Low carb diet not evidenced based

I received an email today with a link to a facebook account. Self explanatory post below.

"Hi everyone

I like to ask for some help/advice from the group please. A dietitian in my area (I’m in Australia) has put in a complaint to my employers and DAA (Dietitians Association Aust) about my use of a lower carb approach in the management of type 2 diabetes. The allegation is that lower carb diets do not conform to current guidelines and are not evidence based.

My response to my employers was that DAA recommends Aust dietitians follow ADA’s guidelines, and ADA says that low carb diets, ie between 21 gm carb to 40% energy from carbs, have a place in diabetes management.

I’ve shown my employers these guidelines and explained that because my suggested eating plans are between 21 gm carb to 40% energy from carbs (I felt that I had to spell it out), my practice is in line with the guidelines and therefore evidence based. Even so, they have decided against me. One work place has said that I have to prescribe a dietary intake of not less than 40% carbs to people with type 2. I’m yet to hear from DAA.

I’m stumped as to where I go from here and I’d love to hear any comments or advice from this group. Are dietitians in the US using lower carb approaches? Is it accepted practice?
Thanks in advance, Jen"

https://www.facebook.com/groups/276354325431/permalink/10152869390355432/

If the low carb diet for diabetics is not evidenced based what is? How about the official NHS audited annual statistics for diabetes control. Just about the most 'evidenced based' data it is possible to obtain and it makes for very grim reading. Nothing could provide more evidence of the total failure of the NHS to control diabetic blood glucose. As we all know the NHS does not recommend a low carb diet. What does the NHS diet achieve.

Results for England. The National Diabetes Audit 2010-2011

Percentage of registered Type 1 patients in England

HbA1c >= 6.5% (48 mmol/mol) = 92.6%
HbA1c >   7.5% (58 mmol/mol) = 71.3%
HbA1c > 10.0% (86 mmol/mol) = 18.1%

Percentage of registered Type 2 patients in England

HbA1c >= 6.5% (48 mmol/mol = 72.5%
HbA1c > 7.5% (58 mmol/mol) = 32.6%
HbA1c >10.0% (86 mmol/mol) = 6.8%

These results are very similar to those obtained in previous NHS audits over the past 5 - 6 years.

Link to NHS audit here http://www.hqip.org.uk/assets/NCAPOP-Library/NCAPOP-2012-13/Diabetes-Audit-Report-2010-11-Care-Process-and-Treatment-Targets-published-2012.pdf

It's my opinion if you want to go with so called 'evidenced based' diet start looking for a good funeral plan, a wheel chair and learning braille might be a good idea.

Not being a Facebook member, I can't access Jen's account there, so perhaps someone could pass this on:

Jen, I assume from your email that you are a medical practitioner, so you may be particularly interested in this paper by a UK GP, who has used a low carb approach with his patients.  His contact details are in the paper, it might be useful to get in touch.
[url=http://www.practicaldiabetes.com/SpringboardWebApp/userfiles/espdi/file/March 2014/PP Unwin final proofs revised.pdf]http://www.practicaldiabetes.com/SpringboardWebApp/userfiles/espdi/file/March 2014/PP Unwin final proofs revised.pdf[/url]
Sally

Ps. I've just tested the link and it seems to be coming out as gibberish. Also been back to my original source, same result. Perhaps it is a temporary fault. This is copied directly from the original source of the link:
http://www.practicaldiabetes.com/SpringboardWebApp/userfiles/espdi/file/March 2014/PP Unwin final proofs revised.pdf
It does give the details of the paper. If it's not working, I'll look up the doctor's published details and post later on.
Sally

Evidenced based studies proves low carb works ! check out this huge amount of evidence, how much evidence do you want?

http://thelowcarbdiabetic.blogspot.co.uk/2014/12/evidenced-based-studies-proves-low-carb.html

Here's some evidence coming at this from the other side; a meta analysis has looked at numerous observational and randomized controlled studies and says this about saturated fats and heart disease;

http://annals.org/article.aspx?articleid=1846638

"Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats."

That's a scientific way of saying; 'there is no evidence' for the fat/heart disease link. This is inline many other reviews of the evidence including a Cochrane Collaboration review. It is not inline with the advice we are given though!

Don't forget that the most basic association in a study is expressed as 'there is a significant relationship between the two' - that only means that the association is not random and could be a tiny tiny increase/decrease. They don't even say that; so you can rest easy that your butter, eggs and red meat are not going to cause your heart any damage at all.

Best

Dillinger

I was going to start a new topic with this one, but I thnk it is just as relevant here.

http://www.dietdoctor.com/diabetes-clinic-wouldnt-listen-reported-authorities

The comment that was attached to this article on Facebook was from a poor Mum who felt she could have been arrested for feedng her diabetic child a low carb diet if they still lived in Sweden. They've had to move to another country!

(Low carb experiences with a type 1 kid)

Looks like she's getting a lot of support on Facebook - and from other professionals who know their stuff or have been through a similar situation.

As another 'controversial' dietician from NZ who had been through a similar experience put it, they can threaten, but a very public confrontation may find them with egg on their faces....

AliB wrote: but a very public confrontation may find them with egg on their faces....

Which as the studies show will not impact their heart health at all..!

best

Dillinger

For decades we have been brainwashed into believing saturated fat causes heart disease. So many people believe this a fact. This is arguably, the most ludicrous piece of dietary information and biggest scam ever hoisted on the medical profession and general public.

"A meta-analysis published in the American Journal of Clinical Nutrition, pooled together data from 21 unique studies that included almost 350,000 people, about 11,000 of whom developed cardiovascular disease (CVD), tracked for an average of 14 years, and concluded that there is no relationship between the intake of saturated fat and the incidence of heart disease or stroke.

Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat."

"CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat" Err...that be code for carbs I reckon.

http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract