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    The interpretation and effect of a low-carbohydrate diet

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    graham64
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    The interpretation and effect of a low-carbohydrate diet

    Post by graham64 on Wed Dec 27 2017, 21:54

    The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials

    Abstract

    Background/objectives
    Recently, the role of a low-carbohydrate diet in diabetes management has generated interest with claims being made regarding its superiority over the traditional high-carbohydrate, low-fat dietary approach. This systematic review and meta-analysis evaluated the interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes.

    Subjects/methods
    Randomised controlled trials were searched for which included adults with type 2 diabetes aged 18 years or more. The intervention was a low-carbohydrate diet as defined by the author compared to a control group of usual care. MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, ISRCTN, ProQuest and opengrey.eu were searched. Independent experts were contacted and reference lists of selected papers were checked. Results were analysed descriptively and meta-analyses were completed to include trials that presented data at 1 year.

    Results
    Eighteen studies (n = 2204) were eligible for inclusion within the systematic review. The definition of a low-carbohydrate diet varied. At trial end, the descriptive analysis suggested that the low-carbohydrate intervention arm (LCIA) may promote favourable outcomes in terms of HbA1c, triglycerides and HDL cholesterol. The LCIA demonstrated reduced requirements for diabetes medication, which may have reduced the observed benefit of dietary carbohydrate restriction on HbA1c. Seven studies provided data to be included in the meta-analyses at 1 year. The meta-analyses showed statistical significance in favour of the LCIA for HbA1c (estimated effect = −0.28%, 95% CI −0.53 to −0.02, p = 0.03; χ2 = 13.15, df = 6, p = 0.03; I2 = 54%), HDL cholesterol (estimated effect = 0.06 mmol/L, 95% CI 0.04–0.09, p < 0.00001; χ2 = 6.05, df = 6, p = 0.42; I2 = 1%), triglycerides (estimated effect = −0.24 mmol/L, 95% CI −0.35 to −0.13, p < 0.0001; χ2 = 1.88, df = 6, p = 0.93; I2 = 0%) and systolic blood pressure (estimated effect = −2.74 mmHg, 95% CI −5.27 to −0.20, p = 0.03; χ2 = 10.54, df = 6, p = 0.10; I2 = 43%). Meta-analyses for weight, total cholesterol, LDL cholesterol and diastolic blood pressure did not demonstrate a statistically significant difference between interventions.

    Dietary adherence was an issue in most studies. A very low-carbohydrate diet (<50 g/day) seems unrealistic in this population, however, a low-carbohydrate diet (<130 g/day) appears to be achievable. Improved clinical outcomes were observed in some studies as a result of achieving a low- or moderate-carbohydrate diet.

    Fifteen out of 18 studies were considered high risk of bias, with performance bias being a common issue.

    Conclusions

    Reducing dietary carbohydrate may produce clinical improvements in the management of type 2 diabetes. Further research is needed to understand the true effect of dietary carbohydrate restriction on HbA1c independent of medication reduction and to address known issues with adherence to this dietary intervention. Clarity is needed regarding appropriate classification of a low-carbohydrate diet.

    https://www.nature.com/articles/s41430-017-0019-4


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    chris c
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    Re: The interpretation and effect of a low-carbohydrate diet

    Post by chris c on Thu Dec 28 2017, 21:09

    Thanks, I'll read that later

    http://sci-hub.hk/10.1038/s41430-017-0019-4

    meanwhile

    A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

    http://insulinresistance.org/index.php/jir/article/view/30/0

    Dietary intake in people consuming a low-carbohydrate
    diet in the UK Biobank

    http://sci-hub.hk/10.1111/jhn.12527

    Haven't read that one yet but Nicola Guess is involved, she seems to be glacially slowly moving away from her low carb anti stance

    Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes

    https://www.nature.com/articles/s41387-017-0006-9

    includes Stephen Phinney so probably done properly

    Very low-carbohydrate diets in the management of diabetes revisited

    Grant Schofield, George Henderson, Simon Thornley, Catherine Crofts

    https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2016/vol-129-no-1432-1-april-2016/6850

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    graham64
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    Re: The interpretation and effect of a low-carbohydrate diet

    Post by graham64 on Thu Dec 28 2017, 22:56

    @chris c wrote:Thanks, I'll read that later

    http://sci-hub.hk/10.1038/s41430-017-0019-4

    meanwhile

    A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

    http://insulinresistance.org/index.php/jir/article/view/30/0

    Dietary intake in people consuming a low-carbohydrate
    diet in the UK Biobank

    http://sci-hub.hk/10.1111/jhn.12527

    Haven't read that one yet but Nicola Guess is involved, she seems to be glacially slowly moving away from her low carb anti stance

    Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes

    https://www.nature.com/articles/s41387-017-0006-9

    includes Stephen Phinney so probably done properly

    Very low-carbohydrate diets in the management of diabetes revisited

    Grant Schofield, George Henderson, Simon Thornley, Catherine Crofts

    https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2016/vol-129-no-1432-1-april-2016/6850


    That's all well and good but just try and get a dietitian to accept the evidence   floggingdeadhorse


    _________________
    I'm a skinny T2 diagnosed 4/4/2008, a high calorie LCHF diet and one metformin a day A1c 6.2 and no complications.

    Proving the LowCarb sceptics wrong for over ten years

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    chris c
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    Re: The interpretation and effect of a low-carbohydrate diet

    Post by chris c on Sat Dec 30 2017, 22:48

    Spin and damage control

    https://twitter.com/DrDuaneRD/status/913624572481679361

    Has anyone who still reads diabetes forums actually ever seen anyone NOT told to eat high carb low fat by their dietician? Well there may be one or two but in general the advice hasn't changed.

    Give it another decade and they will be claiming that they invented low carb and anyone who ever "claimed" otherwise is lying.
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    Re: The interpretation and effect of a low-carbohydrate diet

    Post by graham64 on Mon Jan 01 2018, 22:07

    @chris c wrote:Spin and damage control

    https://twitter.com/DrDuaneRD/status/913624572481679361

    Has anyone who still reads diabetes forums actually ever seen anyone NOT told to eat high carb low fat by their dietician? Well there may be one or two but in general the advice hasn't changed.

    Give it another decade and they will be claiming that they invented low carb and anyone who ever "claimed" otherwise is lying.

    Think the time spent in the Australian sun has addled Duane Mellors brain he does appear to have got worse since he came back to the UK

    Duane Mellor wrote:
    Inconvient truth 1: both US & UK current guideline don’t suggest %carbohydrate & inc low carbohydrate as option. Has been case since 2011 UK

    But the majority of BDA dietitians don't even consider low carb as an option for T2


    See Eddies blog post https://thelowcarbdiabetic.blogspot.co.uk/2014/05/british-dietetic-association-chris.html


    _________________
    I'm a skinny T2 diagnosed 4/4/2008, a high calorie LCHF diet and one metformin a day A1c 6.2 and no complications.

    Proving the LowCarb sceptics wrong for over ten years

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
    avatar
    chris c
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    Re: The interpretation and effect of a low-carbohydrate diet

    Post by chris c on Tue Jan 02 2018, 21:46

    https://twitter.com/FructoseNo/status/912788025049939968

    https://twitter.com/Botanygeek/status/920262579783655426

    (did I tell you I'm a vegan?) the Joanna Blythman article is here

    http://www.businessinsider.com/nutrition-advice-wrong-2014-3?IR=T

    https://twitter.com/JoannaBlythman/status/946668199847890944

    Most of the Usual Suspects emerge, the rest are probably still in a carb coma

    Someone made a very valid point, over 60% of the world's "available food supply" is carbs (and most of the fat is industrially produced Omega 6 seed oils), then there's soy of course.

    Dieticians' job is to market what is produced by claiming it is "healthy". Hence high carb diets must be imposed on everyone.

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