Draft document on government view of Low carb diet for diabetes

[Toucan]

https://assets.publishing.service.g...nt_data/file/860659/Draft_diabetes_report.pdf

This is a draft document from Public Health England currently out for review by Scientific Advisory Committee on Nutrition.

It isn’t a ‘light read’ (probably useful to insomniacs). I have copied out some extracts and some of the conclusions.

The purpose of this report is to review the evidence on lower carbohydrate diets compared to current UK government advice for adults with type 2 diabetes (T2D). It was initiated in 2017, in response to a request from Public Health England (PHE), in recognition that such diets are gaining attention and increasingly being promoted.

‘There is no universally agreed definition of a low carbohydrate diet. Current UK government advice on carbohydrate intake would be considered high.’

For the purposes of this review

Low > 50 < 130g/day High >230g/day

Some of the conclusions:

The evidence considered for the following markers and clinical outcomes of T2D suggests that for adults with T2D:

• body weight — no difference between lower and higher carbohydrate diets in the longer term (shorter-term weight changes were not considered)

• HbA1c — lower carbohydrate diets have benefits over higher carbohydrate diets in the shorter term but evidence for longer-term effects are unclear

• fasting plasma glucose — lower carbohydrate diets have benefits over higher carbohydrate diets in the shorter term but there is insufficient evidence to assess longer-term effects

• serum total cholesterol — no difference between lower and higher carbohydrate diets in the shorter or longer term

• serum triacylglycerol — lower carbohydrate diets have benefits over higher carbohydrate diets in the shorter term but evidence for longer-term effects are inconsistent

• serum LDL cholesterol — no difference between lower and higher carbohydrate diets in the shorter term or longer term

• serum HDL cholesterol — evidence for shorter-term and longer-term effects is inconsistent

• serum total cholesterol:HDL cholesterol ratio — none of the SRs with MAs considered this outcome

• medication use — lower carbohydrate diets may have a beneficial effect in reducing diabetes medication but the evidence is unclear because of inconsistencies in the reporting and measurement of diabetes medications across primary studies

• diabetes-related symptoms — none of the SRs with MAs considered this outcome

 

[Ralph-YK]

So, for some, a could be. Others: doesn't make a difference. And mostly, we don't know.

 

[trophywench]

LOL @Benny G .

Normally though if a person does eat doughnuts and pizza and a loaf of bread at every mealtime they will put on weight - and being overweight again normally isn't healthy in general, let alone specifically in the case of diabetes (again generally so not restricted to 'Type' of diabetes)

 

[Ralph-YK]

and pizza ... at every mealtime they will put on weight

Pizza (unless you get a dirt cheep one) has plenty of cheese. Which doesn't help. People have a 10" one to themselves. It's like a enormous cheese and tomato sandwich, without a lid. Though, for some reason, they can taste better. Odd

 

[Eddy Edson]

A fun table from a 1986 paper showing how carb recs for diabetes have changed over the aeons:



Pizza: Remember how back in the day pizza was "bad" because of the fat, not because of the carbs? Really, I think it's bad because it's simply c**p food (for most commercial pizzas, anyway), where "c**p" = "lots of calories for not very many micronutrients".

These days, I think a lot of the time "low carb" is used for "less c**p", but it's not the same thing. There's obviously a big difference between cutting wholegrains and cutting donuts.

That draft looks like it's similar to many recent expert reviews. Here's one from the other day: https://read.qxmd.com/read/32131904...for-type-2-diabetes-management-and-prevention

Solely lowering carbohydrate intake does not, in the medium/long term, reduce HbA1c for T2D prevention or treatment, as many mechanisms interplay. Under controlled feeding conditions, LCD are not physiologically or clinically superior to diets with higher carbohydrates for weight-loss, fat loss, energy expenditure or glycaemic outcomes; indeed, all metabolic improvements require weight loss.

 

[trophywench]

Pizza is a ruddy nightmare for me plus I loathe pepperoni and my beloved loves it. He could and would eat a whole one - if I ever let him.

Me - it spikes approx. 5 hours later and usually results in raging heartburn all flippin night - hence I try hard as I can to avoid it.

 

[trophywench]

Funnily enough Benny - I'm naturally more drawn to your suggestions than I ever was a pizza! - and that dates back to well before diabetes raised its ugly little head. (well actually it's an ugly huge one)

I was not brought up to eat or enjoy lots of stodge. Husband's first wife's family had to make sure they had extra bread in if he was eating there. His FIL said to him at the time 'Son - you are supposed to eat bread WITH your meal!' Trouble is here we are, he's over 70, overweight and no longer doing the 2-3 hours of gymnastics he did every day 6 days a week when he was 17!

 

[DaveB]

The SACN response is only to be expected. It was SACN who were responsible for the (in)famous Eat Well Plate & Guide based on university research funded by food companies. They weren't about to admit they had got their view on carbs so badly wrong hence the woolly findings.

 

[Jodee]

Hmmn, bias.
Can any one remember when smoking was good for you?
Those scientists didn't lose any sleep.

Don't get me wrong, I love science; it's the bias of scientists, politicians, and the media that makes me cringe.

Doc's use to recommend smoking for stress at one time, and
a guinness and raw egg for pregnant women who were iron deficient.

 

[everydayupsanddowns]

Interesting that the review doesn’t see raised LDL chol with low carb diets.

 

[Eddy Edson]

Interesting that the review doesn’t see raised LDL chol with low carb diets.

Not sure why you'd expect to see any particular diff without having any info re sat/unsatfat comparison?

 

[everydayupsanddowns]

Not sure why you'd expect to see any particular diff without having any info re sat/unsatfat comparison?

I guess I was assuming an increased fat content to make the LC more sustainable over the medium term?

 

[Eddy Edson]

I guess I was assuming an increased fat content to make the LC more sustainable over the medium term?

Probly, but unsaturated fat doesn't raise LDL, and may lower it.

 

[trophywench]

OOOO! - he can knit!

Nearly 20 years ago we went motorbike camping and went to a site in deepest France, which was situated at the bottom of a deep ravine. We chose our pitch but the bike was still parked by the reception office, so pete said he'd walk back there and get it. I said I'd nip to the loo whilst he did, when I came out of the loo block there were a Dutch couple, I smiled and said Good Morning, they swapped to English so the three of us were chatting whilst ambling back to the same-ish part of the site. Pete passed us on the bike and about 25 yds further along the track across the field, the front tyre 9washed out' on the loose sandy surface at the edge of said track and the bike started to fall over - the 3 of us had stopped dead as it happened. Pete rose upright on the footpegs and pushed off vertically, did a neatly tucked in somersault in mid air, and landed at the side of the bike, knees properly bent and arms outstretched at either side. Mr Holland had started running towards him by this time but I - completely gobsmacked that he still had it and found myself saying to his wife - and still don't know where it came from - 'Oooh - I haven't seen him do that, since he left the circus!'

PS - I thought I'd lost this post and wasn't going to retype it as irrelevant to the thread, but as it's still here I'm posting it.

 

[Toucan]

May be I have got this wrong, but isn't SACN the organisation that is the main influence on NHS guidelines, that eventually filter through to official messages given out to Newbies at GP surgeries?
If so I was slightly encouraged by :
' HbA1c — lower carbohydrate diets have benefits over higher carbohydrate diets in the shorter term but evidence for longer-term effects are unclear'

Could this mean that at last there may be more official support for low-carb eating as an option, although maybe the 'long-term effect' being unclear will be the new show stopper, because of lack of evidence?

I am not sure if there is any formal research evidence on this, but I'm sure on the forum we can provide a lot of practical evidence.
I can claim 5 years of low-carb eating and I'm not falling to bits too much yet, and I'm sure there are others can claim more.

 

[everydayupsanddowns]

isn't SACN the organisation that is the main influence on NHS guidelines

The body which develops clinical guidance in the UK is NICE. I suspect SACN would be a stakeholder during the scoping and development of NICE guidance?

 

[DaveB]

The body which develops clinical guidance in the UK is NICE. I suspect SACN would be a stakeholder during the scoping and development of NICE guidance?

NICE isn't largely involved with NHS health/diet advice; it tends to only cover medical/clinical tretaments. PHE uses SACN which is a different organisation from NICE.