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  #1   ^
Old Fri, Mar-06-20, 06:36
Demi's Avatar
Demi Demi is offline
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Default SACN consultation on lower carbohydrate diets for people with type 2 diabetes

Perhaps they should talk to Dr David Unwin ...

Quote:
SACN consultation on lower carbohydrate diets for people with type 2 diabetes

The Scientific Advisory Committee on Nutrition (SACN) has published a consultation on its draft report on lower carbohydrate diets for people with type 2 diabetes.

Public Health England (PHE) asked SACN – an independent committee of scientific experts that advises government on nutrition and related health matters – to review the best available evidence base on lower carbohydrate diets alongside current UK government advice, for people with type 2 diabetes.

The comprehensive review of existing systematic reviews and meta-analysis was conducted by a joint working group comprising members of SACN and members nominated by Diabetes UK, NHS England, the British Dietetic Association, Royal College of Physicians and Royal College of GPs.

The effect of lower compared to higher carbohydrate diets were considered on a range of outcomes important in the management of type 2 diabetes - including body weight and measures of blood glucose concentrations.

Following a robust, systematic assessment of the available evidence, SACN’s draft conclusions are:
  • for body weight, there is no overall difference between lower and higher carbohydrate diets in the long-term (at or beyond 12 months)
  • for blood glucose (sugar) levels, lower carbohydrate diets may have benefits over higher carbohydrate diets in the short term, but their longer-term effects are unclear, based on the evidence considered

People with type 2 diabetes are currently advised to follow healthy eating advice for the general population. Current UK government advice (represented by the Eatwell Guide) is that for the general population, around 50% of total dietary energy should be from starchy carbohydrates (such as potatoes, bread and rice), opting for higher fibre or wholegrain versions where possible. This is based on recommendations made by SACN following its 2015 review of the evidence on carbohydrates and health.

Dr Adrienne Cullum, head of nutrition science at PHE, said:

The Scientific Advisory Committee on Nutrition (SACN), with support from a range of partners including Diabetes UK and NHSE, have undertaken a thorough review of the evidence on low-carb diets for adults with type-2 diabetes.

SACN is consulting on the draft report to make sure it has considered all the relevant evidence, and to invite comments on the draft conclusions.

Once SACN has considered all the responses to the consultation, it will publish its final report and make recommendations to government. SACN will also consider research recommendations based on limitations in the current evidence base.

The consultation opens today, 5 March 2020 and closes 30 April 2020.
You can access the draft report and all other consultation documents on the consultation website.

https://www.gov.uk/government/news/...type-2-diabetes



Last edited by Demi : Fri, Mar-06-20 at 06:48.
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  #2   ^
Old Fri, Mar-06-20, 07:16
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WereBear WereBear is offline
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Well, my head won't bang itself on the wall.
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  #3   ^
Old Sat, Mar-07-20, 08:52
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GRB5111 GRB5111 is offline
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I agree. There's probably a much more useful way to use this time and money. Just take a ride to meet Dr. David Unwin and spend a couple months witnessing his practice and learning from his results with real patients rather than reviewing ad nauseum epidemiological crap and biased studies from the past.
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  #4   ^
Old Sat, Mar-07-20, 13:03
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bevangel bevangel is offline
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I haven't read the whole draft report but I did scan thru is and apparently they did look at randomized controlled trials (the gold standard) but, "in the absence of RCTs" ALSO resorted to relying on other types of studies, such as "prospective studies" (which I take to mean epidemiological crap.
Quote:
Most weight is placed on evidence from randomised controlled trials (RCTs) since well-conducted RCTs minimise the potential for selection bias and confounding. Less weight is placed on observational studies because such studies are potentially subject to bias, confounding and reverse causality. However, in the absence of RCTs, evidence from non-randomised intervention studies and prospective studies is considered stronger evidence than other study designs...."


Tho they were willing to resort to epidemiology, they specifically EXCLUDED reports from practicing physicians such as Dr. Unwin. In fact, studies by both Hallberg and Unwin are mentioned by name as not meeting their "inclusion criteria."

Quote:
A number of clinical studies (including Saslow et al (2017); Bhanpuri et al (2018); Hallberg et al (2018), Athinarayanan et al (2019)) and case reviews (Unwin & Tobin, 2015) have assessed the effectiveness of lower carbohydrate diets on glycaemic control and other markers in adults with T2D. These are largely based in primary or secondary care clinic settings or use data from participants self-enrolled in commercial dietary programmes. The study design employed in such published research includes quasi-experimental studies, nonrandomised trials, single-arm trials or experiences in clinical practice. Some of the key limitations of these studies are: lack of randomisation, lack of a comparator arm and self-selection (for example, participants may choose a particular study or study arm).
These studies were not considered in this report because of the number of limitations associated with this study type. They also did not meet the inclusion criteria for study selection


Finally, although I haven't read the report carefully, I can't find any mention of what constituted an acceptable "lower carbohydrate" diet plan for inclusion within this study. I strongly suspect that most, if not all, of the included RCT studies were probably had their "lower carbohydrate" arm eating 45-50% carb diets and comparing that against a control group eating 60% or more carbs.

Pretty much everyone with any real experience with low-carb dieting agrees that 50% carbs is NOT low-carb enough to be of benefit. And those of us with experience with controlling T2 diabetes with diet KNOWS that you have to go a whole lot lower than that. (My husband has been successfully controlling his T2 diabetes now for over five years with diet alone!)


Having SEEN firsthand the benefits of T2 patients going low-carb, no clinician worth his/her medical license is going to recommend that ANY patients enroll in a study where there is a 50% chance that they're going to be told to eat a high carb diet! Can you imagine Dr. Unwin being willing to send one of his patients to such a study???



So, the necessary studies to meet the "inclusion criteria" for reports like this SACN report are probably never going to get done. Instead, hopefully, more and more real doctors will learn from one-other... or from their patients... that low-carb WORKS. Eventually, low-carb will become the defacto acceptable treatment for T2 diabetics. It's just too bad that, in this instance, the scientific method is slowing down the progress of truth being spread.
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  #5   ^
Old Sun, Mar-08-20, 06:27
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teaser teaser is online now
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When they gave insulin to the first poor little wretch, and instead of wasting away, the kid thrived--did that fit this inclusion criteria? You don't need a randomized, controlled study for something that actually works and is repeatable in one person.

Somebody on another thread--I think Benay? asked why Dr. Atkins didn't release his clinical data in a way similar to what Dr. Unwin did--this is why, prejudice against certain sources of data.

Quote:
Pretty much everyone with any real experience with low-carb dieting agrees that 50% carbs is NOT low-carb enough to be of benefit.


Yes. Even if epidemiology was better than doctor's practical experience--epidemiology not even looking at the thing we're talking about isn't just bad evidence, it's not even relevant evidence.

Randomized controlled studies seem to be one of the worst ways to treat obesity or diabetes long-term. Compliance to randomized controlled studies is awful.
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  #6   ^
Old Sun, Mar-08-20, 07:40
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WereBear WereBear is offline
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Quote:
Originally Posted by bevangel
Having SEEN firsthand the benefits of T2 patients going low-carb, no clinician worth his/her medical license is going to recommend that ANY patients enroll in a study where there is a 50% chance that they're going to be told to eat a high carb diet! Can you imagine Dr. Unwin being willing to send one of his patients to such a study???

...

So, the necessary studies to meet the "inclusion criteria" for reports like this SACN report are probably never going to get done. Instead, hopefully, more and more real doctors will learn from one-other... or from their patients... that low-carb WORKS. Eventually, low-carb will become the defacto acceptable treatment for T2 diabetics. It's just too bad that, in this instance, the scientific method is slowing down the progress of truth being spread.


AGAIN, that is. This same diet used to be the Diabetes treatment plan before the Lipid Hypothesis.
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  #7   ^
Old Sun, Mar-08-20, 09:11
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GRB5111 GRB5111 is offline
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Quote:
Originally Posted by bevangel
I haven't read the whole draft report but I did scan thru is and apparently they did look at randomized controlled trials (the gold standard) but, "in the absence of RCTs" ALSO resorted to relying on other types of studies, such as "prospective studies" (which I take to mean epidemiological crap.

Finally, although I haven't read the report carefully, I can't find any mention of what constituted an acceptable "lower carbohydrate" diet plan for inclusion within this study. I strongly suspect that most, if not all, of the included RCT studies were probably had their "lower carbohydrate" arm eating 45-50% carb diets and comparing that against a control group eating 60% or more carbs.

Good comments. This is exactly what I mean by "epidemiological crap and biased studies (RCTs) from the past." Even when RCTs are done rigorously, the definitions are meaningful and have everything to do with outcomes. To refer and use these flawed findings as the basis for the conclusions tells you all you need to know. Unfortunately, too many of today's scientific pursuits like this are engineered to establish intended perceptions in a population not inclined to challenge and confirm whether there's actually a factual basis for these findings.

ETA: To further illustrate my strident position that the SACN report is utter BS, here's a timely post by Tom Naughton reviewing Tim Noakes' recently published book. The details sound eerily familiar:

https://www.fathead-movie.com/index...-food-on-trial/

Last edited by GRB5111 : Sun, Mar-08-20 at 10:45.
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  #8   ^
Old Fri, Mar-13-20, 13:09
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Demi Demi is offline
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Quote:
Type 2 diabetes: Medics in row after report questions low-carb diets

The Scientific Advisory Committee on Nutrition (SACN) has sparked anger by suggesting foods like bread, rice, potatoes and pasta make no real difference in the fight against weight loss. Public health experts currently recommend one third of daily diets diet should be made up of starchy foods.

But in new draft guidance SACN, which advises the Government on nutrition, said there was no overall difference between low and high carbohydrate diets on body weight in the long-term.

It also said low-carb diets might have benefits over high-carb diets on blood sugar in the short term, but their long-term effects remain unclear.

The findings are at odds with the rationale behind many popular low-carb diets.

These typically consist of 5oz or less of carbohydrate a day. Those who follow them eat fats, proteins through meat, poultry, fish and eggs, and some non-starchy vegetables.

NHS cardiologist Dr Aseem Malhotra said: “It’s clear the Scientific Advisory Committee of Nutrition are not fit for purpose and cannot be trusted to give independent dietary advice. To recommend Type 2 diabetics should make up half their calories from starch is in effect poisoning them. This committee is putting the interests of the food industry ahead of public health which is a national scandal that needs to be exposed and challenged. The totality of evidence reveals a low carbohydrate diet is most effective for Type 2 diabetics.”

Dr Adrienne Cullum, head of nutrition science at Public Health England, said: “SACN, with support from a range of partners, has undertaken a thorough review of the evidence on low-carb diets for adults with Type 2 diabetes.

“SACN is consulting on the draft report to make sure it has considered all the relevant evidence and to invite comments on the draft conclusions.”


https://www.express.co.uk/life-styl...s-diets-obesity
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  #9   ^
Old Fri, Mar-13-20, 18:40
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Calianna Calianna is offline
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Quote:
These typically consist of 5oz or less of carbohydrate a day.




That's about the most vague description of a LC diet I've ever heard, not to mention that I don't know of anyone doing a LC diet who records or measures carbs by the ounce.



Five ounces of bread could easily be 71 g of carbs.

On the other hand, apparently Cold Stone Creamery manages to pack 168 grams of carbs into 5 ounces of their ice cream with gumballs mixed in.

On the opposite end of the spectrum, 5 ounces of raw spinach only has about 5 g of carbs.



That's a pretty broad range of carb counts for 5 oz of carbs.
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