Study: Low Carb the first approach in diabetes management?

[pdmjoker]

I recently came across this informative 2015 study

https://www.sciencedirect.com/science/article/pii/S0899900714003323

which is titled "Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base" and says

Abstract

The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science. The seriousness of diabetes requires that we evaluate all of the evidence that is available. The 12 points are sufficiently compelling that we feel that the burden of proof rests with those who are opposed.​

Robust evidence/science?

The paper seems credible, but is the evidence "robust"? I suppose if someone (or an organisation) just wanted to dismiss the evidence, they could quibble with it not being from "long-term randomized controlled trials" and therefore not "robust science". However, it appears it can withstand "vigorous cross-examination" as the paper concludes on this constructive note:

We would recommend that government or private health agencies hold open hearings on these issues in which researchers in carbohydrate restriction can make their case. We think that traditional features of the analysis of evidence such as vigorous cross-examination should be part of the process. We suggest that open discussion with all sides contributing will be valuable. The seriousness of diabetes suggests that a bench decree will be inappropriate.​

I actually came across the above study since it is cited in the "Position statement" on "Low-carb diets for people with diabetes" from the charity Diabetes UK and is available here: https://www.diabetes.org.uk/profess...style/low-carb-diets-for-people-with-diabetes

Below I quote part of their "Position statement" where it references "[4]" the above study:

As the total amount of carbohydrate eaten has the biggest effect on the rise of blood glucose levels after eating, some experts have argued that everyone with diabetes should follow a low-carbohydrate diet [4]. However, this call for low-carb diets as a default for people with diabetes is based on opinions rather than robust science. Interpreting dietary research is not without disagreements, which is why Diabetes UK continues to base recommendations on robust evidence rather than opinions.​

Notes

1 The study doesn't say "everyone with diabetes should follow a low-carbohydrate diet" but actually says "It is unlikely that one dietary strategy, any more than one kind of pharmacologic treatment will be best for all individuals."

2 There's that term "robust" again!

Saturated Fat?

The Diabetes UK Position statement says:

People who want to follow a low-carb diet should ensure their fat intake comes mainly from unsaturated sources, whilst limiting saturated fat intake.​

The study says:

Point 7. Dietary total and saturated fat do not correlate with risk for cardiovascular disease

Several large and expensive clinical studies have been carried out since the so-called diet–heart hypothesis was framed in the middle of the 20th century [40], [41]. From the original Framingham study [42] to the WHI [26], as well as more than a dozen additional studies, have failed to show an association between dietary lipids and risk for cardiovascular disease (CVD). There is now a large volume of literature of both scientific papers [43], [44], [45], [46], [47] and popular books [48], [49], [50], [51] documenting the failure of attempts to support the diet–heart hypothesis. Few rebuttals have been offered [52]. The very strong recommendations from health agencies predicted that none of these trials should fail. In fact, almost all of them have failed.​

Remember: "Diabetes UK continues to base recommendations on robust evidence rather than opinions"

 

[zand]

I thought I was reading the joke section!

I wonder what robust evidence DUK have for the 'carbs are necessary' for T2s lol.

You couldn't make this up. We'll I guess you could if you were paid enough by food and drugs companies to do so.

So sad.

 

[NicoleC1971]

I recently came across this informative 2015 study

https://www.sciencedirect.com/science/article/pii/S0899900714003323

which is titled "Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base" and says

Abstract

The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science. The seriousness of diabetes requires that we evaluate all of the evidence that is available. The 12 points are sufficiently compelling that we feel that the burden of proof rests with those who are opposed.​

Robust evidence/science?

The paper seems credible, but is the evidence "robust"? I suppose if someone (or an organisation) just wanted to dismiss the evidence, they could quibble with it not being from "long-term randomized controlled trials" and therefore not "robust science". However, it appears it can withstand "vigorous cross-examination" as the paper concludes on this constructive note:

We would recommend that government or private health agencies hold open hearings on these issues in which researchers in carbohydrate restriction can make their case. We think that traditional features of the analysis of evidence such as vigorous cross-examination should be part of the process. We suggest that open discussion with all sides contributing will be valuable. The seriousness of diabetes suggests that a bench decree will be inappropriate.​

I actually came across the above study since it is cited in the "Position statement" on "Low-carb diets for people with diabetes" from the charity Diabetes UK and is available here: https://www.diabetes.org.uk/profess...style/low-carb-diets-for-people-with-diabetes

Below I quote part of their "Position statement" where it references "[4]" the above study:

As the total amount of carbohydrate eaten has the biggest effect on the rise of blood glucose levels after eating, some experts have argued that everyone with diabetes should follow a low-carbohydrate diet [4]. However, this call for low-carb diets as a default for people with diabetes is based on opinions rather than robust science. Interpreting dietary research is not without disagreements, which is why Diabetes UK continues to base recommendations on robust evidence rather than opinions.​

Notes

1 The study doesn't say "everyone with diabetes should follow a low-carbohydrate diet" but actually says "It is unlikely that one dietary strategy, any more than one kind of pharmacologic treatment will be best for all individuals."

2 There's that term "robust" again!

Saturated Fat?

The Diabetes UK Position statement says:

People who want to follow a low-carb diet should ensure their fat intake comes mainly from unsaturated sources, whilst limiting saturated fat intake.​

The study says:

Point 7. Dietary total and saturated fat do not correlate with risk for cardiovascular disease

Several large and expensive clinical studies have been carried out since the so-called diet–heart hypothesis was framed in the middle of the 20th century [40], [41]. From the original Framingham study [42] to the WHI [26], as well as more than a dozen additional studies, have failed to show an association between dietary lipids and risk for cardiovascular disease (CVD). There is now a large volume of literature of both scientific papers [43], [44], [45], [46], [47] and popular books [48], [49], [50], [51] documenting the failure of attempts to support the diet–heart hypothesis. Few rebuttals have been offered [52]. The very strong recommendations from health agencies predicted that none of these trials should fail. In fact, almost all of them have failed.​

Remember: "Diabetes UK continues to base recommendations on robust evidence rather than opinions"

Great post . I was on a call in which the current research on remission was discussed by Diabetes UK. Their current strategy is to promote remission but they are keen to talk about the Direct Study and Newcastle Diet (funded by DuK) or bariatric surgery as the preferred route to that goal.
When discussing low carb, the researcher claimed that unlike Direct and its successors, the Virta Health trial (not mentioned by name but assumed it was this plus many other studies showing advantage of low carb over low fat) was invalid because it wasn't an RCT. This is true but then I would argue that the Direct study wasn't either. GP practices were randomised but the patients had a choice to follow normal standard of care or take the shakes! How could it be otherwise? Virta was robust enough to confirm that the participants were in nutritional ketosis ie. had complied. It had a substantial number of patients too so not underpowered.

Also the 800 kcal diet is low carb. If the next bit of research (can you strip back the liver fat without starving people into 15kg weight loss) then this will change the paradigm that it is weight loss alone which reverses diabetes.
As you have implied the problem with promoting low carb is that it means higher fat given that protein tends to come with its own fat.
I think that until the diet heart hypothesis is refuted by the official bodies, then it will be hard for the likes of Diabetes UK to promote the best solution.

 

[bulkbiker]

then it will be hard for the likes of Diabetes UK to promote the best solution.

Assuming they ever will after piling £3 million, I think it was, into DIRECT.

 

[Oldvatr]

I recently came across this informative 2015 study

https://www.sciencedirect.com/science/article/pii/S0899900714003323

which is titled "Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base" and says

Abstract

The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science. The seriousness of diabetes requires that we evaluate all of the evidence that is available. The 12 points are sufficiently compelling that we feel that the burden of proof rests with those who are opposed.​

Robust evidence/science?

The paper seems credible, but is the evidence "robust"? I suppose if someone (or an organisation) just wanted to dismiss the evidence, they could quibble with it not being from "long-term randomized controlled trials" and therefore not "robust science". However, it appears it can withstand "vigorous cross-examination" as the paper concludes on this constructive note:

We would recommend that government or private health agencies hold open hearings on these issues in which researchers in carbohydrate restriction can make their case. We think that traditional features of the analysis of evidence such as vigorous cross-examination should be part of the process. We suggest that open discussion with all sides contributing will be valuable. The seriousness of diabetes suggests that a bench decree will be inappropriate.​

I actually came across the above study since it is cited in the "Position statement" on "Low-carb diets for people with diabetes" from the charity Diabetes UK and is available here: https://www.diabetes.org.uk/profess...style/low-carb-diets-for-people-with-diabetes

Below I quote part of their "Position statement" where it references "[4]" the above study:

As the total amount of carbohydrate eaten has the biggest effect on the rise of blood glucose levels after eating, some experts have argued that everyone with diabetes should follow a low-carbohydrate diet [4]. However, this call for low-carb diets as a default for people with diabetes is based on opinions rather than robust science. Interpreting dietary research is not without disagreements, which is why Diabetes UK continues to base recommendations on robust evidence rather than opinions.​

Notes

1 The study doesn't say "everyone with diabetes should follow a low-carbohydrate diet" but actually says "It is unlikely that one dietary strategy, any more than one kind of pharmacologic treatment will be best for all individuals."

2 There's that term "robust" again!

Saturated Fat?

The Diabetes UK Position statement says:

People who want to follow a low-carb diet should ensure their fat intake comes mainly from unsaturated sources, whilst limiting saturated fat intake.​

The study says:

Point 7. Dietary total and saturated fat do not correlate with risk for cardiovascular disease

Several large and expensive clinical studies have been carried out since the so-called diet–heart hypothesis was framed in the middle of the 20th century [40], [41]. From the original Framingham study [42] to the WHI [26], as well as more than a dozen additional studies, have failed to show an association between dietary lipids and risk for cardiovascular disease (CVD). There is now a large volume of literature of both scientific papers [43], [44], [45], [46], [47] and popular books [48], [49], [50], [51] documenting the failure of attempts to support the diet–heart hypothesis. Few rebuttals have been offered [52]. The very strong recommendations from health agencies predicted that none of these trials should fail. In fact, almost all of them have failed.​

Remember: "Diabetes UK continues to base recommendations on robust evidence rather than opinions"

Many of the authors are active proponents for LC dieting. The article should be viewed as having a bias towards that point of view.

I am a user of Low Carb myself, and find that it works well for me. There is evidence to support these claims, and we have discussed them many times in the forum. Suggest you read the Success Stories and Testimonials thread on this forum to get a flavour for whether it has a benefit or not. The proof of the pudding so they say. LC works for many but not everybody.

 

[pdmjoker]

Many of the authors are active proponents for LC dieting. The article should be viewed as having a bias towards that point of view.

I am a user of Low Carb myself, and find that it works well for me. There is evidence to support these claims, and we have discussed them many times in the forum. Suggest you read the Success Stories and Testimonials thread on this forum to get a flavour for whether it has a benefit or not. The proof of the pudding so they say. LC works for many but not everybody.

If you mean "Many of the study authors are active proponents for Low Carb dieting" perhaps that is simply because the evidence and their clinical experience suggest it is effective?

To me the study seems more objective and credible than the position statement.

Yes, the Low Carb Success Stories thread is inspirational and helpful, but amounts to individual "anecdotal evidence" so in some sense provides less "proof" than evidence from formal studies cited by the study paper...

 

[pdmjoker]

I thought I was reading the joke section!

I wonder what robust evidence DUK have for the 'carbs are necessary' for T2s lol.

You couldn't make this up. We'll I guess you could if you were paid enough by food and drugs companies to do so.

So sad.

Yes, quite ironic although, I wouldn't claim to understand all the reasons for the blinkered view...

 

[pdmjoker]

Great post . I was on a call in which the current research on remission was discussed by Diabetes UK. Their current strategy is to promote remission but they are keen to talk about the Direct Study and Newcastle Diet (funded by DuK) or bariatric surgery as the preferred route to that goal.
When discussing low carb, the researcher claimed that unlike Direct and its successors, the Virta Health trial (not mentioned by name but assumed it was this plus many other studies showing advantage of low carb over low fat) was invalid because it wasn't an RCT. This is true but then I would argue that the Direct study wasn't either. GP practices were randomised but the patients had a choice to follow normal standard of care or take the shakes! How could it be otherwise? Virta was robust enough to confirm that the participants were in nutritional ketosis ie. had complied. It had a substantial number of patients too so not underpowered.

Also the 800 kcal diet is low carb. If the next bit of research (can you strip back the liver fat without starving people into 15kg weight loss) then this will change the paradigm that it is weight loss alone which reverses diabetes.
As you have implied the problem with promoting low carb is that it means higher fat given that protein tends to come with its own fat.
I think that until the diet heart hypothesis is refuted by the official bodies, then it will be hard for the likes of Diabetes UK to promote the best solution.

Thank you - and you make valid points.

I gather healthcare professionals are bound by the guidelines. From My Low Carb Journey by me:

This page illustrates a fairly recent example of the guidelines not being changed despite the contrary evidence and medical professionals realising the guidelines are incorrect:
https://www.zoeharcombe.com/2018/07/saturated-fat-consultation-sacn-my-response/​

 

[Oldvatr]

Predjudice and bias arise on both sides of the argument. It is important that where there is knowledge of such bias that it be identified so that readers of the study or article can make their own judgement. You are obviously expecting a certain response to your OP post, which identifies which side you support. I can play Devil's Advocate on occasions. I have to play that if I want to be believed when I critique a study written in support of the other side. As my signature here attests, I seek truth in science.

 

[HSSS]

Not so sure the low fat regime for treatment of type 2 has the “robust” evidence of success and no long term detriments it’s proponents seem to want of low carb.

 

[pdmjoker]

Predjudice and bias arise on both sides of the argument. It is important that where there is knowledge of such bias that it be identified so that readers of the study or article can make their own judgement. You are obviously expecting a certain response to your OP post, which identifies which side you support. I can play Devil's Advocate on occasions. I have to play that if I want to be believed when I critique a study written in support of the other side. As my signature here attests, I seek truth in science.

I agree that bias can arise on both sides and I value you putting and explaining a counter perspective.
I found the study a better portrayal of objective truth since (among other things) it was nuanced and expressed the limitations of its claims. It also invited discussion from dissenters.
The Position statement, though, made sweeping unqualified statements which, with a little digging, could be shown incorrect or a misrepresentation of the truth. It also sought to stifle debate. I therefore concluded the study to be more credible.

Here I detail one aspect of the previous Diabetes UK Position statement, but the piece quoted and citation still appear in the current one: https://www.diabetes.co.uk/forum/th...low-carb-v-low-cal.176773/page-2#post-2307741

Edit to add: I sometimes ask myself "Would I prefer to believe I am right, or prefer to know the truth?" and I endeavour to know the truth...

 

[pdmjoker]

Predjudice and bias arise on both sides of the argument. It is important that where there is knowledge of such bias that it be identified so that readers of the study or article can make their own judgement. You are obviously expecting a certain response to your OP post, which identifies which side you support. I can play Devil's Advocate on occasions. I have to play that if I want to be believed when I critique a study written in support of the other side. As my signature here attests, I seek truth in science.

When it comes to negating prejudice and bias, having at least two credible independent sources for the same info seems a good place to start.
With regards "Point 7 Dietary total and saturated fat do not correlate with risk for cardiovascular disease" in the study, quoting from My Low Carb Journey by me:

Nina Teicholz spent nine years doing background research and analysing the relevant US dietary
research studies published since the 1950s, and found that the US dietary guidelines against
saturated fat have not been supported by good science. She published her findings in the 2014
book The Big Fat Surprise, which has received positive appraisal in more than a dozen scholarly
review papers, including The Lancet. The piece in The Lancet Vol 390 August 19, 2017 titled “Fat
and heart disease: challenging the dogma” says “ … readers might be incredulous at some of
Teicholz’s claims and want to check the references. When many of those papers are read again
from a more critical perspective, the angst and anger will rise.” i.e.: what Nina claims in her book
can be verified, and realising how for decades we have been given incorrect advice about diet and
saturated fat will produce anger and angst.

The review continues: "Teicholz reminds us to … remember that associations do not provide
evidence of causality … "​

and

The UK, among many countries, has simply adopted the US lead against dietary
saturated fat ...
​

so there is pretty good evidence that where the Diabetes UK Position statement says:

People who want to follow a low-carb diet should ensure their fat intake comes mainly from unsaturated sources, whilst limiting saturated fat intake.
​

their claim "Diabetes UK continues to base recommendations on robust evidence rather than opinions" is untrue.

 

[Dark Horse]

This article discusses the difficulties in obtaining enough evidence for unequivocal public health messages about fat and saturated fat:-
https://www.bmj.com/content/361/bmj.k2139

Interestingly, the authors include Gary Taubes AND Walter Willet.

 

[Oldvatr]

When it comes to negating prejudice and bias, having at least two credible independent sources for the same info seems a good place to start.
With regards "Point 7 Dietary total and saturated fat do not correlate with risk for cardiovascular disease" in the study, quoting from My Low Carb Journey by me:

Nina Teicholz spent nine years doing background research and analysing the relevant US dietary
research studies published since the 1950s, and found that the US dietary guidelines against
saturated fat have not been supported by good science. She published her findings in the 2014
book The Big Fat Surprise, which has received positive appraisal in more than a dozen scholarly
review papers, including The Lancet. The piece in The Lancet Vol 390 August 19, 2017 titled “Fat
and heart disease: challenging the dogma” says “ … readers might be incredulous at some of
Teicholz’s claims and want to check the references. When many of those papers are read again
from a more critical perspective, the angst and anger will rise.” i.e.: what Nina claims in her book
can be verified, and realising how for decades we have been given incorrect advice about diet and
saturated fat will produce anger and angst.

The review continues: "Teicholz reminds us to … remember that associations do not provide
evidence of causality … "​

and

The UK, among many countries, has simply adopted the US lead against dietary
saturated fat ...
​

so there is pretty good evidence that where the Diabetes UK Position statement says:

People who want to follow a low-carb diet should ensure their fat intake comes mainly from unsaturated sources, whilst limiting saturated fat intake.
​

their claim "Diabetes UK continues to base recommendations on robust evidence rather than opinions" is untrue.

Whilst I can see where you are with this, it is SACN that provides and advises on the science evidence that Eatwell is based on since they control Eatwell. It is worth looking at the SACN committee members and find out who they are employed by Kellogg, Nestle, Tesco, etc. Then look at who is funding their work. Talk about bias ? Moi? Did you know that DUK shared a bed with Tesco on writing diabetes guidelines, and Tesco published their findings in a free booklet nationwide. I've got a copy somewhere,

If you ask DUK or SACN for what they base their evidence based data comes from, you will probably find it goes back to the US Food Pyramid and the American Heart Association. There you will find it was sponsored by the likes of Barilla, Cargill, and the California Walnut growers association. Much of the evidence comes from the FAO and WHO who based their findings on population studies since they controlled the statistics of food production, disease, diet macro's etc.

 

[pdmjoker]

Whilst I can see where you are with this, it is SACN that provides and advises on the science evidence that Eatwell is based on since they control Eatwell. It is worth looking at the SACN committee members and find out who they are employed by Kellogg, Nestle, Tesco, etc. Then look at who is funding their work. Talk about bias ? Moi? Did you know that DUK shared a bed with Tesco on writing diabetes guidelines, and Tesco published their findings in a free booklet nationwide. I've got a copy somewhere,

If you ask DUK or SACN for what they base their evidence based data comes from, you will probably find it goes back to the US Food Pyramid and the American Heart Association. There you will find it was sponsored by the likes of Barilla, Cargill, and the California Walnut growers association. Much of the evidence comes from the FAO and WHO who based their findings on population studies since they controlled the statistics of food production, disease, diet macro's etc.

Thank you - you make some great and informative points.

Regarding bias, I heard Dr Jason Fung say that it would be far better if medical experts who influence public policy were not permitted to accept money from companies who clearly have a commercial interest in those policies. I wouldn't disagree.

I gather 75% of the US panel who recommended wider use of statins in the US also receive money from Pfizer, who manufacture statins. I gather the American Heart Association was a few doctors meeting in a cupboard until Proctor & Gamble, makers of vegetable oil, made a substantial donation.

 

[pdmjoker]

This article discusses the difficulties in obtaining enough evidence for unequivocal public health messages about fat and saturated fat:-
https://www.bmj.com/content/361/bmj.k2139

Interestingly, the authors include Gary Taubes AND Walter Willet.

Thank you for the citation.

I had a quick look at the paper. It says

Notably, these lipid markers improve—that is, triglycerides decrease or HDL cholesterol increases—when saturated, monounsaturated, or polyunsaturated fats replace carbohydrates.​

I found that when I went Keto. It also makes a distinction between lipid marker improvements and health improvements, which seems wise.

In the Peer Review section, a reviewer noted "the recent interest in the ratio of serum triglycerides to HDL cholesterol (TG:HDL ratio) as a surrogate marker for small dense LDL." I gather small dense LDL is the major Atherosclerosis culprit (not LDL in general) and that Trigs/HDL is regarded by some as a good indicator of CDV risk...

 

[ianf0ster]

Those interested in this thread may also like to watch this, the latest from Dr Paul Mason:
'How to deceive a doctor'

Basically :
1. People with the highest quartile of LDL live longer than those with the lowest quartile and this is more or less the same when comparing any quartile with the ones lower than it.
2. Replacement of Saturated Fat by Polyunsaturated Fat increases mortality (even when trans fats are absent from the polyunsaturated fat).

Several of these studies were done over 40yrs ago and the results buried ( because the results were 'disappointing') only to be found and published in the last decade. But then to be mostly ignored.

 

[pdmjoker]

Those interested in this thread may also like to watch this, the latest from Dr Paul Mason:
'How to deceive a doctor'

Basically :
1. People with the highest quartile of LDL live longer than those with the quartile and this is more or less the same when comparing any quartile with the ones lower than it.
2. Replacement of Saturated Fat by Polyunsaturated Fat increases mortality (even when trans fats are absent from the polyunsaturated fat).

Several of these studies were done over 40yrs ago and the results buried ( because the results were 'disappointing') only to be found and published in the last decade. But then to be mostly ignored.

Great video - thanks!

 

[pdmjoker]

Assuming they ever will after piling £3 million, I think it was, into DIRECT.

I once emailed Diabetes UK about their low carb Position Statement specifically regarding the main points made here. Their reply was evasive, uninformative and ended "We do hope this has been helpful".