What is the story with Diabetes UK?

[Oldvatr]

Precisely this. The official definition of T2 is that it is a progressive disease that may start by being treated with diet but will lead through various drugs to insulin. As a result, the recommended diet, which complies with this point of view, is not out of step at all. As the history of T2 is longer than the diet, the received wisdom is that T2 has always been progressive and the variation of diet recommendations to handle CVD has not affected this.

It's only in a very short timeframe in all of this that anyone has raised the idea that a) T2 can be reversed and b) T2 can be reversed by diet . Indeed, it appears, having a dig through google that it's only really Dr. Roy Taylor's paper in 2012 that is where you first see the idea that it is insulin resistance causing the issues that cause mitochondrial dysfunction and not the other way around, and that reducing this might offer a reversal, officially peer reviewed and published. Even there he discusses using very low calorie diets to recover insulin resistance.

So while there have been people anecdotally discussing the benefits of low carb for T2 for longer (this forum for example), "official" recognition of the need to reduce insulin release to manage the condition has much a much less long life. This is why the current evangelists are important, and things like the data gathered from the Low Carb programme are being turned into studies for peer review. It only takes the body of evidence to build to that inertial point...

Your use of the term 'evangelist' is a sad reflection of the state that some people become overtly enthusiastic over something, and tend to bang their drum and blow their whistles with gusto, and this will actually be counter productive in gaining support. It is a human trait to become blinded by something that affects our lives, be it a good or bad influence, but it is something we all need to be aware of and try to avoid since it stifles free speech, and we are beginning to see comments being expressed in this forum about some adherents to LC diets taking an agressive stance to other posters.

The thing I like about This site compared to the site identified in the OP is that we appear to have greater freedom to argue both sides of a discussion, and explore the issues. Sometimes I have found myself acting as Devils Advocate simply to make sure that potential negative aspects are aired. Although I personally use and support the LCHF way of life, and have great hopes that it is a significant step in the fight against Diabetes for both T1 and T2, nonetheless I am minded that there may be latent problems further down the line. I am particularly concerned that our diets directly affect the flora and fauna in the gut microbiome, and that something in the particular diet I use may actually be working against me. So I do try to keep an open mind as much as possible.

[End of Rant]

 

[RFSMarch]

I find myself in the peculiar position of having a couple of rellies who managed to "reverse" their initial pre-diabetes diagnoses but have since found themselves the wrong side of the mmol tracks, and find themselves wondering why, while all the time gleefully telling me "no more of this for you, none of that neither" or "go and buy pakchoi... it's good for you"

Now I am being asked about the Freestyle Libre and how I have managed to get my numbers down (according to the libre at any rate).

My cousin's husband swears by 16:8 and for the longest time, I had to bite my tongue when I was round theirs when he kept telling me to try it. He is retired. He can sleep all day if he wants to. He has the time to go for a stroll in the middle of the day.
I run a business and I freelance. I could be working at home one day, or in an office the next - it changes from week to week when I am home. Let's not even get started on the challenges when I am on the road.

I get that people are filled with a missionary zeal to convert all to what has worked for them, it is just human nature to want to shout about the story of your success from the rooftops. But one size does not fit all. I love my cousin and her hubby dearly - they have been no end of support this past year or so especially after I lost my mother suddenly. But sometimes it does require the patience of a saint to tell them to stop preaching when they themselves need to re-establish control (by their own admission!)

 

[ickihun]

Precisely this. The official definition of T2 is that it is a progressive disease that may start by being treated with diet but will lead through various drugs to insulin. As a result, the recommended diet, which complies with this point of view, is not out of step at all. As the history of T2 is longer than the diet, the received wisdom is that T2 has always been progressive and the variation of diet recommendations to handle CVD has not affected this.

It's only in a very short timeframe in all of this that anyone has raised the idea that a) T2 can be reversed and b) T2 can be reversed by diet . Indeed, it appears, having a dig through google that it's only really Dr. Roy Taylor's paper in 2012 that is where you first see the idea that it is insulin resistance causing the issues that cause mitochondrial dysfunction and not the other way around, and that reducing this might offer a reversal, officially peer reviewed and published. Even there he discusses using very low calorie diets to recover insulin resistance.

So while there have been people anecdotally discussing the benefits of low carb for T2 for longer (this forum for example), "official" recognition of the need to reduce insulin release to manage the condition has much a much less long life. This is why the current evangelists are important, and things like the data gathered from the Low Carb programme are being turned into studies for peer review. It only takes the body of evidence to build to that inertial point...

I agree with @tim2000s about progression.
I also worry about certain posters claiming if you eat lchf you wont get complications. This has no backing/proof either.
I worry that posters or readers will not see their gp or dn because "they dont get it" or should be "ignore"d.
I worry sufferers with a complication write it off or ignore it as afterall they are on lchf.
Low carbing is a tool to manage diabetes and it's need for insulin. Nothing more has been proven with longterm use.
I can declare ive used metformin longterm and see it's longterm results. Everytime. For me!

 

[Tannith]

There is understandable resistance in the NHS to recommending anyone to cut out a major food group. Starchy carbs (grains etc) provide us with much of our vitamin b and a large proportion of our fibre. And most of us are short of fibre anyway. I can understand why the generalists at least, suggest the Eatwell " a little bit of everything" approach. They aren't going to know which of their patients can and will make the necessary adjustments to replace missing nutrients.

 

[Oldvatr]

There is understandable resistance in the NHS to recommending anyone to cut out a major food group. Starchy carbs (grains etc) provide us with much of our vitamin b and a large proportion of our fibre. And most of us are short of fibre anyway. I can understand why the generalists at least, suggest the Eatwell " a little bit of everything" approach. They aren't going to know which of their patients can and will make the necessary adjustments to replace missing nutrients.

Grains do not normally have good levels of B vits, which is why by law products using wheat flour and cereals have to be fortified by adding B vits and calcium. Meat and dairy are much better sources of these. So no, carbs are not essential for those nutrients. This is why vegans are advised to take a Vit B supplement every once in a while. Fibre can easily be obtained from veg and root veg, so again, grains and starchy carbs are not essential nutrient sources.
Edit: There is resistance in the NHS, but it is not understandable

 

[NoCrbs4Me]

There is understandable resistance in the NHS to recommending anyone to cut out a major food group.

And yet the NHS has no problem recommending people to greatly reduce their meat and fat intake, which have more nutrients than starchy food.

 

[badcat]

But should that allow their for the most part appalling dietary advice for the majority of the people they are there to help?
if 90% of diabetics are Type 2 then maybe 60-70% of them could be helped with a low carb diet. So why will they only admit through gritted teeth that they aren't totally opposed to it. Could it maybe have something to do with the major contributors or do they just want us all dead?

Or something to do with all their advice having to be evidence based in order to maintain charitable status - their research arm needs to be bent rather than their intentions ridiculed. It matters not in that respecr whether we or they believe the available evidence ( and by that I mean research that passes nhs etc evidential thresholds, and yes nhs reseach isnt a remotely level playing field)

 

[bulkbiker]

Or something to do with having to be evidence based - their research arm needs to be bent rather than their intentions riddiculed

As I said before show me the evidence for their current advice..the flawed seven countries study aside there isn't any for that either...

 

[badcat]

Even If the only 'evidence' available is flawed, its still the only evidence - target research arms

 

[Oldvatr]

Or something to do with all their advice having to be evidence based in order to maintain charitable status - their research arm needs to be bent rather than their intentions ridiculed. It matters not in that respecr whether we or they believe the available evidence ( and by that I mean research that passes nhs etc evidential thresholds, and yes nhs reseach isnt a remotely level playing field)

But there is no evidence based studies that support their guidelines in the first place. That is what is so frustrating. The guidelines were put together by a panel of so called experts, In fact I think the work of producing those guidelines was contracted out to the same firm that produced the DVLA guidelines. Why does their report on the new guidelines not provide a single reference to any studies at all. It is usual to provide source references in such a report, but they chose not to identify either the sources or the participants who were involved in making these important decisions.

 

[Oldvatr]

Even If the only 'evidence' available is flawed, its still the only evidence - target research arms

That is no longer a tenable position to hold, given the reports that have been published over the last 2 or 3 years. It has been fully proven that studies done before 2006 use biassed statistical methods that are now banned from being used in new research since that date. Even the textbooks describing the methods have had to be overprinted with a disclaimer that they are to be used for archive studies only since they contain mechanisms for hidden bias and are open to different interpretations. There has been a lot of work recently re-running these old studies, and with very different conclusions. I know, because I took a couple of the old ones apart myself, and there was no sensible way that the conclusions were related to the raw data.

 

[badcat]

I find myself in the peculiar position of having a couple of rellies who managed to "reverse" their initial pre-diabetes diagnoses but have since found themselves the wrong side of the mmol tracks, and find themselves wondering why, while all the time gleefully telling me "no more of this for you, none of that neither" or "go and buy pakchoi... it's good for you"

Now I am being asked about the Freestyle Libre and how I have managed to get my numbers down (according to the libre at any rate).

My cousin's husband swears by 16:8 and for the longest time, I had to bite my tongue when I was round theirs when he kept telling me to try it. He is retired. He can sleep all day if he wants to. He has the time to go for a stroll in the middle of the day.
I run a business and I freelance. I could be working at home one day, or in an office the next - it changes from week to week when I am home. Let's not even get started on the challenges when I am on the road.

I get that people are filled with a missionary zeal to convert all to what has worked for them, it is just human nature to want to shout about the story of your success from the rooftops. But one size does not fit all. I love my cousin and her hubby dearly - they have been no end of support this past year or so especially after I lost my mother suddenly. But sometimes it does require the patience of a saint to tell them to stop preaching when they themselves need to re-establish control (by their own admission!)

I have been diabetic for over 20 years and have had to adjust my dietary approach several times in conjunction with low dose of Gliclizide in order to accomodate the vageries of diabetes and maintain my control within acceptable ( to me) parameters i.e. In the non diabetic / pre diabetic range. I learned long ago that missionary zeal for one approach is dangerous and pragmatic experimentation essential if I am to keep both control and my sanity

 

[badcat]

That is no longer a tenable position to hold, given the reports that have been published over the last 2 or 3 years. It has been fully proven that studies done before 2006 use biassed statistical methods that are now banned from being used in new research since that date. Even the textbooks describing the methods have had to be overprinted with a disclaimer that they are to be used for archive studies only since they contain mechanisms for hidden bias and are open to different interpretations. There has been a lot of work recently re-running these old studies, and with very different conclusions. I know, because I took a couple of the old ones apart myself, and there was no sensible way that the conclusions were related to the raw data.

Evidence of bias in one piece of research exploring hypothesis a is not evidence in favour of hypothesis b
Ps i do not follow eat well myself at this stage in my diabetic journey and do follow reduced carb but thats a personal choice based on individual experience rather than a formally evidence based position. Duk cannot do the same

 

[Oldvatr]

Evidence of bias in one piece of research exploring hypothesis a is not evidence in favour of hypothesis b
Ps i do not follow eat well myself at this stage in my diabetic journey and do follow reduced carb but thats a personal choice based on individual experience rather than a formally evidence based position. Duk cannot do the same

But they DO, THEY DO There is no formal evidence based reports that anyone has been able to find that support their assertion that a HCLF diet is safe for diabetics. It may be fine for the general populace, but not for those with a metabolic disorder.

None of their documentation has sources referenced, and their press releases are media pap,, and do not identify the study that is being reviewed. At least DCUK BOT and other sites I am member of do that so that I can see the techie bits and make sure it is not fanciful thinking, or someones blog. Note: ADA now has support for LC diets, and has dropped their version of Eatwell completely.

I was not the only one finding bias in medical reports. It seems to have been a systemic problem for many years, and not limited to one study or funding sponsor.

Edit to add the following report findings
<<<<Some RCTs are fully or partly funded by the health care industry (e.g., the pharmaceutical industry) as opposed to government, nonprofit, or other sources. A systematic review published in 2003 found four 1986-2002 articles comparing industry-sponsored and nonindustry-sponsored RCTs, and in all the articles there was a correlation of industry sponsorship and positive study outcome. A 2004 study of 1999-2001 RCTs published in leading medical and surgical journals determined that industry-funded RCTs "are more likely to be associated with statistically significant pro-industry findings." These results have been mirrored in trials in surgery, where although industry funding did not affect the rate of trial discontinuation it was however associated with a lower odds of publication for completed trials. One possible reason for the pro-industry results in industry-funded published RCTs is publication bias. Other authors have cited the differing goals of academic and industry sponsored research as contributing to the difference. Commercial sponsors may be more focused on performing trials of drugs that have already shown promise in early stage trials, and on replicating previous positive results to fulfill regulatory requirements for drug approval.>>>>>

 

[badcat]

I know how much bias and manipulation there is in medical research - I saw enough of it in my time working in the nhs. There is stull a lack of robust enogh research into low carb over the long term for any organisation to make an acceptable ( to the mainstream) case to unreservadly reccomend it, whatever we think

 

[kokhongw]

The simple fact is that diabetes associations around the world has existed for decades...and failed to provide any meaningful information or discussion regarding ketosis. Their understanding of ketosis remains only in the primitive, singular context of ketoacidosis. They see only its dangers, and remains blind to its essential utility and purpose.

Untold millions remains ignorant and starved of this basic information, while continually being dumbed down, fattened with "healthy" wholegrains just like cattle to be readied for the slaughter.

 

[Oldvatr]

I know how much bias and manipulation there is in medical research - I saw enough of it in my time working in the nhs. There is stull a lack of robust enogh research into low carb over the long term for any organisation to make an acceptable ( to the mainstream) case to unreservadly reccomend it, whatever we think

OK try this comparison summary between LC diet vs LF diet
https://phcuk.org/wp-content/uploads/2016/04/Summary-Table-53-RCTs-Low-Carb-v-Low-Fat.pdf

A few more reports on LC diets
http://www.xperthealth.org.uk/Portals/0/2015-5-15_Evidence base that supports a low carb high fat diet_May 2015.pdf

And from the PubMed archive
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674467/
and
https://www.ncbi.nlm.nih.gov/pubmed/14672862
and
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555979/
and
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555979/

And this from Harvard school of Medicine:
https://www.hsph.harvard.edu/nutritionsource/carbohydrates/low-carbohydrate-diets/

And then, this is what I could find on HCLF studies in the archives
https://www.ncbi.nlm.nih.gov/pubmed/17823420

And that is all I could find in any recognised archive, There were other articles, but these were either magazine write-ups or bloggers, Nothing comparable to the RCT trials on LCHF diet. The main people doing research into HCLF are the Mormons in Salt Lake City or the WFPB brigade who use their trial reports and draw their own interpretations from them.

Even Nutrition has little to say about High Carb diets
https://www.healthline.com/nutrition/randomized-controlled-trials-in-nutrition#section5

I have ignored sites like DietDoctor and others that I know to be connected to LC diets, and who are not independent sources.

I could not find the Swedish RCT study done some 15 years ago, and it seems to have been moved or withdrawn since my bookmark no longer works. It seems it has been replaced with
http://healthimpactnews.com/2013/sw...ogma-in-favor-of-low-carb-high-fat-nutrition/

Its late, and I am getting bored with this. There is much more published evidence supporting LCHF than there is supporting Eatwell or the DUK stance. I am resting my case.

 

[KathyCP]

When I was first diagnosed and very scared, and very alone in the hospital, Diabetes UK were there for me in a way that no one else was. They gave me the information and support my overworked DSN simply didn't have the time to give me. And later when I went through a phase of burn out they were there for me again. And both times they came to me rather than me having to search them out. They run workshops, go into schools, run holiday camps, support research and provide literature all of which costs money.

I'm glad that they helped you so much, that's great to know. But I guess my own experience has been very different - it was only when i stopped following their dietary advice that i was able to really get my bg levels under control. so what is the point of spending large amounts of money on literature, etc.,, if it is actually misleading for many of us?

 

[KathyCP]

Like I said they may want to give a different perspective to the whole diabetes disease and not become primarily for new type2s?

no problem with that, but their blanket, general dietary advice isn't really helpful for anyone, and can actually make things worse for some people.

 

[Oldvatr]

no problem with that, but their blanket, general dietary advice isn't really helpful for anyone, and can actually make things worse for some people.

I was looking up a complication associated with diabetes, and whilst there was useful advice from other sites, including this one, there were several entries for DUK but they all went to the 'make donation' page. I found that very offputting. and so it put me right off, ok? Actually it was something they do not have any info on anyway, so the Google search was on diabetes only as far as they were concerned.

Edit: Actually IMO their dietary advice will be keeping many surgeons in gainful employment into the future, so someone will benefit from it.