IanD said:
This thread is to a 44 month Swedish study cited by DUK in their position statement, & largely ignored.
viewtopic.php?f=1&t=20859
Yes, although it doesn't point to the original study I found the study by searching the DUK site
https://www.diabetes.org.uk/About_u...ydrate-diets-for-people-with-Type-2-diabetes/
That "Position Statement" has been discussed on this forum - including my comments.
The citations do not lead to the DUK conclusions.
I have looked up:
8. Daly M, Paisey P, Millwards B, Eccles C, Williams K, Hammersley S, Macleod K and Gale T (2006). Short-term effects of severe dietary carbohydrate-restriction advice in type 2 diabetes – a randomized controlled trial. Diabetic Medicine 23; 15–20
This is a genuine clinical study, with ongoing treatment of patients. In a recent email responding to my query about adverse effects, Dr Daly wrote:
We have presented our results at 3 national and 1 international meetings. We found no serious adverse effects over 2 years but not everyone is as good at sticking to low carbohydrate diets as you
13. Nielsen J and Joensson E (2008). Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycaemic control during 44 months follow up. Nutrition and Metabolism 5; 14
Swedish genuine clinical study, with ongoning treatment of patients. See my linked thread.
16. Dyson P (2008) A review of low and reduced carbohydrate diets in weight loss in type 2 diabetes. Journal of Human Nutrition and Dietetics, 21; 550–538
Meta-analysis
Results Six studies investigating the effects of hypocaloric reduced carbohydrate diets in people with type 2 diabetes were identified. The studies were heterogenous and most included small numbers, were short-term and provided varying amounts of carbohydrate. No studies were identified that were both low carbohydrate (<50 g day−1) and also designed as randomized controlled trials. All studies reported reductions in both body weight and glycated haemoglobin, with no deleterious effects on cardiovascular risk, renal function or nutritional intake.
Conclusions Conclusions are limited by study design and small numbers, but it appears that reduced carbohydrate diets are safe and effective over the short term for people with type 2 diabetes.
18. Worth J, Soran H (2007). Is there a role for low carbohydrate diets in the management of type 2 diabetes? Q J Med 100; 659–663
Meta-analysis
In summary, low-CHO diets of 6–12 months duration have no adverse effect on CVD risk factors, and show no major adverse effects to preclude their use. Meaningful weight loss is achieved, but this does not appear to be sustained beyond 6 months. Long-term trials are required to assess their safety, and studies are awaited to define the role of such diets within patients with diabetes. In the study by Samaha et al., 39% had diabetes, and the mean fasting glucose level decreased more in the low-CHO group than in the low-fat group (−9 ± 19% vs. 2 ± 7%, p = 0.02) at 6 months.13 A 16-week pilot diet intervention trial also demonstrated that a low-CHO, ketogenic diet can improve glycaemic control in obese type 2 DM patients (mean BMI 42), such that diabetes medications were discontinued or reduced in 17 of the 21 participants.19 However, to date there has been no randomized controlled trial in type 2 DM patients and health care professionals remain wary of their use, particularly as standard dietary advice from Diabetes UK does not support this approach.7
....
On the basis of this, a two-year randomized controlled study of CHO-restriction versus a prescribed energy deficit diet, in 300 obese type 2 DM patients has been funded by Diabetes UK. The study is due to report this year, {2007} and will provide information regarding the long-term efficacy and any potential side-effects of a low-CHO diet in patients with type 2 DM.
What happened to that study - due to report this year, {2007} ??????
This is a fairly neutral statement, but it basically says that low carb can help reduce both weight and BG levels and is not known to cause any harm.
Long term benefits are still to be proven, and other approaches work equally well.
Beware of hypos, monitor your BG and medication, and talk to your HC team.
So basically just like any other change to diet and exercise.
So it can do you good, probably won't do you harm, and isn't the only valid approach for T2s.
Although this position statement is neutral in tone, I think it must be regarded as an endorsement of low carbing because it doesn't advise against it. They key point is that other approaches may be equally valid.
So, officially main stream
I don't agree - DUK's warnings against low carb persist, particularly with the 2010 reissue of their "Eating well with Type 2 diabetes" booklet which maintains as ever:
Why is carbohydrate important?
All carbohydrate is converted into glucose and will have an impact on blood glucose levels. Since this is the case, some people with diabetes wonder if it would be better not to have any carbohydrate in their diet to keep their glucose levels under control. This is not recommended, as:
# glucose from carbohydrate is essential to the body, especially the brain
# high fibre carbohydrates, such as wholegrains and fruit, also play an important role in the health of the gut
# some carbohydrates may help you to feel fuller for longer after eating.
How much do I need?
The actual amount of carbohydrate that the body needs varies depending on your age, weight and activity levels, but it should make up about half of what you eat and drink.
DUK "Position Statement" summary:
Evidence exists suggesting that low-carbohydrate diets can lead to improvements in HbA1c and reductions in body weight in the short term (less than one year).
Weight loss from a low-carbohydrate diet may be due to a reduced calorie intake and not specifically as a result of the carbohydrate reduction associated with this diet.
Despite the short-term benefit there is a lack of evidence related to long-term safety and benefit of following this diet.
Why ignore the ongoing clinical studies on patients (8. Exeter & 13. Sweden) that report the long term benefits? Why also ignore the serious experiential evidence that diabetes, treated with the DUK diet is progressive, & therefore raises serious questions about its long term safety.
In my experience, following the DUK diet results in: neuropathy (muscle pain & debility); chronic tiredness; retinopathy. All three conditions were reversed by following a low carb diet, & there has been NO adverse effect after 3½ years.
The thread LOW CARB SUCCESS STORIES is a testimony to the effectiveness & long term benefits & safety.
Will that "Position Statement" be seen by dietitians & patients? Or is the possibility of turning away from DUK's standard advice to be buried in cyberspace - dare they change their advice of 30 years & risk the embarrassment of admitting they are WRONG?
