.

All that and I have not made their diet decisions for them. A much better result. And of course the diet that works is the diet that works. As many people will attest, we are all different. It is not how we manage our diabetes that is the big issue it is making sure we do manage it!

Regards

Doug

Doug, for the vast majority of new diabetics, there is only the NHS & DUK, they don't have the backup of contacts who say, "There are a wde varieties of methods, lets find the one that works for you!"
Telling people the options is not making their decisions, it is allowing them to look at choices.

 

[IanD]

Thanks, Fergus.

Doug, it's NOT about ME. If it were, I would not bother to waste my time here. After all, I'm all right, Jack!

My experience is not unique. Have you looked at the questions newcomers ask & read the advice given by Daisy? That is real info that they can work on.

This thread begins by warning against the life shortening effect of low carb diets, & now you & others are saying "any diet will do as long as it works." Without ANY advice as to what might work, or even what "working" is. We all know that self testing is widely discouraged, so what "works" will only be established by the annual HbA1c. One of my friends (diabetic for years) has just been told by his Dr "stop eating bread & potatoes." I asked what his HbA1c was - he hasn't been told.

At an XPERT follow-up meeting, one patient said he had a CHD problems, but was assured that his Dr would be making regular checks on his diabetes. "Regular" was annual!

Doug, we are in the real world of diabetes - we are living people coping with a chronic condition with a range of life-threatening complications. We need ALL the advice we can get, & frankly, the best possible advice is from T2s who have achieved good control, NOT researchers who conclude "eat what works for you" or "more research is needed." We want real advice NOW.

 

[Yorksman]

The Desmond course that I attended spent the afternoon discussing foods, complete with plastic models in case we didn't know what a fried egg looked like and spoke in general terms about various fats, from trans fats to poly and mono unsaturated fats, soluable and insoluable fibre, types of carbohydrate, glycaemic index, glycaemic load, calories, vitamins and other nutrients and so on and what sort of information was on food packaging.

When asked by a couple of the attendees, 'what should we eat' they stated that they didn't specify a diet and referred to the topics of the morning session, how carbohydrates are metabolised and transported, fatty deposition on the internal walls of blood vessels and so on and all the risks associated with these processes, high blood pressure, strokes, damage to nerves, eyes, organs etc.

'Providing the customer with the information which will allow them to make an informed choice' is the new phraseology in our little part of the NHS.

Qué? I am from Barcelona

 

[Yorksman]

Telling people the options is not making their decisions, it is allowing them to look at choices.

Patients and the Public - Your Rights and NHS Pledges to You
Informed choice:

The NHS also commits:

to offer you easily accessible, reliable and relevant information in a form you can understand, and support to use it. This will enable you to participate fully in your own healthcare decisions and to support you in making choices.

from, The NHS Constitution
http://www.nhs.uk/choiceintheNHS/Rights ... d-2013.pdf

It's written by politicians and lawyers.

 

[equipoise]

Telling people the options is not making their decisions, it is allowing them to look at choices.

Patients and the Public - Your Rights and NHS Pledges to You
Informed choice:

The NHS also commits:

to offer you easily accessible, reliable and relevant information in a form you can understand, and support to use it. This will enable you to participate fully in your own healthcare decisions and to support you in making choices.

from, The NHS Constitution
http://www.nhs.uk/choiceintheNHS/Rights ... d-2013.pdf

It's written by politicians and lawyers.

Oh goody -- if the NHS wants us to have access to reliable information, and support to use it, that will enable us to participate fully in our own healthcare decisions, and will support us in making choices, that must mean that they will be happy to give all T2s meters and test strips, doesn't it?

 

[Osidge]

Fergus

We are talking about people who have reached this Forum so your assertion that they only have DUK and the NHS would not apply. In relation to telling people what their choices are - I have always *freely* advocated this.

Ian

The advice would not, of course, only be that the diet that works is the diet that works but the options - the knowledge - would also be given. That should put people's mind at rest that they not only have *choice* in managing their diabetes to enable them to avoid complications but that they also have guidance on various diets (from people like yourself and others) and the strong prompt to test blood glucose to see how various foods affect them and what diet they wish/need to choose.

Regards to you both

Doug

 

[Yorksman]

Oh goody -- if the NHS wants us to have access to reliable information, and support to use it, that will enable us to participate fully in our own healthcare decisions, and will support us in making choices, that must mean that they will be happy to give all T2s meters and test strips, doesn't it?

Except, those are the words of politicans, at least I suspect they are.

They are suppose to agree a plan with you for your personal management of diabetes but my DN doesn't seem to know what day it is. HBA1c tests are invariably 8 weeks, 12 weeks, 6 months and she keeps wanting to 'fine tune my medication', even though I don't take any.

Hopeless.

 

[ilnar]

Telling people the options is not making their decisions, it is allowing them to look at choices.

Patients and the Public - Your Rights and NHS Pledges to You
Informed choice:

The NHS also commits:

to offer you easily accessible, reliable and relevant information in a form you can understand, and support to use it. This will enable you to participate fully in your own healthcare decisions and to support you in making choices.

from, The NHS Constitution
http://www.nhs.uk/choiceintheNHS/Rights ... d-2013.pdf

It's written by politicians and lawyers.

Oh goody -- if the NHS wants us to have access to reliable information, and support to use it, that will enable us to participate fully in our own healthcare decisions, and will support us in making choices, that must mean that they will be happy to give all T2s meters and test strips, doesn't it?

sure, if all T2s actually used SBGM to actively modify diet and/or medication, which then led to an actual difference in HBA1c readings. sure, the NHS would gladly pay,

but,
most t2s DONT.
most simply take readings, note the value and do nothing about it.
im a big advocate of SBGM, for all diabetics. but i don't believe T2/1.5s on diet/exercise/metformin should be testing everyday, just after diagnoses sure, to get an idea of how sugar levels rise and fall and to get an idea of what they should be eating/doing.

but after that? unless you are testing 4 times a day and tailoring everything you eat to achieve a perfect score, it shouldnt be nessesary.

i do mine roughly once a fortnight, and test about 4-5 times on that one day, and match readings with the foods I've eaten and the exercise I've done. i have a massive chart on my study wall, showing all my test days, estimated calorie/glucose intake, all the readings, and the exercise ive done. by now, after almost a year of testing. i have about 35 "days" fully mapped out. some from at work, where i can get away with a really low carb day, some from weekends working in the house/garden/shopping, and some from training days, when i go out and do 60 odd miles on my bike. i have a good idea of exactly what i should and shouldn't eat, depending on my activity level on a given day.
i got my strips on a repeat prescription (admittedly only a small amount, but its an amount i am happy with) by inviting my DSN and my GP over and showing them exactly what i did with the meter and 50 strips i got on diagnoses. as the DSN said
"if everyone was this well organised, I'd be out of a job"

you cannot provide one diet that all diabetics should follow slavishly, all diet plans should be modified to each individual depending on LOTS of factors. find a decent dietician,

 

[IanD]

Comments

Fergus
We are talking about people who have reached this Forum so your assertion that they only have DUK and the NHS would not apply. In relation to telling people what their choices are - I have always *freely* advocated this.

Not all - most diabetics get their advice from GPs & other HPs who get their info from their training, DUK leaflets, or even these research articles cited. The possibility of many being referred to this forum by their HPs is remote.

People who do read articles such as the OP that this thread is all about might believe it is relevant to T2s, & use it to confirm & repeat DUK's unsubstantiated warnings against the long term dangers of low carb.

Others might find the latest offering that we should eat a diet that works, without being being told what "works" means or the means & advice on self monitoring. That hardly provides an incentive for personal diet research. People to a large extent trust their GPs, until the damaging effects of no or bad advice are apparent. And then they are reassured that the disease itself is progressive - it's not anyone's fault. And of course "we" can treat retinopathy, CHD, CKD, & amputate the offending peripherals.

Ian
The advice would not, of course, only be that the diet that works is the diet that works but the options - the knowledge - would also be given. That should put people's mind at rest that they not only have *choice* in managing their diabetes to enable them to avoid complications but that they also have guidance on various diets (from people like yourself and others) and the strong prompt to test blood glucose to see how various foods affect them and what diet they wish/need to choose.

Regards to you both
Doug

Doug, do you live in the real world? A world where infrequent HbA1c is the authoritative guide to the PROGRESS of our progressive disease, & where the info, aka DUK leaflets, encourages a high starchy carb diet & warns against low carb.

Your postings here show very good reasons why I & others campaign against professional disinformation.

 

[Daibell]

Hi Ilna

What's SBGM; that's a new one on me? You say 'T2/T1.5s on Diet, exercise & Metformin', but most T1.5s (which is Late onset T1) will be on more than Metformin and probably insulin as well so quite different from the general T2 grouping. You mention later in your post about 'diet plans'. I have never had a diet plan but I do take note of my meter readings and have reduced my carbs over the years as my sugars crept up and noted what foods affected the readings. I suspect a lot of T2s do react to their meter readings and not just note them. Are you serious about finding a good dietician? From the many posts on this forum over the years they are very, very rare with most just pushing the 'balanced diet' or have 'plenty of starchy carbs' mantra. Sadly, I would never recommend anyone with diabetes to see a dietician as the risk of getting bad advice is too high.

 

[ilnar]

Hi Ilna

What's SBGM; that's a new one on me? You say 'T2/T1.5s on Diet, exercise & Metformin', but most T1.5s (which is Late onset T1) will be on more than Metformin and probably insulin as well so quite different from the general T2 grouping. You mention later in your post about 'diet plans'. I have never had a diet plan but I do take note of my meter readings and have reduced my carbs over the years as my sugars crept up and noted what foods affected the readings. I suspect a lot of T2s do react to their meter readings and not just note them. Are you serious about finding a good dietician? From the many posts on this forum over the years they are very, very rare with most just pushing the 'balanced diet' or have 'plenty of starchy carbs' mantra. Sadly, I would never recommend anyone with diabetes to see a dietician as the risk of getting bad advice is too high.

HI!
sorry, Self Blood Glucose Monitoring SBGM
depending on how early you catch T1.5 depends on how much medication we start up on hence the diet/exercise grouping, anyone taking insulin should be monitoring, obviously.

i only mention diet plans in relation to the (slightly off topic now) thread, a low carb diet is still a diet plan, you are planning your diet after all.

a lot of T2s do act on their meter readings, most of those fighting for strips unsurprisingly, but a lot of people just tested and did nothing about the results, hence the belief among health professionals that SBGM is infective. and not worth the (fairly) high cost surprisingly, this isn't always a patient education thing. some people just aren't interesting in improving until its too late. its true that a fair number of patients do feel depressed when they get repeatedly high readings, especially when they dont know/wont do anything to improve

i have seen both good and bad dieticians, mostly bad, but i still would very much recommend trying to find one, its not easy, but they do exist, and can be very good.