Dec 2014 update: New research on the Low Carb Diet in general practice

[catherinecherub]

It would, but he tends to be infrequent on his posts unfortunately. I'd like to know it there were ratios as well.

Send him a PM?

 

[douglas99]

Send him a PM?

Ha, thanks, sometimes the obvious eludes me!
I've sent him a pm, hopefully he'll be back on to comment.

 

[NoCrbs4Me]

Have you looked at the fasting levels of those on low carb. I have a theory that as you go lower in carb amount the level rises and your BG levels become more stable throughout the day. This makes it look like people have developed insulin resistance when they haven't. I wonder if there is a study/paper in there to determine a statistical correlation.

I have found that going on low carb (<100 g per day) has slowly lowered my fasting blood glucose to around 5.4 mmol/L, then last week I was on vacation and my carb intake increased to 150 to 200 g per day and my fasting blood glucose went up to around 6.4 mmol/L. Now, back home and carbs below 100 g and my fasting blood glucose is close to what it was before the vacation. For me, lower carbs equals lower fasting blood glucose.

 

[izzzi]

@Southport GP, You don't appear to use the words "high Fat" in your documentation.
I know what you mean when you described diets higher in fats which reads well.
Do you think many people might miss understand that "high fat" means eat as much fat as you want instead of moderately.

 

[Southport GP]

It would, but he tends to be infrequent on his posts unfortunately. I'd like to know it there were ratios as well.

 

[Southport GP]

Hi sorry having problems with my computer ye
Yes

 

[Southport GP]

@Southport GP, You don't appear to use the words "high Fat" in your documentation.
I know what you mean when you described diets higher in fats which reads well.
Do you think many people might miss understand that "high fat" means eat as much fat as you want instead of moderately.

A valid point but we found that in the context of most of the patients were trying to loose weight this didn't seem to be a problem ,also fat on its own without carbs would seem to be less appetising

 

[Southport GP]

As its part of research and also very interesting and motivating for folk to know how they are doing most of the participants have their HbA1c, chol including the ratio and liver function done about every 12 weeks
Around last Christmas several of the participants did suffer 'carb creep' and their HbAic went up with their weight after only 4-6 weeks. So they felt a post Christmas test was a usefull wake up call !

Thanks for the reply.

I am interested in this statement,
"I suspect their diabetes will deteriorate if they go back to carbs"
I decided to go back on the carbs and in doing so my HbA1c reduced further. Now I do not know if it would have continued falling if I had continued with the low/medium carbs. I have not found carbs, as such, to be addictive. I do find at times I crave nuts, especially peanuts (yeah I know not really nuts) and find when I have these cravings I can polish off a 1/2 kg bag. What is amazing is this has no impact on my BG levels or weight. I do not quite understand the craving but I do indulge it as I assume it is my body telling me I need something it requires that I am not providing in other ways (maybe I am not eating enough fats or it wants the combination of fats and carbs in the nuts to top up my fat stores.

Have you looked at the fasting levels of those on low carb. I have a theory that as you go lower in carb amount the level rises and your BG levels become more stable throughout the day. This makes it look like people have developed insulin resistance when they haven't. I wonder if there is a study/paper in there to determine a statistical correlation.

Are you testing their HbA1c yearly or more frequently? After my first 3 month HbA1c my surgery decided I didn't need one for a year as I was in normal range. Personally I do feel this is not often enough and would allow too much "carb creep". I therefore test every few days around my main meal to ensure I am not getting drift but do find spot checking is difficult for trending and I am trying to not be as obsessive with my testing like I used to be (I was able to predict my HbA1c with some accuracy and I had to show my GP how I did it with all my calculations). Out of interest did you get your trialists to test their BG levels as they went to provide them with even further incentive and if so did you need to explain the levels they were obtaining?

Sorry, more questions, just ignore me if you wish.[/Q

 

[andcol]

As its part of research and also very interesting and motivating for folk to know how they are doing most of the participants have their HbA1c, chol including the ratio and liver function done about every 12 weeks
Around last Christmas several of the participants did suffer 'carb creep' and their HbAic went up with their weight after only 4-6 weeks. So they felt a post Christmas test was a usefull wake up call !

That is really interesting that you found that their HbA1c went up where my HbA1c has actually gone down as I have introduced some carbs. Does this mean I went past "Prof Taylor's fat threshold" and your participants didn't? Does losing weight through a starvation diet reduce fat in a different way to LCHF as @douglas99 is finding in his thread? Does starvation switch cells into repair mode and not replace as is the theory behind the 5-2 diet and as such repaired my beta cells? May be a combination of them all! Food for thought I think

 

[Southport GP]

It would, but he tends to be infrequent on his posts unfortunately. I'd like to know it there were ratios as well.

Yes we did the cholesterol ratios on a regular basis and there were significant improvements in the first group of patients - and about fifty more since then -despite a diet higher in fat

 

[AndBreathe]

Yes we did the cholesterol ratios on a regular basis and there were significant improvements in the first group of patients - and about fifty more since then -despite a diet higher in fat

I note you state "cholesterol ratios". Did you observe some patients where their total cholesterol score increased but their ratios were actually very good? If so, what was your approach for those patients, regarding statin recommendations?

I am currently about to go into Round 3 of discussions regarding statins, as my total is high, but trigs and other ratios are good. My GP ended the last conversation (having "allowed" me 3 months to work on my diet) by saying all diabetics should be taking statins. As only my diagnostic tests have ever been in the diabetic range I was hoping for a some form of discounting (as opposed to disregarding) based on that history.

 

[douglas99]

That is really interesting that you found that their HbA1c went up where my HbA1c has actually gone down as I have introduced some carbs. Does this mean I went past "Prof Taylor's fat threshold" and your participants didn't? Does losing weight through a starvation diet reduce fat in a different way to LCHF as @douglas99 is finding in his thread? Does starvation switch cells into repair mode and not replace as is the theory behind the 5-2 diet and as such repaired my beta cells? May be a combination of them all! Food for thought I think

That is an interesting point.
@Southport GP
Did you run any similar test to the results from the Newcastle diet, and test your patients glucose tolerance, or reaction to carbs, after a suitable re-introduction period?
Or was it a diet targeted at those who intended to adopt the diet for life, continuing after their weight loss?

Which actually leads to another thought, how do you stop their weight loss, as some on here find that to be an issue?

 

[cold ethyl]

That is really interesting that you found that their HbA1c went up where my HbA1c has actually gone down as I have introduced some carbs. Does this mean I went past "Prof Taylor's fat threshold" and your participants didn't? Does losing weight through a starvation diet reduce fat in a different way to LCHF as @douglas99 is finding in his thread? Does starvation switch cells into repair mode and not replace as is the theory behind the 5-2 diet and as such repaired my beta cells? May be a combination of them all! Food for thought I think

I guess I'd like to know the average length of diagnosis for these patients ( obviously there's bit of margin as we've all had it longer than that )compared to those on the Newcastle trial. I seem to recall Taylor's Banting lecture talking about uninhibiting beta cells which is neither repair nor replacement. Also what percentage of weight lost are we talking about in these trials? Taylor is looking at minimum 15% and the chap he gave as an example in his recent talk had gone down to 74 kg from some enormous figure so if you've just lost just enough weight, I can understand how carb creep could have this effect, especially when combined with a post christmas weight gain.

 

[Southport GP]

I guess I'd like to know the average length of diagnosis for these patients ( obviously there's bit of margin as we've all had it longer than that )compared to those on the Newcastle trial. I seem to recall Taylor's Banting lecture talking about uninhibiting beta cells which is neither repair nor replacement. Also what percentage of weight lost are we talking about in these trials? Taylor is looking at minimum 15% and the chap he gave as an example in his recent talk had gone down to 74 kg from some enormous figure so if you've just lost just enough weight, I can understand how carb creep could have this effect, especially when combined with a post christmas weight gain.

Heavens we are getting to complex stuff now - I find myself on less certain ground
Most of the folk with type two diabetes I have talked to expect that going low carb is a lifelong lifestyle choice and that when they get down to their target weight they may have more fat to avoid further weight loss(and perhaps the odd carby special occasion ) I have several patients who have kept their weight stable for years in this way
The average weight loss on the study was less than Prof Taylor's 15% more like 10% but I know which diet I would prefer to be on (I have been on a low carb diet for nearly two years now)
I have heard it discussed that the longer one is diabetic the less reversible are the metabolic changes and seen some limited evidence for this

 

[douglas99]

@Southport GP

Heavens we are getting to complex stuff now - I find myself on less certain ground
Most of the folk with type two diabetes I have talked to expect that going low carb is a lifelong lifestyle choice and that when they get down to their target weight they may have more fat to avoid further weight loss(and perhaps the odd carby special occasion ) I have several patients who have kept their weight stable for years in this way
The average weight loss on the study was less than Prof Taylor's 15% more like 10% but I know which diet I would prefer to be on (I have been on a low carb diet for nearly two years now)
I have heard it discussed that the longer one is diabetic the less reversible are the metabolic changes and seen some limited evidence for this

Where the patients in your study long term diabetics already low carbing, or recently diagnosed who switched from their old diet to a low carb diet?
Or a mix of both?

 

[cold ethyl]

Heavens we are getting to complex stuff now - I find myself on less certain ground
Most of the folk with type two diabetes I have talked to expect that going low carb is a lifelong lifestyle choice and that when they get down to their target weight they may have more fat to avoid further weight loss(and perhaps the odd carby special occasion ) I have several patients who have kept their weight stable for years in this way
The average weight loss on the study was less than Prof Taylor's 15% more like 10% but I know which diet I would prefer to be on (I have been on a low carb diet for nearly two years now)
I have heard it discussed that the longer one is diabetic the less reversible are the metabolic changes and seen some limited evidence for this

Thanks for that. Yes Taylor's team looked at reversal in longer diagnosed as initial research candidates were all less than five years post diagnosis and found that best results were around that time frame. It would be interesting to see whether it is just the magical figure of 15% or more weight loss that can trigger reversal by whatever dietary means or whether there is something unique to VLC diets that has this effect in some people.For both groups weight gain whether through carb creep or general additional calories is going to push HbA1c levels up, I'd assume, though those with less visceral fat are going to be able to handle higher carb levels. The chap from US in Taylor's recent slides was 4.2 after a blueberry muffin!

 

[Southport GP]

@Southport GP


Where the patients in your study long term diabetics already low carbing, or recently diagnosed who switched from their old diet to a low carb diet?
Or a mix of both?

 

[andcol]

Yes the 15% ties up with my data

This graph plots my percentage weight loss against my fasting reading. A 0% weight loss I had a fasting of 9.4 but didnt start testing until February so did not get to see my changes. Within 5 weeks (including the Christmas and New Year period) I brought my levels down to normal at about 12% weight loss (was also on met until end Jan) and at 15% my numbers just tightened up to my current range of 4.8 to 5.2

 

[Southport GP]

They were mainly newly diagnosed - though since then we have been working with far more longer term diabetics If I get a chance will have to see if the groups vary but suspect the results are very similar

 

[douglas99]

They were mainly newly diagnosed - though since then we have been working with far more longer term diabetics If I get a chance will have to see if the groups vary but suspect the results are very similar

So mostly newly diagnosed, on the diet for about a year, average weight loss 8.6kg by March if I'm reading your paper correctly.
Are they still losing weight, or did you find a means to stabilise it? Or did the loss simply stop?