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John Briffa said,
“I don
June 25, 2008 @ 11:25 am
John
An interesting point. Acording the ABPI/PMCPA code pharmaceutical companies must disclose funding of patients’ groups:
http://www.bmj.com/cgi/content/full/332/7533/69-a
though I have not located the precise place in the document where it states this.
http://www.abpi.org.uk/links/assoc/PMCPA/pmpca_code2006.pdf
It is evident that the only meaningful way that this could be achieved is if said groups advertise this information in their literature or on their websites.
http://www.bmj.com/cgi/eletters/332/7533/69-a#126085
One possibility is that you might try applying to Heather Simmonds, Director of the PMCPA for her views on the matter, although you may have to wait till doomsday or beyond for an answer.
http://www.bmj.com/cgi/eletters/336/7634/0#187763
http://www.bmj.com/cgi/eletters/335/7618/480#188132
June 25, 2008 @ 12:52 pm
“Or did I miss something?”
By my count, 3 question marks in the paragraph.
June 25, 2008 @ 6:30 pm
Reading this article made me recall an old joke.
Q: What do you call a med student that graduates last in his class?
A: Dr.
June 25, 2008 @ 7:11 pm
It’s definitely not right. I think all the Diabetes associations are the same – giving out the wrong advice that benefits the pharmaceutical companies not the patient.
June 25, 2008 @ 11:23 pm
Ross. Do you go around blog sites correcting grammar all day?
June 26, 2008 @ 7:39 am
@Barry Sharp
I think you
June 26, 2008 @ 1:15 pm
Food is divided into five main food groups and we need to eat from these groups, in the right proportions every day in order to enjoy a healthy balanced diet. The five food groups are below. Each of these food groups contains different nutrients that our bodies need to function and be healthy.
June 26, 2008 @ 2:45 pm
Amen. Looks very much like Diabetes UK uses the same play book as the American Diabetes Association.
If I followed ADA/Diabetes UK guidelines, I would be well on my way to frank T2 diabetes with chronically very high post-prandial BG levels after eating the recommended high starch meals, as well as very overweight. I have no doubt about this. My glucose meter doesn’t lie.
Instead, I ignore just about everything both groups advise and follow a very carb restricted diet of whole, minimally processed foods prepared at home (much of my food comes direct from the farms), take no diabetic medications, and achieve normal or nearly normal blood glucose readings throughout the day. Any food that gives me a high post meal reading is off my diet. It’s very simple. There is also something else that can provide the same nutrients without raising blood sugar levels. Additionally, I lost the weight gained from my former bread and pizza baking efforts and now maintain a normal BMI of about 21-22 or so.
The only interest these “charity” groups have in “helping” people with diabetes is “helping” them stay diabetic, on medications, and in need of diabetic support products and services. Diabetes has grown into a huge cash cow for all sorts of ancillary businesses. Follow the money … the ADA/DUK won’t kill the cow, not while they can milk it so profitably.
I guess I sound cynical … well, let’s just say I had a rude awakening about health “care” a few years ago and cynicism seems like an essential life skill now.
June 26, 2008 @ 5:09 pm
Sara Spiers, Care Manager, Diabetes UK
June 26, 2008 @ 8:22 pm
Would Dr. Briffa like to suggest foods containing carbohydrates that are not disruptive to blood sugar levels?
June 26, 2008 @ 8:55 pm
Adam
Would you like to have a go at answering your own question before I do?
June 26, 2008 @ 9:19 pm
Starchy carbohydrates are not required in the diet. Have low carbohydrate vegies instead:
leafy green salad veg, celery, cucumber, zucchini, cabbage, mushrooms, broccolli, asparagus, aubergine, cauliflower, gren beans, peppers, tomatoes, spinach etc.
Diabetics have a problem with controlling blood sugar – those foods that contribute to this should be removed.
June 26, 2008 @ 10:44 pm
what question? that was the first time i typed something!
June 26, 2008 @ 11:34 pm
Hi, Doctor Briffa, once again, you are spot on. I am so, so, disappointed, fed up, even angry, with people like Sara Spiers and medical docs who never spend a minute doing their own research and actually reading all the true evidence, but instead follow the party line. This whole type 2 diabetes information structure nearly destroyed me completely, over 10 years of total compliance with “THEIR so called balanced diet recommendations and medications, I nevertheless came within a hairs breath of kidney disease and dialysis until I decided to do some research, discovered the real facts about the notorious “Balanced Diet” (and the utterly false positive messages about fibre, invented because they couldn’t seem to make the false cholesterol hypothesis work the way they wanted it to work) and its effects on diabetics, and reversed my own kidney disease within 18 months. It is absolutely criminal the way the establishment is literally killing diabetics (slowly and painfully) by giving them incorrect information and then blaming them for non-compliance when things go wrong. People go to your local hospital’s Renal department and see 50 and 60 year olds already on dialysis because of their type 2 and become as enraged with the system and the current guidelines as I am.
Sorry about the rant Dr Briffa, but as you can guess I am somewhat angry with the likes of Spiers and all the diabetes associations around the world who blindly follow what the American diabetes Association does, easy isn’t it, to follow blindly and never do your own research!
Glenice
June 27, 2008 @ 9:34 am
Adam
If you can’t or won’t answer the question, just say. Which is it?
June 27, 2008 @ 10:31 am
i can’t answer my question – that i why i asked you.
June 27, 2008 @ 10:57 am
I’m glad someone from Diabetes UK is reading your website Dr Briffa. I am astounded at their dietary recommendations. If I followed what they said my diabetes (type 2) would be out of control….I know because I’ve tested my blood glucose after eating starchy vegetables, fruits, rice and wholemeal bread, and even in small quantities of those my blood glucose levels rise too high and stay that way 2 hours post prandial.
As for carbohydrate, nowhere did you say to cut out carbohydrate as Sara Speirs suggests you have ! I eat lots of low carbohydrate vegetables, lots of kale, cabbage, chicory, asparagus, salads, broccoli, okra, cauliflower, and more. For fruit I can eat avocados and a small quantity of berries sometimes. I check my blood glucose levels often so I know what effects various foods have on it. The rest of my diet consists of fresh fish, meat, nuts, seeds and eggs…..my diet is well balanced and my diabetes is well controlled. I am slim too
Anne
June 27, 2008 @ 7:37 pm
“SANOFI-AVENTIS continues to support the NHS to develop tailor-made solutions to help meet local circumstance and priorities, such as an initiative among the south Asian population in Warwickshire to improve awareness of diabetes and heart disease. In 2006, sanofiaventis supported more than 70 patient groups and charities, including Diabetes UK, the Stroke Association, the British Heart Foundation, Cancerbackup, the Prostate Cancer Charity and Bowel Cancer UK. The company supported Diabetes UK’s Measure Up awareness campaign, which helps the charity achieve its objective of reducing the number of people with undiagnosed diabetes.”
http://www.abpi.org.uk/publications/publication_details/annualReview2006/ar2006_community.asp
“Lilly funding to Diabetes UK in 2007 was
June 27, 2008 @ 10:00 pm
I hope more and more people begin to listen to you Dr Briffa. I have previously written to you directly regarding the diabetic diet and I am the proof in the pudding. I have stopped following dietician’s advice for a few years now and follow a very low carbohydrate diet, avoiding starchy carbohydrate. My HBAc1 results are fantastic, on average 5.5%, I feel great and I have more enery. On the odd occasion I do eat starchy carbohydrate I regret it. I eat lots of fruit (carbohydrate) vegetables fish eggs and meat. Together with small portions of pulses. I now have a very low dose of insulin. I have been insulin dependant for 30 years, since the age of ten, and I have always been in control of my diabetes and not scared of it. Unfortunately too many people are afraid to cut out starchy carbohydrate as they believe and trust what their doctor says as being gospel…It disgusts me that diabetes is a big money making business…Good Luck Doctor Briffa, don’t give up
June 27, 2008 @ 11:46 pm
To Sara , Dietician, You have 5 food groups. Two of these are carbohydrates and fruit and vegetables, but fruit and veg are also carbohydrates. Your food pie chart (not a pun) includes a large section for breads etc and another section for fruit and veg so the daily diet is supposed to be mainly carbs according to that. No wonder there is so much diabetes. Also where is the evidence that ‘we need to eat from these 5 groups every day’? You and your colleagues seem to have learned this parrot fashion. I do not mean to be insulting but do you sometimes wonder why there is so much against this. This is just an arbitrary classification and out-of-date. Where did the Stone Age people get these ‘carbs’ from?
Grains and carbs in that form were grown in order to feed a population who had nearly run out of meat but that does not mean that they are a necessary food.
June 27, 2008 @ 11:56 pm
Anne, I wrote mine without seeing your contribution. I’m glad we agree and that the diet is working for you.
June 28, 2008 @ 12:15 am
When I was told I had Type II, an appointment was arranged with a dietician. She just trotted out the high-carb line – bread, pasta, potatoes, etc., etc.,
When I told her what I eat (bacon & egg for breakfast, etc) her response was “are you on the Atkins diet?”. An interesting response.
Doctors don’t heal, they manage symptoms and prescibe drugs.
June 28, 2008 @ 12:22 am
“Doctors don’t heal, they manage symptoms and prescribe drugs.” Thank you, Robin, I’ll have to remember that. Sadly it is so true for almost all of them.
June 28, 2008 @ 4:44 am
The main problem with the dietary advice issued by Diabetes UK is that it doesn’t work. Eat the high carb low fat diet advocated and your diabetes will progressively worsen and your need for medication will increase. Even with increased medication Blood Glucose levels will fluctuate, increasing the risk of both hypreglycemia and hypoglycemia.
Diabetics have trouble utilising glucose as a fuel. In type 2 diabetes this is appears to be caused by a combination of insulin resistance and an absolute or relative insulin deficiency. Why on earth would you choose to use the very fuel that your body has trouble utilising as your preferred source of energy? This will inevitably result in dangerously high blood glucose levels, chronically high insulin levels, weight gain, difficulty utilising fat as a fuel and a host of long term complications.
Better to follow a low carb, higher fat diet which humans have been happily consuming in many parts of the world for thousands of years. Base your diet around natural foods: eggs, cheese, meat, fish, nuts and seeds (in moderation), and non starchy vegetables. These foods are satiating, nutrient dense and a good source of complete amino acids.
In my opinion, by advocating the othodox low fat high carb diet Diabetes UK have damaged the health of the very people they claim to be seeking to help. I have seen very little evidence that saturated fat is unhealthy and leads to weight gain. Indeed, as fat consumption has decreased the population of the UK has gained weight. The chief culprit seems to be the very food advocated for weight loss: starchy carbohydrates (complex carbs). How can the very same food that farmers feed cattle to promote rapid weight gain, ie corn, lead to weight loss in humans? The answer, of course, is that they don’t.
These foods are nutrient poor and often need to have nutrients adding to them as part of the maufacturing process.
Diabetes UK should uregently readdress the dietary advice it gives. I am not aware of any long term studies that show the current dietary advice works – specifically for diabetics, but just as importantly for the wider population as a whole. The resistance to advocating a low carb diet would have more credability if there was was scientific evidence to support the current approach. In fact the low fat high crab dodietary approach ahs been a hopeless failure, as evidenced by the increasing lelves of obesity, metabolic syndrome and diabetes.
Sara Spiers has trotted out the same old nonsense:
The brain does not run exclusively on sugar – it can also run perfectly well on ketones. Additionally carbs are not the sole source of blood glucose – the liver can manufacture glucose from amino acids if need be.
Type 2 diabetics don’t normally have a problem with low blood glucose. This only tends to occur if they are following the dietary advice advocated by Diabtes UK when over medication in conjunction with a high carb diet leads to roller coster blood glucose levels.
The 5 categories of foods are somewhat arbitary. Why on earth link fatty and sugary foods. It shows a bias against fats. In nature these foods are hardly ever combined, as they might be in processed and manufactured foods: cakes, biscuits, etc.
Diabetes UK is doing a great disservice by recommending the same “healthy well balanced” diet for diabetics as for everybody else. Show me the research that proves that following this advice leads to a reduction in medication and normal bllod glucose levels for diabetics. I very much doubt it eexists. Whereas there have been a large number of recent studies that show the superiority of the low carb, higher fat approach.
Paul Anderson
June 28, 2008 @ 6:38 am
Well said, Glenice, and sorry to hear you’ve had to suffer at the hands of these people.
What the ‘mainstream’ medical establishment is too stupid/self-complacent/insert your own adjective to realise is that they no longer control the medical information that their patients get, now that the internet makes it so much easier for ‘alternative’ theories and treatments to be publicised, and for patients to access them.
More and more people are accessing their own (very likely more up to date) information, make up their own minds about how their condition should be treated, and where they can’t get what they want from mainstream medicine, they’re going to ‘alternative’ practitioners or simply self-treating with medications or nutritional supplements bought online. (If anyone thinks self-treatment isn’t already happening, just look at some of the thyroid and adrenal forums).
Jackie
June 28, 2008 @ 6:54 am
It
June 28, 2008 @ 9:44 am
I found this comprehensive review article a big help in understanding the science behind low-carb diets.
JOEL M. KAUFFMAN ‘Low-Carbohydrate Diets’. Journal of Scientific Exploration, Vol. 18, No. 1, pp. 83
June 28, 2008 @ 12:17 pm
Sarah Spiers and Adam
Welcome to the ‘Curious World of Dr Briffa and friends’!
Sarah – I hope you weren’t hoping to join some meaningful debate on the relative merits of one dietary approach versus another. If so, I hate to disillusion you – but this really isn’t the website on which to do it.
Dr B doesn’t do meaningful debate. He does mocking comments (based on his own unique interpretation of the medical research) and deliberate misinterpretation of your comments readily supported by his band of merry supporters (you have already met ‘Cathy’, ‘Hilda’ and ‘John’).
All in the hope that by your 4th patient, evidence based reply to his facetious/ insulting/ incorrect comments you will admit defeat, and kindly go away so Dr B and friends can post unpleasant comments about yourself, your organisation, and any collateral bodies.
Adam – i guess you’ve worked out what degree of ‘futile cycling’ goes on here!
So feel free to add another post as I and many dietitians do when we feel like we have a moment to spare for entertainment. But please don’t expect meaningful debate. Your time may be better spent finding out whether Dr Briffa has a case to answer with his comments that debase the excellent job that your organisation does in representing the diabetic population in the UK.
June 28, 2008 @ 11:25 pm
Catherine Collins RD
Once again you focus not on the issue at hand, but on me.
And again you fail to engage with the science and the woefully inadequate dietary advice diabetics are usually given (and then accuse me of shying away from meaningful debate
June 29, 2008 @ 7:19 pm
Ecce homo
June 29, 2008 @ 7:52 pm
Catherine Collins RD – if you have anything meaningful to add then go ahead otherwise scram!
Sara Spiers – look closely at what you are recommending for diabetics – when you do you will realise that its wrong. Do the right thing and get those diet recommendations changed.
June 29, 2008 @ 10:37 pm
Sara Spiers – here is some homework for you:
http://nmsociety.org/index.php?option=com_content&task=view&id=31&Itemid=50
You will learn a lot.
June 29, 2008 @ 10:47 pm
Catherine Collins
June 29, 2008 @ 11:53 pm
To Sara Spiers and Catherine Collins, just in case you visit again to read more comments: if your dietary advice is correct, where are all the diabetics who are getting better, reducing or eliminating their diabetes medications by following your eating advice? The only time I hear diabetics claim their blood glucose is under control and they don’t need as much medication or they can eliminate it altogether is when they reject your advice and follow a low-carbohydrate nutrition plan. Show us all the diabetics who listen to you and get better! And as far as the nutritional advice you give, I don’t care how much you’ve studied, all you do is parrot the same assimilated nutrition commonplaces anyone could rattle off just by repeating what can be gleaned from reading the newspaper and popular women’s magazines.
June 30, 2008 @ 4:52 am
You only have to read the evidence to see that it makes entirely logical sense. It’s not an ‘idea’ or a ‘cult’ – the evidence is there. I think we should do a large study and perhaps the dieticians could lead this and change the working practice! I used to believe the low fat advice, but since reading all the evidence I have had to admit that low carbs is the way to go, to control diabetes and lose weight! Think how we could could change things if the ‘establishment’ would go with us.
June 30, 2008 @ 12:26 pm
I do not wish to be charged with Briffaphilia but have to agree with his stance on both diabetes and weight loss/nutritional dietary advice. I have been following a paleo style diet for nearly two years with excellent results in terms of body composition and general health (I have not had a day off work since going paleo – prior to that colds would really hit me and I would take about two sick-days a year). Before Paleo (BP), I was a classic ‘whole grain, low-fat’ eater. But after looking at the results of traditional dietary advice on my own body, I knew that it was not working as dieticians and nutrionists suggested it should or would. A state of voluntary chronic hunger cannot be sustained by ANYONE.
What I find staggering about the exchange above is that there is good evidence (annecdotally, if not otherwise), that diabetes can be managed and cured with an appropriate change in diet to ‘low-carbing’. If I was involved with ANY organisation “devoted to the care and treatment of people with diabetes in order to improve the quality of life for people with the condition”, I would investigate these claims. A single case of a person curing themselves of diabetes should be worthy of investigation as it might ‘open the door’ for a cure, but there appear to be hundreds of people curing themselves by REJECTING the official dietary advice. To maintain their credibility the diabetes organisations must grasp this nettle and undertake controlled clinical trials – I mean what have they got to lose? Either their current advice will be proven to be good advice (which will ‘silence Dr Briffa and his cult’), or it will be proven wrong (in which case they can change their advice and still fulfill their objective of providing care and treatment to people with diabetes and improve the quality of life for people with the condition).
Simple really!
In fact the risk of losing drug company funding is the ONLY reason I can think of that would cause Diabetes UK would not to conduct such an experiment.
June 30, 2008 @ 2:28 pm
Diabetes UK may have been frank with the Commons Health Committee about their funding but they haven’t been here. Any hope that Sara Spiers might return to clear the matter up has been in vain.
June 30, 2008 @ 7:05 pm
Sue
There’s a lot of reading on that website! Are there any articles in particular that you think are most useful?
June 30, 2008 @ 8:14 pm
sokpuppet,
Have a read of the presentation by Ron Raab and Dr Katharine Morrison.
They are short presentations. There is much more info on the site under different sections.
July 1, 2008 @ 12:29 am
Dr B – I don’t think you answered Andy’s question – “Would Dr. Briffa like to suggest foods containing carbohydrates that are not disruptive to blood sugar levels?”
July 1, 2008 @ 10:53 am
Seriously though. what next. Will charities that help people with drug problems be suggesting the go and have lots of the very thing that is making them ill in the first place “drugs”. (oh but it will help you loose weight though)
Drug problem – solution – take more drugs
Peanut allergy – solution – eat more peanuts
Torn Muscle – solution – run more
Alcohol problem – solution – drink more alcohol
sugar problem (diabetes) – UK diabetic solution – eat more high sugar carbohydrate foods
weird…..
July 1, 2008 @ 1:06 pm
Hi Sue
Thanks! Seems like common sense really – low GI foods reduce glucose spikes and will lessen the burden on the pancreas. Have I got that right?
July 1, 2008 @ 1:24 pm
All those who are seriously interested in knowing the facts behind the diabetes & obesity debate, must please read ‘The Diet Delusion’ by Gary Taubes. The answers to everyone’s questions are in there.
It is a long read but certainly anyone who calls themselves a dietician, nutritionist or doctor would be wise to ensure they fully digest this book.
July 1, 2008 @ 2:52 pm
Sally, thanks:
“It is a long read but certainly anyone who calls themselves a dietician, nutritionist or doctor would be wise to ensure they fully digest this book.”
Mind you, uncomfortable.
July 1, 2008 @ 7:47 pm
ross
“my triglyceride levels have plummeted from a pretty scary level to a point where I
July 1, 2008 @ 8:17 pm
Another thought crossed my mind – we have had several people on this site who have posted to the effect that once they eschewed the regular/traditional/diabetes UK advice and went paleo/low carb, their condition improved markedly.
What I would like to know from the defenders of the regular/traditional/diabetes UK advice is, can anyone of them encourage a post from a diabetic for whom they have improved the quality of life?
What would be particularly interesting is if the diabetic concerned had actually tried a ‘paleo’ approach, but found that the nutritional guidelines of Diabetes UK produced better results.
You’d think that a big (and growing), organisation like Diabetes UK would have numerous success stories. Statistically, several of their diabetics must surely have tried the paleo route – so, IF DUKs GUIDELINES ARE EFFECTIVE, some of them must have tried paleo/low-carbing and found it inferior to complex/starchy carbing.
Just a thought!
Come out! Come out! Wherever you are!
July 1, 2008 @ 10:21 pm
Dr Briffa
Thanks for eventually answering the question Dr Briffa, and I hope you gain a modicum of satisfaction in the way you address your commentators.
But I have some concerns, Dr B, about your – dare I suggest – rather pass
July 1, 2008 @ 10:25 pm
SkepTicTacToe, there’s a link here:
http://www.badscience.net/forum/viewtopic.php?f=3&t=5487
Curiously enough, since moving to a more low GI oriented diet and starting going to the gym earlier this year my triglyceride levels have plummeted from a pretty scary level to a point where I’ve been able to reduce my medication. And you know what? A low GI diet and exercise are recommended by Diabetes UK. Their paymasters must be sorely displeased.
Just to repeat for the benefit of any Briffas reading who may be hard of thinking …. by following Diabetes UK’s advice I have been able to reduce my medication. And that’s even without taking Briffa’s patented snake-oil, amazing. OK,so that’s just me but I don’t imagine that I’m unique here.
Disclaimer: I have never received a penny from Big Pharma… although I admit I have played a small part as a conduit for taxpayers money to flow their way in recent years. I refer to this relationship as “keeping myself alive.”
July 1, 2008 @ 10:48 pm
Ross,
Just a few observations. THe GI of several of the foods you refer to are: Instant Rice (91), brown rice (55), Mashed Potatoes (73), New Potatoes 56, Wholemeal Bread (69), All Bran (42) Porridge Oats (49).
By way of comparison the GI of table sugar is 65 and a mars bar 68 and chocolate 49. I am sure diabetes woudn’t advocate eating these foods. Or do they?…… And they don’t receive funding from Cadbury’s …… or do they?
And then of course there’s the glycemic loads of these starchy carbohydrates which, unless you eat ridiculously small and unsatisfying portions tends to be very high.
A low GI is something in the teens, or lower eg brocolli (15), cauliflower (15), cucumber (15).
even better still eat fats and protein. You will find that this lowers both your tryglicerides and blood sugar, is more statiating, and quite possibly imporves you quality of life.
If you are managing your diabetes without drugs and achieveing a hba1c below 5 I would be pleasantly surprised – good luck to you.
One further point – the more inuslina diabetic uses, the more difficult or not impossible it is to avoid both highs and lows. A type 1 diabetic needs to use as little insulin as possible whilst maintaining tight control. This can only be done by eating a low carb diet. The greater the insulin use, the greater the margin of error.
Starchy carbohydrates are of no help to a diabetic, if indeed they are good for anyone at all, in my opinion.
Paul.
July 1, 2008 @ 11:15 pm
John Stone said,
“Mind you, uncomfortable.”
Yes, and I can feel my ‘irritable bowel’ coming on at the thought …
July 1, 2008 @ 11:44 pm
Frank: “sugar problem (diabetes) – UK diabetic solution – eat more high sugar carbohydrate foods”
That’s misrepresenting the advice. As Diabetes UK’s advice is only partially quoted in this blog post you might find the following gives a better context:
http://jkn.com/View?j=912225.421546931238
July 1, 2008 @ 11:52 pm
Insulin is a multi-billion dollar industry worldwide. What business would put this at jeopardy with usage reduction strategies? (or heaven forbid ….. a cure.)
You’ll note the bulk of the research dollars are devoted to delivery systems (nasal, tablet) so as to move away from needles. This will allow them to keep selling insulin in some form or another.
Message to the pharma cartels – we do not want new delivery systems – we want a cure. (for type 1 that is: type 2 people should be changing their lifestyles and curing themselves.)
July 2, 2008 @ 6:19 am
Catherine Collins RD
My, you do seem so very pleased with yourself! Why is that?
Could it be because you believe you have managed to deflect the issue from the woefully inadequate dietically-driven dietary advice many diabetics are given?
Or could it be that you think you have got away without having to really engage with the science (never mind the common sense) which shows how flawed such advice is?
Notice, Catherine, how Sara Spiers (Care Advisor at Diabetes UK) has stayed away from here after posting her, I think, ridiculous assertions. Seems she is unable or unwilling to answer the simplest of questions I posed to her above. Maybe you’d like to have a go at answering these questions for her?
Oh, and do please to remember to focus on the issue and not on me. Remember, Catherine, people’s lives are at stake here…
July 2, 2008 @ 6:48 am
except, of course, dr briffa the title you give the blog post , the reference you give, and the content of the actual blog post is largely to do with the vague notion that Diabetes UK’s advice is flawed due to their relationship with drug companies. Yet, you have a cosy relationship with a pill company.
The reference you give suggest that patient groups should declare interests – yet you have studiously failed to declare your interest in SucroGuard!
Anyway, thinking about the science. Would you like to describe the diet you would like to see diabetics following, and back it up with some evidence, then point out the substantial differences between your ideas, and diabetes UK’s advice?
July 2, 2008 @ 9:46 am
Dr B – I don
July 2, 2008 @ 10:16 am
“Or could it be that you think you have got away without having to really engage with the science (never mind the common sense) which shows how flawed such advice is?”
Dr B, I think Catherine Collins did engage with the science. You stated that:
“Justification for the inclusion of manganese in Sucroguard comes from studies which show that manganese levels are generally low in diabetics (Biol Trace Elem Res. 2001;79(3):205-19) and that manganese deficiency appears to contribute to glucose intolerance in animals and may be reversed by supplementation (J Nutr 1990;120:1075
July 2, 2008 @ 10:38 am
Hi Ross, thanks for the link. You would hope that at least someone would achieve the results that this guy did, by following Diabetes UK advice. It would be interesting to know if the guy involved would see even greater benefits if he went ‘paleo’.
I must point out that by going ‘paleo’, Anna (#9) seems to have removed her need for medication completely, Glenice (#15) has reduced her medication significantly – and has achieved results she was otherwise unable to, following the advice of Diabetes UK. The same goes for Anne (#18), who found that following the dietary recommendation of Diabetes UK her ” blood glucose levels rise too high and stay that way 2 hours post prandial.” Christine’s position (#20) on Diabetes UK dietary advice is similar also. None of them seem to have taken “Briffa
July 2, 2008 @ 12:47 pm
Dr B, I cant see my original post re. this so I wondered what your thoughts are in relation to NHS Blog Doctor’s article stating that you think Diabetes UK is “deliberately and maliciously encouraging diabetics to eat an inappropriate diet, knowing that such a diet will make their diabetes deteriorate, thus increasing their need for medication.”
http://nhsblogdoc.blogspot.com/search/label/Dr%20John%20Briffa
July 2, 2008 @ 3:42 pm
Admittedly they will find it hard to swallow (!) but Catherine Collins RD and Sara Spiers really do need to digest ‘The Diet Delusion’ by Gary Taubes!
In my personal experience, once people receive a diagnosis of diabetes (both types) and start following the advice of their GPs, endocrinologists, diabetes nurses, and dieticians, their condition always worsens. They are locked into a downward spiral of ill-health, driven by high blood glucose & high insulin levels (endogenous or not) and compounded by pharmaceuticals.
As far as their impact on blood glucose is concerned, there is no difference between the so-called good, complex carbs and simple sugars. As Paul Anderson demonstrates by quoting the GI of some examples, we might as well be eating chocolate, jelly babies and spoonfuls of table sugar, as bread, potatoes, rice and breakfast cereals. In simple terms, the more processed (including by cooking) a carbohydrate-based food is, the worse it is for us.
For anyone battling with diabetes or weight issues the only way out is to ignore the ‘experts’ and drastically cut the carbs. Find a doctor and / or a nutritionist that doesn’t spout dogma (much easier said than done…) and does understand the science of metabolism.
Clearly, the received wisdom on the subject of diet is not right. If it was correct the incidence of obesity & diabetes (not to mention all our other epidemic ills) would be decreasing, as patients followed doctors’ orders. There is a wealth of evidence (from research, clinical experience & anecdotal) that indicts processed carbohydrates as the scourge of the 21st century. Whilst we argue the toss on this site there are millions of people suffering, in this country alone, because the truth is not reaching the masses. Much more could be achieved if our dissenting voices were united. If there are any clinicians and biochemists out there who feel the time is right to move this forward, please contact me.
I don’t know if I’m allowed to post my e-mail address here but I guess it’ll soon be removed if not! sally@diet-therapy.co.uk.
July 2, 2008 @ 3:54 pm
SkepTicTacToe,
I
July 2, 2008 @ 4:21 pm
Hi Rob – interesting point.
I was reading Lauren Cordain’s Paleo Diet for Athletes the other day and he actually recommends athletes broadly follow the paleo diet but ingest refined carbs at key points through the day to restore glycogen levels
This approach was only proposed for athletes following a program of heavy training and on consecutive days (regardless of whether they had diabetes).
Cheers,
July 2, 2008 @ 6:44 pm
I wondered what John Briffa thought of ‘The Diet Delusion’ by Gary Taubes that Sally Taylor recommended. Do you think it a book worth buying?
July 2, 2008 @ 7:01 pm
Catherine Collins you are doing it again; ascribing something to me that I didn
July 2, 2008 @ 8:36 pm
SkepTicTacToe wrote (message 58):
“I must point out that by going
July 2, 2008 @ 8:54 pm
sally (and dr briffa)
would you like to suggest an approximate diet for diabetics and explain the substantial difference between your proposal, and ‘standard’ advice to diabetics?
July 2, 2008 @ 11:58 pm
superburger,
Dr Bernstein recommends the following amount of carbs – 6g for Breakfast and 12g for lunch and dinner = total 30g for the day.
You can read some of the chapters of his book online here:
http://www.diabetes-book.com/readit.shtml
Also, an article from Bernstein re the ACCORD Study and ADA:
http://www.diabeteshealth.com/read/2008/03/26/5701.html
July 3, 2008 @ 1:46 am
dr bernstein is free to advise what he likes.
It would be nice if you could provide some sort of peer reviewed reference for some diet that you would advise diabetics. Then highlight the differences between this advice and D-UK adivce.
July 3, 2008 @ 3:15 pm
To address the question posed by Superburger, I believe a ‘paleo’ diet, as has been suggested already by various posts (see http://paleodiet.com/ for info), or the best approximation we can get to it in this day & age, is what’s required to maintain or re-establish good health in anyone.
Man is not designed to eat any other way. It is common sense that the more we deviate from that path, the more our health will suffer. And the evidence is all around us. If conventional beliefs regarding diet were correct, the incidence of chronic disease in Westernised societies would be falling, not increasing.
The clear difference between this view and the standard advice to diabetics is both the quantity and the quality of carbohydrate, fat and protein that is recommended – and the precise ratios of these macronutrients should be tailored to an individual’s needs.
There is an awful lot uttered about diet but I believe the subject is overcomplicated by the ‘experts’. And therein lies the problem. People are confused by conflicting advice from doctors, dieticians, nutritionists, diet gurus, et al. Surely the right basic diet for mankind can be distilled into simple principles – we need to eat REAL food, not manufactured substitutes, and preferably that which is not inherently toxic if it were to be consumed raw. Perhaps a useful rule of thumb might be the closer a food resembles its natural state, the better it is for us, and the longer it can remain in a cupboard without spoiling, the worse it is for us.
Now, I’m sure there are those who will come up with exceptions to these rules, and some may even be valid, but the point I’m making is that we have to simplify it so every man, woman & child can grasp the facts of what constitutes a healthy diet.
Our lifestyles are so far removed from nature that we’ve lost sight of these basic truisms. Our obsession with convenience foods has been compounded by experts’ advice to increase our intake of processed carbs. But how can anyone who claims an understanding of nutrition seriously believe that a diet of bread, pasta, breakfast cereals, etc, provides the quality of fuel our bodies need to operate, repair and regenerate efficiently & effectively – let alone stabilise blood sugar?!
As far as diabetics are concerned they must be encouraged to take control of their health, just as others on here have successfully done, rather than trusting to experts. Use those BS monitors throughout the day and see what happens when standard dietary advice is followed. And should anyone want to try an alternative approach these two books contain all the supporting information needed: ‘Dr Bernstein’s Diabetes Solution: Complete Guide to Achieving Normal Blood Sugars’, and ‘Atkins Diabetes Revolution: Control Your Carbs to Prevent and Manage Type 2 Diabetes’.
Sally
July 3, 2008 @ 6:32 pm
Superberger,
Show me a peer reviewed diet for the Standard Diabetic Diet as advocated by Diabetes UK that produces stable blood sugars and good health. You will not find such evidence for a type 2 diabetic who manages their condition by diet and exericse alone – or if you do it will be very much the exception to the rule.
The same is almost certainly true for a type 1. Just for clarity, I would regard stable control as a hba1c around or below 5, with no, or very few episodes of hypoglycemia. The diabetes target of 7 is far too high and all but guarantees the developmnet of diabetes related complications.
Very few people argue that Dr Bernsteins regime doesn’t work. The main criticism levelled against it is that is austere, too restrictive and that many patients won’t comply with it. I would suggest that patients should be made aware that this is an approach that they might wish to consider and adopt: better to have a good quality of life on a restricetd diet than eat a high carb diet and suffer from a host of long term complications.
Paul.
July 4, 2008 @ 12:19 am
that’s not an answer to my question sally.
July 4, 2008 @ 8:21 am
interesting review
Diabetes Care 25:148-198, 2002
from the summary
“With regard to the glycemic effects of carbohydrates, the total amount of carbohydrate in meals or snacks is more important than the source or type.”
“Although the use of low
July 4, 2008 @ 3:13 pm
can i just ask what qualifications sally taylor has as regards nutrition? not an aggressive question, but i was wondering if you just take the paleo diet as read or have some grounding in biochemistry, nutrition, etc
Thanks.
July 4, 2008 @ 4:20 pm
superburger – here is an answer for you: http://www.sciencedaily.com/releases/2007/06/070627225459.htm
But I’ve copied and pasted it below in case you don’t want to go to the link. The “Mediterranean-like prudent diet” that was compared to the Paleolithic ‘Stone Age’ diet (Paleo) is the type of diet Diabetes UK recommends.
Original Human ‘Stone Age’ Diet Is Good For People With Diabetes, Study Finds
ScienceDaily (June 28, 2007)
July 4, 2008 @ 4:41 pm
Why do people who would not conceivably endorse creationism, still seem to think that carb diets are God-given?
July 4, 2008 @ 6:55 pm
Superburger (#72), I am interested in a quote from the your extract above:
July 4, 2008 @ 7:46 pm
couple of comments, anne.
Firstly sciendaily is not a source of peer reviewed leiterature. it’s an online newspaper.
I think i’ve tracked down the work that you refer to (doi: 10.1007/s00125-007-0716-y) I’m sure you’ve read it too…..
Interesting – but bear in mind the following – it was a minute study (total sample size of 29) and all the participants were suffering heart disease (and not all of the sample actually had type II diabetes either) and the study only lasted 12 weeks.
I’m not sure that the conclusions of this work contrast strongly with the conclusion of the review I pointed out, which included
July 4, 2008 @ 8:18 pm
skeptictactoe said
“
July 4, 2008 @ 8:31 pm
What is more relevant, I think, is that there is no evidence whatsoever that the much touted low fat, high carbohyrdate diet results in sustained weight loss. Indeed, as fat consumption has reduced and carbohydrate consumption has increased there has been a steep rise in obesity, and the majority of the UK population is now oveweight. This is in marked contrast with previous generations who ate more fat, red meat, butter, eggs, lard and cheese.
I am not aware of any society where a low carbohydrate diet is consumed where there the population suffers from obesity and other western lifestyle dieseses.
Voluntary starvation, as followed by many people following a reduced calorie low fat dietary regime is almost guaranteed to fail in the long term.
Where are the peer reviewed studies that show a low fat high carb diet results in long term sustained loss – they don’t exist, despite their widespread adoption of this approach by health authorities throughout the world. This doesn’t stop them being recommended for weight loss. It seems to me that double standards are applied when dietitions, etc discuss the effects of low carb diets, and caution about possible long term negative effects of these diets.
Paul.
July 4, 2008 @ 9:16 pm
Hello Adam…
I’ve studied nutritional therapy and nutritional biochemistry both formally and through autonomous learning, but don’t hold a degree in any subject. I’ve practised as a diet therapist, advising clients (as well as other natural health practitioners and some private doctors) on dietary matters relating to health, well-being and nutrition. Why diet therapy? Because, unlike many nutritionists, my approach concentrates on dietary modification to correct underlying imbalances that lead to poor health, rather than on supplements to address specific symptoms.
My original interest stemmed from a personal battle with weight, which was solved when I discovered the Atkins’ Diet seven years ago. Up to that point I ate pretty much the orthodox ‘healthy’ diet, and ended up 3.5-stone overweight. I’ve eaten low-carb ever since, as paleo as is practical for me, and maintained my weight loss. Being the sort who has to know how and why things work, I was driven to study the subject in depth, and study I did, and do.
Both my parents are Type 2 diabetics (hence my particular interest in this area), and both have CVD & arthritis. At 49 years old I have no health problems and more energy than most people half my age. Given my genetic inheritance, I believe I am a good example for others to follow.
Please don’t get me wrong – I’m far from perfect and certainly no earth-mother type. I live in the real world. I lead a busy, stress-filled life and have four school-aged children who, left to their own devices, would subsist on a diet of processed carbs and spend all day glued to a TV / PC. I was moved to post here because I feel passionately that we need to spread the message that our high-carb, convenience food lifestyle is killing us. I’m fed-up with my kids being told at school that a healthy breakfast comprises corn flakes, skimmed milk, orange juice, and toast spread with butter-substitute, jam, marmalade or lemon curd.
So, those are my ‘qualifications’ for daring to voice an opinion that contradicts the establishment line.
And Superburger…
All the references you require are cited in ‘The Diet Delusion’ by Gary Taubes. In my opinion, blinding people with science is what got us into this predicament in the first place. We need to cut the crap and explain the issues in terms that every man, woman and child in the street can understand. However, if you really are interested in the science, rather than in appearing clever, invest
July 4, 2008 @ 11:14 pm
“I have yet to see evidence of obesity in hunter gatherer populations who follow their traditional
July 5, 2008 @ 9:31 am
Groovey,
I think the anwer to you question is no, its not simply a question of higher calorific intake. Some foods are easier to consume over consume than others – you could say, almost addictive, eg sugar, wheat. You are very unlikely, the the other hand to binge on meat, or fish for example, or brocolli or lettuce.
The calorie issue is just too simplistic, in my opinion. You cannot really expect to regulate calories by counting everything you eat. If you think about it a 40 year old who is 1 stone overweight, has accumulated 49,000 surplus calories (stored as fat) during their life to date. That means that, on average they have consumed just over 3 suprlus calories per day on average over their lire to date. If you accept the calories argument, that person would not have gained their weight if they had eating 1997 calories a day, rather than 2000. In theory, if they had eaten 20 calories a day less they would weigh approximately 6 stone less. Do you know anyone who is capable of calculating their calorie intake (and level of activity) with that level of precision.
My suggestion would be that if you eat the correct foods – natural, unprocessed and low GI your body can evolved to regulate weight effectively. On the other hand if you eat processed and high GI foods you body’s weight regulation mechanism will, eventually, go haywire, resulting in weight gain and metabolic disturbances.
If you are in perfect health and at a perfect weight I guess you have found a diet that works for you. If not, why not give it a go for a week or to and see for yourself jow you feel. Even the mainstream medical establishment concede that a low carb approach is effective for short term weight loss and that it is safe to follow in the short term. They have, more or less, had to given to accumulating number of studies indicating its effectiveness.
Paul Anderson.
July 5, 2008 @ 2:12 pm
Also Groovey, the active lifestyle of hunter gatherers (all that hunting and gathering for instance) contrasts markedly with the modern sedentary lifestyle. It would be interesting to know if this confounding factor been taking into account in the research.
(I’d like to see some research on the paelo diet – is there any good quality peer reviewed literature in the public domain?)
July 5, 2008 @ 2:40 pm
sally,
I don’t think i would say I’m blinding you, or anyone else, with science.
You might not like the arguments I present, nor the scientific papers which have been peer reviewed, but i note that you choose not to engage with them, instead claming you are being blinded with science and say that i am trying to ‘appear clever’ by pointing out things which you seem not to agree with.
I would argue a compehensive literature review, peer reviewed, and offering a bullet pointed summary section, written in accesible language, is an excellent way of communicating a complex subject.
It says a lot about the level of debate you are capable of engaging in when, once questioned about the actualy hard evidence for your claims, you can only point to online newspapers, books with positive reviews on amazon! and your own conjecture and anecdote.
You try to point to a piece of work (the Lund Univ study) – when i tracked down the reference and offered some honest criticism you fail to engage with it.
So again, I would ask you to point towards some peer-reviewed evidence that a paleo diet offers a safe, long term solution towards the management of diabetes and why it is better advised than the current recommendations.
July 5, 2008 @ 6:09 pm
“Also Groovey, the active lifestyle of hunter gatherers (all that hunting and gathering for instance) contrasts markedly with the modern sedentary lifestyle. It would be interesting to know if this confounding factor been taking into account in the research. ”
Absolutely Ross.
“My suggestion would be that if you eat the correct foods – natural, unprocessed and low GI your body can evolved to regulate weight effectively. On the other hand if you eat processed and high GI foods you body
July 5, 2008 @ 8:06 pm
superburger,
Read The Diet Delusion and you’ll see how the current thinking on diet is so infuriatingly wrong.
July 6, 2008 @ 1:24 am
Superburger
The Medical Journal of Australia is a peer-reviewed journal and while this doesn
July 6, 2008 @ 3:40 am
Hi Superburger,
You wrote:
“Firstly sciendaily is not a source of peer reviewed leiterature. it
July 6, 2008 @ 11:41 am
cathy – interesting work you point to – although I would say that the change of lifestyle (high to low physical activity) could be as, or more important than dietary factors. There is nothing in their description of “low fat, high fibre” coupled with high physical activity that contradicts the recommendations made by D-UK. Plus there is the obvious possibilty of genetic differences between australin aborignes and UK population.
Anne – not sure the relevance of your personal anecdote here – you still haven’t engages with any substantial point i have made. Glad your diabetes is well managed though.
July 6, 2008 @ 7:41 pm
>>Dr B – I don
July 6, 2008 @ 9:59 pm
Thank you Michael
July 6, 2008 @ 10:14 pm
it is you that failed to answer, dr briffa!
would you, personally, care to name a “non-starchy” vegetable that is also a significant source of carbohydrate – and will not affect blood sugar?
you’ve also not been able to describe an alternative diet, differing from the broad advice of D-UK, which would suit diabetics better. In particular, it would be interesting if you were able to offer the reasons why the recommendation in this review are incorrect.
Diabetes Care 25:148-198, 2002
the recommendations in which are generally the same as offered by D-UK.
July 6, 2008 @ 10:42 pm
>>Research has shown that by reducing carbohydrate consumption, the amount of fat they eat tends to increase drastically, particularly saturated fat.
um.. Two Points!
1. Please provide links to this research.
2. Please show that fat and/or saturated fat in a low carbo diet is a problem.
Seriously, it does appear that saturated fat and a high carbo diet is an evil combination.
I have seen NO EVIDENCE that saturated fat is a problem in a low carbo diet. None.
If any of the dieticians lurking here can point to any studies showing problems with saturated fat in very low carbo diets, I would like to see the studies.
The common pattern in low carbo diets is a drastic fall in Triglycerides, a significant rise in HDL and improvement in LDL particle size.
See:
http://jn.nutrition.org/cgi/content/full/135/6/1339
To all the dietitians lurking here – Yes, we all know what you were taught in school.
The point is that we don’t believe it.
Low-carb has certainly improved my BG control.
Nobody can produce evidence that increasing carb intake would reduce blood sugar levels.
Low-carb has also drastically improved my lipid profile.
Triglycerides dropped from 300 to 88
HDL improved from 38 to 61
LDL has dropped and more significantly LDL particle size has increased.
If saturated fat is still a demon, I don’t understand how.
I am very open to a science based, evidence backed discussion supporting what you dietitians were taught in school.
Links to current studies would help illuminate the discussion a lot more than just repeating the standard low-fat dogma.
Thanks,
Michael
July 6, 2008 @ 11:13 pm
“It is telling that all the
July 6, 2008 @ 11:16 pm
>>Do you think that a fundamental ignorance of nutritional matters (as demonstrated by a failure to be able to answer this question) is behind why some seem not to be able to accept that Diabetes UK
July 6, 2008 @ 11:29 pm
Superburger I am sure physical activity plays a role but why avoid the issue of glycaemic load?
The same authors I quoted above took issue with that review
July 6, 2008 @ 11:40 pm
superburger
“name a
July 6, 2008 @ 11:45 pm
Michael
“Dr. B, does it ever get lonely to be the one pointing out that the emperor has no clothes?”
Never – it seems from the comments here and elsewhere that there are plenty (including yourself) who seem willing and able to demonstrate the erroneous nature of much dietetic dogma.
And even if I was the only one pointing it out, loneliness would be something I’d gladly put up with as this would be more than compensated for by knowing that the exchanges here only further serve to reveal to truth (as well as the apparent attempts of some to obfuscate it).
July 6, 2008 @ 11:54 pm
>>would you, personally, care to name a
July 7, 2008 @ 12:00 am
sue
“superburger,
Read The Diet Delusion and you
July 7, 2008 @ 12:01 am
Superburger, you say:
“cathy – interesting work you point to – although I would say that the change of lifestyle (high to low physical activity) could be as, or more important than dietary factors.”
- I don’t thinks so! Its a diabetic epidemic with the aboriginals. Its definitely the western diet!
“There is nothing in their description of
July 7, 2008 @ 12:05 am
Michael re post 97
Seems like you’ve had to give superburger another lesson in elementary nutrition.
Strange how he/she seems to purport to know what’s best for diabetics to eat, don’t you think?
July 7, 2008 @ 12:10 am
It is telling that all the “refutations” of Dr. B’s post are ad hominem – they attack the man by pointing out that he is not specially trained in appreciating the emperor’s clothes.
The refutations would be more persuasive if they referred to evidence based science and cited studies rather than just repeating the current standard thinking.
Can anybody point to studies that show better health in diabetics by raising their blood sugars? Sorry to be so rude as to point it out, but that is exactly the “standard” line of reasoning.
July 7, 2008 @ 12:19 am
>>Strange how he/she seems to purport to know what
July 7, 2008 @ 12:33 am
Michael
“The refutations would be more persuasive if they referred to evidence based science and cited studies…”
Some common sense would be nice too, but I suppose that’s too much to ask for too.
July 7, 2008 @ 12:35 am
Dr briffa,
I still don’t think you have provided clear answers to any of the following questions, and have instead chosen to dull ad-hom attacks on other people., whilst failing to engage with the science.
Perhaps you have missed the point of my posts, so I will give three questions that would be really interesting if you could anwer.
1) What diet do you propose that diabetics should follow, and what *evidence* do you have that this will be more beneficial than the current D-UK advice.
2) I pointed you towards a review article which contained a series of recommendations for diabetic lifestlye/diet – these were in broad agreement with D-UK’s. Do you agree or disagree with this review and for what reasons?
3) If it is possible that D-UK’s judgment/advice is clouded by their relationship with pill-makers, is it also possible that your advice is clouded by your relationship with pill-maker, BioCard for whom you formulate ‘SucroGuard’
July 7, 2008 @ 8:15 am
superburger
Glad to see you’ve stopped asking the vegetable/blood sugar question at last (seeing as it had been answered here already and more than once).
“What diet do you propose that diabetics should follow, and what *evidence* do you have that this will be more beneficial than the current D-UK advice.”
As I
July 7, 2008 @ 9:12 am
Dr B – the timing of these comments seem to be all over the place, I posted this afer 108 but it turned up as 94. I’m reposting as I didn’t want Michael to miss it:
July 7, 2008 @ 10:25 am
“First up, how would you propose we could have measured rates of obesity in paleo populations with any degree of accuracy?”
Good point, but I specified morbid obesity – which I think is the proverbial elephant in the room. We know it when we see it. Basically obesity to the point that a person is incapacitated (such that they cannot run, jump or climb), due to their fat levels.
“Second, would you agree that the abundance of food in the western idiet is probably far higher than our paleo ancestors – couldn
July 7, 2008 @ 10:41 am
Michael
Oh, don’t worry about the tragic nature of the advice: it’s only other people’s lives that are at stake, after all.
July 7, 2008 @ 11:00 am
>>Oh, don
July 7, 2008 @ 11:26 am
dr briffa,
your blog post claims there are flaws with D-UK’s advice and you imply that their relationship with pill-makers may be the reason for this apparently flawed advice. Correct?
I suggest to you that there *is* an evidence base for the broad approach that they suggest – evidence for this is, for example, the large review article I point towards. Do you agree?
You have still failed to engage with contents of this review – because it prevents evidence contrary to your own position. Whilst it isn’t in the blog post – it *does* offer a rationale for D-UKs advice. Do you agree?
Of course, it is possible that the current approach advised by D-UK is wrong, or at least not wholly correct. There’s no harm in suggesting so, and discussing the benefits of the low-carb approach. (although in your blog post you failed to provide any evidence for your position in the form of references to peer reviewd journals). I think you would have to agree with this.
w.r.t. the meta-analysis (kirk et al), the main problem, to me, seems to be that most of the studies included were short duration, so the long term effects of low-carb diets are still unlcear (and diabetics are a diverse group so D-UK’s advice needs to be the best for the broadest range of people. That doesn’t prevent the work being interesting or exciting, of course. Fair comment?
Personally, i would place a lower weight than you on personal anecdote, as personal experience carries quite a low weighting on the evidence base scale (though of course, is a starting point for further study). Do you agree with my thoughts on this?
However, the tone of your blog post is that it is a relationship with drug companies which is clouding the judgement of D-UK.
But, what is sauce for the goose, must also be sauce for the gander – you too have a relationship with a drug company (Sucroguard is still on sale) so why is it not possible that *your* judgment is clouded by your commercial relationships. Why is this not a legitimate question?
i have no reason to wish to discredit you, I hope you can accept this. The science and the ideas are interesting, not dull ad-homs.
July 7, 2008 @ 11:29 am
superburger
“You have still failed to engage with contents of this review – because it prevents evidence contrary to your own position. Whilst it isn
July 7, 2008 @ 11:57 am
Ross,
Post 29:
“Catherine Collins RD says:
Sarah Spiers and Adam
Welcome to the
July 7, 2008 @ 12:01 pm
———
“
July 7, 2008 @ 12:22 pm
superburger
July 7, 2008 @ 1:27 pm
MC “Post 29:
July 7, 2008 @ 3:16 pm
Superburger – I don’t want really want to get drawn in to this argument – I, like a lot of people, have drawn my own conclusions about what constitutes a balanced diet and all health indicators (thus far), suggest I am doing something right. (And I am not evening taking Sucraguard)
However, my question is that do you not think that DUK’s nutritional advice is given as “an article of faith”? There is little on their site to suggest that their nutritional advice is anything other than ‘one size fits all’.
Personally speaking, if I had diabetes (or any disease/illness),
I would be absolutely furious if I was not informed of an alternative solution to a medication approach – particularly if other patients with the same condition had removed their need for medication completely – with something as simple as a change to diet. This comes back to an idea of treating the cause rather than the symptom.
Looking at it another way, has ANYONE ever managed to control their diabetes to the extent of not requiring medication, simply by following the official DUK nutritional advice?
By association, if ANY diabetic has completely removed their need for medication by following an alternative nutritional pattern, why aren’t DUK heavily researching it given their objectives? As you say, a particular diet may not suit everyone, but if a particular diet assists 5, 10 or 20% of the diabetic population to a point of not needing medication, then is this not a worthy area for study? Given their objectives you
July 7, 2008 @ 3:31 pm
ross
Here
July 7, 2008 @ 4:00 pm
We’ll have to agree to disagree about Catherine’s comments. I read them as valid criticism written in a somewhat gladitatorial style, not as the usual ad hom logical fallacy.
But you must agree that MC’s argument that all refutations of your position are ad hom attacks is a false one?
I’ve already got back to you, here:
http://www.drbriffa.com/blog/2008/06/23/bmj-article-explores-the-cosy-relationship-that-drug-companies-often-have-with-doctors-considered-%e2%80%98key-opinion-leaders%e2%80%99/
Juts to be clear, you state:
‘as well as the
July 7, 2008 @ 4:27 pm
dr briffa,
if you want to go back to MMR/autism, that’s fine – i still believe you were going to write a blog about the experiments you would like to see done to prove/disprove a link between MMR and autism. In particular it would be interesting yo know what result(s) would demonstrate beyond rational doubt that MMR is not linked to autism. I think you acknowledged that such a result existed, but were’nt ready to reveal it?
anyway, as for D-UK’s advice. As my last post went missing in the electronic ether, i will cut it down to this
your blog post here is ca 50% about the relationship between D-UK and drug companies and the implication is that their advice is clouded because of this relationship.
I suggest to you that the overhwhelming majority of D-UKs advice is based on sound evidence (don’t smoke, physical activity good, excess alcohol bad). Their specific advice on carbs has a genuine evidence base – and w.r.t low carb diets there is an excellent review which acknowledges possible benefits but cannot recommend for long term as not enough evidence. I think this is a fair summary.
Now, key to all of this is your notion that the drug company link may cloud D-UK’s thinking. i say to you that ther advice is evidence based, but obviously can and should change in the face of any significant weight of new evidence.
I believe ‘carbs at every meal’ advice is based upon the need to make dietary advice easy to follow for a large number of people(including the elderley) and it has been suggested that a qualitiative ‘plate’ approach at each meal is useful (camelon et al, J Am Diet Assoc, 1998, 98, 1155-1158). I think D-UK are very aware that individual diabetics should be managed by GPs/RDs/nurses, but aim to offer broad advice.
if D-UK’s advice should be viewed through the prism of their relationship with a pill-seller, then surely all advice re: diabetes should be viewed through the prism of the advisors relationsip with a pill-seller. None of which means that briffa, D-UK or anyone else has their advice distorted, of course.
cheers.
July 7, 2008 @ 4:30 pm
superburger
Common sense, science and my clinical experience all demonstrate that Diabetes UK’s advice for diabetics to include starchy carbohydrates with every meal is bad advice. Never mind, just keep attempting to divert us from this with your talk about this body’s ‘broad’ advice and the need to make things ‘simple’.
“if D-UK
July 7, 2008 @ 5:16 pm
dr briffa,
i’m not trying to divert, I just don’t think you recognise the shades of grey that exist. D-UK’s advice is evidence based – although contrary evidence does exist and is acknowledged.
I would say that it is extremely important to make diabetic dietary advice simple – given the age range of people who suffer diabetes. i point, for example, to the ‘plate’ model as a method of giving qualitative advice to groups who may not have the capacity to think in terms of percentages and grams every day, or when confronted with ‘difficult’ choices when dining socially.
i fully appreciate that you don’t agree with D-UKs advice -but i am suprised that you don’t conceed that it is evidence based and much of thei other advice is excellent for the general population too! (don’t smoke, exercise more, cut down on alcohol, plenty of fresh veg and oily fish, don’t waste money on vitamin tablets and supplements unless indicated).
Given your obvious interest and concern for the topic – have you considered putting together a short communication / letter to one of the diabetes journals to raise the topic in the open academic literature?
Perhaps that is the best way to raise your concerns to the widest possible audience of people able to have the most influence?
Hypothetically, if you did submit such a communication for peer review would you declare your relationship with BioCare (as formulator of SucroGuard) as a conflict of interest?
cheers.
July 7, 2008 @ 6:02 pm
superburger
On the point regarding Diabetes UK’s advice for diabetics to include starchy carbohydrates in every meal, I don’t think there is much in the way of “shades of grey’ here. It’s just bad advice. And, yes, you are diverting, and my sense is that I’m not the only one who had noticed.
“Hypothetically, if you did submit such a communication for peer review would you declare your relationship with BioCare (as formulator of SucroGuard) as a conflict of interest?”
Still banding on about this, superburger, even though you hit the buffers with it before? Oh, the desperation!
July 7, 2008 @ 6:10 pm
dr briffa,
i think i pointed out to you an evidence base for both the carbohydrate levels and spacing recommend by D-UK. You haven’t acknowledged or discussed them. That’s your choice.
but, seriously, have you thought about writing up a short communication to put your concerns across to a wide audience? If your concerns are real and think there is a scientific case for making D-UK change their advice, surely the best thing to do is submit a communication or letter, detaling the evidence. Maybe even a mini-review?
is that something you are interested in?
*Hypothetically* if you did submit such a communication for peer review would you declare your relationship with BioCare (as formulator of SucroGuard) as a conflict of interest?
July 7, 2008 @ 6:55 pm
superburger
Still the same (lame) lines, and a failure to concede that the advice Diabetes UK dispenses regarding starchy carbohydrates at every meal is not support by science, common sense or clinical experience.
July 7, 2008 @ 7:03 pm
dr briffa,
I think i’ve pointed you towards the reason i have for suggesting D-UK have evidence to suggest that using a ‘plate’ model at meal times has advantages (hence starchy-carbs at meals) along with the scientific evidence supporting DUKs other advice for their diet and lifestlye advice. I shan’t do so again.
it seems we’ve reached an impasse, you have strong views about the flaws in D-UKs advice. With the best will in the world, this blog won’t change a thing.
If you have “science, commen sense and clinical experience” on your side why don’t you write it all up, submit it for peer review and publish it? Youve stated before that ‘lives are at stake’.
If the evidence is as compelling as you make out, then a good communication, or mini-review submitted could start D-UKs proverbial ball rolling.
Is there any particular reason preventing you putting together a communication or letter? (appreciate reviews might be rather time demanding)
When writng such an article would you declare any CoIs? (clue, it’s a yes/no asnwer)
cheers,
July 7, 2008 @ 8:08 pm
superburger
So, after asking questions that have already been answered as well as others that don’t need answering because the answer is obvious, you’ve resorted to asking hypothetical questions (more than once).
Gosh, how some will do all they can to divert attention away from the truth, it seems.
Do please persist with these tactics though, superburger, because they do serve again and again to draw our attention to the assertions that I made in the original post, as well as the fact that no-one (including you) has been able to prove them wrong.
July 7, 2008 @ 8:21 pm
“Still the same (lame) lines, and a failure to concede that the advice Diabetes UK dispenses regarding starchy carbohydrates at every meal is not support by science, common sense or clinical experience.”
The way you have presented such a distorted version of the Diabetes Uk website would leave the casual reader with the impression that your assertions in the above article are fair. They are not; the information presented on D.Uk is fully inline with best clinical practice and is supported by solid peer reviewed science.
I find it rather sad that you have failed to engage rationally with the points superburger has raised and particularly troubling that you seem unable to produce *any* peer reviewed data that would support your claims re low carb diets; your attempts at smoke screen with inversion of proof deflection and patronising ad-hominem attack are beneath contempt – especially for a ‘qualified’ medical doctor.
But perhaps most tragic of all is your stamped-foot arrogance that your association with Sucroguard does not present a conflict of interest when it clearly does so.
July 7, 2008 @ 8:47 pm
grooverider
Do please quote the ‘solid peer reviewed science’ which demonstrates that including starchy carbohydrates with every meal is the best dietary advice for diabetics. And do inject some common sense too here. Or some of your clinical experience (if you have any). And perhaps comment on the experiences of individuals here who have benefited from carbohydrate control? Preferably, do ALL of these things.
And I’ll ask you, like I asked superburger, HOW me formulating Sucroguard may have influenced the advice I give to diabetics that would be of benefit to me and of detriment to them? Note how superburger was unable to address this point in any meaningful way. Perhaps you’ll have better luck.
July 7, 2008 @ 9:05 pm
dr briffa, rather than attempt to prove you wrong, i’ve attempted to explain why D-UK’s advice is evidence based and valid. Anyone reading these posts will notice how, not once, have you chosen to engage with any of the papers I point to, or arguments I raise. Indeed, i readily agreed that there is lots of interesting work pointing towards alternative approaches to diabetes and they may yet prove to be a new way forward. I don’t see that as a mark of failure, incidentally.
By contrast, you have failed to point directly to any peer reviewed evidence to support your position. You indirectly pointed to an interesting meta-analysis, and I discussed its merits and drawbacks and pointed out that the concepts it raised were (possible benefit of low-carb high protein diet) also discussed in a large review article in diabetes care.
I suspect this could go on forever. So i shall ask just a couple of questions, and let blog-readers interpret your answers for themselves.
1) Given you say “lives are at stake” will you consider submitting a piece of work for peer review, detailing the failings of the DUK approach based on “science, commons sense and clinical experience.” If not, why not? Nowhere have you answered this question, not has anyone answered on your behalf….
2) given the overall theme of this blog was, inter alia, conflicts of interest. Would you declare a CoI if you were to submit something for peer review? This has not been answered directly.
cheers.
July 7, 2008 @ 9:21 pm
superburger
Again you attempt to lead us away from the point that telling diabetics to eat starchy carbphydrates at each meal looks like singularly bad advice.
And, again, you round off with a hypothetical and irrelevant question.
I do want to thank you for one thing, though: my sense is that your persistent attempts to divert attention from the real issue at hand here will cause even more individuals to question the validity of the dietary advice so commonly given to diabetics. And that HAS to be a good thing, I reckon.
Cheers.
July 7, 2008 @ 9:42 pm
“Again you attempt to lead us away from the point that telling diabetics to eat starchy carbphydrates at each meal looks like singularly bad advice.”
dr briffa,
why do you disagree with the D-UK ideas of carbohydrate based meals with general advie to facour the low GI carbs?
http://www.diabetes.org.uk/Guide-to-diabetes/Food_and_recipes/Food_and_diabetes/Eating_well/
The below meta analysis suggest this is a valid approach with good evidence. I suggest your readers study it themeselves and make their own conclusions.
Anderson et al, Journal of the American College of Nutrition, Vol. 23, No. 1, 5-17 (2004)
(the every meal concept is also supported by the camelon et al paper on food ‘plates’)
cheers.
July 8, 2008 @ 12:00 am
superburger
From the abstract it appearts the Anderson paper doesn’t even consider low-carbohydrate diets, so how is it relevant here? The answer, of course, is that it isn’t.
Cheers!
July 8, 2008 @ 12:19 am
Dr Briffa wrote:
“Do please quote the
July 8, 2008 @ 12:33 am
Superburger the Anderson review beautifully demonstrates the statistical shenanigans the low fat brigade resort to when trying to shore up the hypothesis
They claimed that the meta-analysis included 12 studies with a
July 8, 2008 @ 12:37 am
“The most effective diabetes diet, based on a detailed review and meta-analysis of the literature, is a higher carbohydrate, higher fiber diet.”
I don’t agree – its not the most effective – if it works at all. If the Anderson paper looked at low carb it would have found it the most effective diet for diabetes.
July 8, 2008 @ 3:11 am
Read the Diet Delusions:
“Taubes traces how the common assumption that carbohdrates are fattendng was abandoned in the 1960s when fat and cholesterol were blamed for heart disease and then – wrongly – were seen as the causes of a host of other maladies, including cancer. He shows us how these unproven hypotheses were emphatically embraced by authorities in nutrition, public health, and clinical medicine, in spite of how well-convceived clinical trials have consistently refuted them.”
July 8, 2008 @ 3:27 am
Peer-reviewed are supposed to be the be all in studies – well take a read of this post from Dr Michael Eades:
http://www.proteinpower.com/drmike/obesity/another-china-study/
July 8, 2008 @ 3:42 am
grooverider
July 8, 2008 @ 8:24 am
dr briffa, you seem to have become confused.
firstly, i offered the Anderson metaanalysis to show *that there is evidence* to support to high carb approach suggested by D-UK. Do you dispute that this article constitues a body of evidence?
secondly, if one reads the paper (it’s open access so no reason not to) there is actually some discussion of lower-carb diets with higher carb diets (they compare “medium carb high fibre” and “high carb high fibre” diets). They concluded the higher carbohydrate diet improved all indicators of glycaemia.
Dr briffa, you see, there *is* evidence for the D-UK approach. Whether you agree or not, is your choice, but to say there is no evidence supporting the DUK approach is simply not true.
July 8, 2008 @ 9:13 am
superburger
Seems like you’ve not read Cathy’s critique of the Anderson paper above (perhaps you should).
Also, ‘lower’ (with respect to carbohydrate intake) does not necessarily mean ‘low’.
But that’s fine, you keep up the good work of supporting and defending the idea that individuals whose primary problem is handling sugar in the body should include foods that are generally disruptive to blood sugar at every meal.
Nice work (unless, of course, you’re a diabetic and your life depends on getting the best and most appropriate dietary advice).
July 8, 2008 @ 10:23 am
dr briffa, i really don’t think you understand why i point towards the anderson metaanalysis.
It provides, whether you like it or not, evidence that the high carb, high fibre, low fat, tend towards low GI approach suggested by the major western diabetes associations and charities does have an evidence base. Do you agree with this?
But in any case, i would say the strength of this metanalysis is that it demonstrates the existance of the evidence base for D-UKs approach – not that it ‘disproves’ any other position per se.
In any case, dr briffa, if as you say “lives are at stake” and you have “science, common sense and clinical experience” to demonstrate that DUKs position is wrong, have you thought about submitting your findings for peer review, in order to change the DUK position?
Think that would be more productive and benefical than a blog on this interesting topic….
July 8, 2008 @ 11:16 am
“Seems like you
July 8, 2008 @ 4:17 pm
Dr Briffa;
Having read the exchange between yourself and superburger I’m have to say you are the one clearly dodging the issue.
If you feel that D-UK’s advice is wrong write up your evidence, they already have a body of evidence for their approach. If they are influenced by their association with pharmaceutical companies, how are you immune?
I have type 2 diabetes that I control by diet and exercise and have found that the best diet for me is low-carb. Even so, there is no evidence that D-UK’s advice (which I also got when I was first diagnosed) is motivated by anything other than concern for my health. My personal hobby horse is that type 2s should use a glucose monitor and find out for themselves what elevates their blood sugar but I do not maintain that what works for me will work for everybody because my personal experience is not evidence!
July 8, 2008 @ 8:14 pm
Mike Kelly
Science, common sense and my clinical experience show that low-carb is best for diabetics. You found the same yourself. Many others (some of whom have posted here) also find the same thing. There are countless forums on the web with accounts from diabetics who have successfully controlled their condition with low-carb eating.
Now, Diabetes UK recommends that starchy carbs should be eaten with every meal, and encourages, to all intents and purposes a high-carb diet.
And you state: “…there is no evidence that D-UK
July 8, 2008 @ 9:28 pm
Dr Briffa
Science is a method as well as a body of knowledge and is designed to protect you from being mislead by “experience and common sense”. You may well be right and what appears to be working for me may be more generally applicable but you will not find out by standing on a soapbox (or blog) and proclaiming the “truth” to the world. If you believe you’re right, do the work and write it up.
Your habit of avoiding the questions asked of you does not encourage me to think that you’ll take this route; after all you might be wrong, would you be able to cope with that?
Ulf_s. I believe type 2 was only recognised as a separate disease in the 1930s. But you’re quite right, before Banting and Best type 1s were put on low carb diets and mostly died young.
It’s likely that there’s more than one type of NIDDM and maybe not everybody will respond well to the regime I’m on, and maybe in 10 years time I’ll find myself in exactly the same situation I would have been in if I followed the UK-D guidelines plus metformin/avandia/actos/insulin. I note that the recent ACCORD study found that stricter control of blood sugar was associated with higher death rates. This may or may not be relevant. But I’m more than a little convinced, on the basis of the published evidence, that one solution does not fit all.
I’m not pushing my regime, Dr Briffa is pushing his, he should supply the evidence (not anecdote, not “common sense”, not what his personal understanding of the very complicated biochemistry of lipids and carbs would suggest to him). Do the work, publish the work, stop being an arse.
July 8, 2008 @ 10:10 pm
Cathy: “They claimed that the meta-analysis included 12 studies with a
July 8, 2008 @ 10:21 pm
Dr B – superburger said, ref. the Anderson review:
“Dr briffa, you see, there *is* evidence for the D-UK approach. Whether you agree or not, is your choice, but to say there is no evidence supporting the DUK approach is simply not true.”
You replied:
“Seems like you
July 8, 2008 @ 10:34 pm
>>They concluded the higher carbohydrate diet improved all indicators of glycaemia.
I cannot understand how “adding fuel to the fire” can bring the fire under control.
Please explain the mechanism.
July 8, 2008 @ 10:35 pm
A hundred years ago, or just a few decades ago, carb restriction was the obvious answer for diabetics. And they stayed quite healthy on their fatty low carb diets!
Now there’s insulin so diabetics can have all the carbs they want (and they’re encouraged to eat them!) so there’s no need for anyone to feel deprived. And they get all kinds of complications from high blood sugar/high insulin that are considered inevitable, a natural progression…
So what if you, as a diabetic, would end up blind and amputated in a wheelchair because you didn’t want to “restrict” yourself to a low carb diet? Would you think back and fondly remember all the delicious breads, cakes and pasta you enjoyed, and think it was all worth it?
Maybe not.
July 8, 2008 @ 10:41 pm
>>end up blind and amputated in a wheelchair
Tsk Tsk!
You forgot the kidney transplant and heart bypass.
July 8, 2008 @ 10:44 pm
Cathy also states:
“So not many of these studies met their own < 30% stipulation and appeared to be typical SAD diets. ”
There wasn’t a <30% stipulation. The stipulation was to compare high carbohydrate, high fibre diets with lower carbohydrate, lower fibre diets.
“I
July 8, 2008 @ 10:47 pm
Mike Kelly might have been wise enough to follow a low carb approach but what about all the others who take everything the Diabetes Educators take as gospel.
July 8, 2008 @ 11:08 pm
Cathy said:
“And why leave out this low carb study (20%) with 31 subjects, a control group and 44-month follow-up when it fit their criteria?”
Nielsen & Joensson, Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up.
http://www.nutritionandmetabolism.com/content/3/1/22
Published: 14 June 2006
You mean leave it out of the Anderson review? Anderson et al. Carbohydrate and Fiber Recommendations for Individuals with Diabetes: A Quantitative Assessment and Meta-Analysis of the Evidence?
http://www.jacn.org/cgi/content/abstract/23/1/5
Published in the Journal of the American College of Nutrition, Vol. 23, No. 1, 5-17 (2004)?
July 8, 2008 @ 11:21 pm
What a lamentable reflection of modern medical scientific culture is Mike Kelly’s remark that his personal experience isn’t evidence. How very confused we have become.
July 8, 2008 @ 11:46 pm
Ross you completely missed my point. I wasn
July 9, 2008 @ 12:55 am
Mike Kelly I am pleased you can control your diabetes on diet and exercise alone and I agree that the dieticians and other health professionals are not generally
July 9, 2008 @ 9:17 am
“Ross you completely missed my point.”
Cathy, I think that you have completely missed the point of the Anderson review. You seem to want it to be something it isn’t and then criticise the authors of the review and the individual studies because it doesn’t provide the results you want.
I think it would be more valid to bemoan the lack of studies and evidence for the low carb approach to diabetes management rather than criticise a review of the good studies that have been done examining other approaches.
The Anderson review looks fine to me and I can’t find any examples of the authors engaging in ‘statistical shenanigans’ or being ‘dishonest’. Do you want to retract those words?
I also wouldn’t expect to find the kind of massive error that you accuse the Anderson review of (incl. 13 studies that don’t fit their own reviwe criteria) in an open access peer reviewed journal, certainly I would have expected it to have been picked up after 2 years. If you still think you are correct on this point are you going to write a letter to JACN pointing out this massive howler?
“I wasn
July 9, 2008 @ 10:39 am
“A bias shown by Anderson
July 9, 2008 @ 10:48 am
cathy,
D-UK recommend weight loss, because, again, there is solid evidence that a BMI (as imperfect a metric as that may be) > 25 is regarded as a Bad Thing for diabetics.
It is not insulting to suggest the ‘plate’ approach, because, again, there is evidence that it is useful tool in encouraging diabetics to think in terms of proportions (whatever the correct ones may be!) when planning meals. It is not insulting the intelligence of diabetics, but a recognition that for some groups thinking in percentages and grams is not easy – or practical in some social situations.
Obviously for well motivated and attentive diabetics other approaches may work better.
I’m not sure that Anderson et al *do* ignore data that fit the selection criteria. Have you any evidence for this? (as ross points out, they can’t really be blamed for not including data not available at the time). Nor is it a valid criticism to say they include data which doesn’t support their position (that’s part of metaanalysis).
w.r.t your point about ‘diabetic foods’ D-UK are very clear that there is no evidence to recommend them and do not do so. That is their stated position. You at least share some common ground there!
The problems of diabetic misusing insulin for weight loss are not really relevant to the D-UKs positions statements. any diabetic misuing their illness for weight loss needs urgent help.
The relationship between drug companies, health care profs, charities and patients is always important to consider. Dr briffa, in his blog post makes the implication that the reason D-UK reccommend ther carb approach may be clouded by drug company patronage.
Other people have pointed out there is solid, peer-reviewed evidence for their approach.
Dr briffa, of course, has a relationship with a pill-maker and was involved in the formulation. It seems only fair that one considers his relationships when reading his blog post.
July 9, 2008 @ 11:31 am
John Stone “What a lamentable reflection of modern medical scientific culture is Mike Kelly
July 9, 2008 @ 1:47 pm
Mike Kelly
My preference (and Cathy’s, I think) is for low-carb/carb-restricted diets for diabetes (though this is clearly not a view held by Diabetes UK). If it’s science you’re looking for, then you might care to click on the links in comment 107. The conclusions here do seem to be in line with clinical experience and common sense.
Personally, I think we have the answer, but whether anyone listens is obviously another matter.
July 9, 2008 @ 2:46 pm
er, dr briffa, I offered some discussion of the kirk et al metaanlysis in post 112.
Essentially (and the authors suggest this) it seems more work is needed to asses the long term benefits and risks of low-carb approach. How, for example, will the increased protein affect diabetics with renal complicactions? Perhaps low-carb is appropriate for certain sections of diabetics, but not for others? exciting work to be done, i think.
So, do you think there is a sufficient body of evidence to justify D-UK changing its advice?
A body of evidence so large, it can overturn the established body of evidence that exists supporting the current D-UK, american diabetic association, canadian, australian, japanes, indian and european diabetes groups’ positions re: carbohydrate intake and long term nutritional managment of diabetes in type I and II diabetics (how many man-hours of common sense, science and clinical experiene formulated those, i wonder?)
If so, the only mechanism I can see for you to address these concerns is to submit something for peer-review in one of the diabetes journals. A paper with such an exciting set of conclusions should waltz into any high-impact journal, i would have thought?
A real blockbuster of a paper could get into Nature if pitched correctly.
July 9, 2008 @ 3:12 pm
Mike Kelly
No, if a substance makes you ill which is shown to be safe and effective in a study with other people, it still is not illusion that it has made you ill. It is a real effect, like eating rotten fish.
July 9, 2008 @ 6:27 pm
John Stone
Your example does not then allow you to predict what will happen the next time I eat fish. Or what will happen when someone else eats fish.
If a study has shown a treatment to be safe and effective it will have put error bars around both of these parameters allowing you to assess the risk/benefit of the treatment.
A collection of individual anecdotes does not allow you to do this.
I have noticed that intelligent and well informed people can become victims of fraudulent treatments because they equate personal experience (their own or others) with evidence. Please try to accept that the purpose and methodology of the scientific method is to overcome this most damaging of blind spots.
July 9, 2008 @ 8:07 pm
>> So, do you think there is a sufficient body of evidence to justify D-UK changing its advice?
Yes.
The American Diabetes Association has (grudgingly) changed its advice and advocated low-carb diets under certain circumstances.
http://care.diabetesjournals.org/cgi/content/full/31/Supplement_1/S61
My guess would be that more changes will follow.
“In an interesting twist this week, in an updated WedMD article, American Diabetes Association spokesman Nathaniel G. Clark, MD acknowledged in an interview that carbohydrate restricted diets help people with type II diabetes control blood sugar.” http://weightoftheevidence.blogspot.com/2006/06/ada-acknowledges-low-carb-diets-help.html
Best,
Michael
July 10, 2008 @ 12:01 am
Carbohydrate restriction is the way to treat diabetics!
From Taubes’ book:
“1986 FDA exonerated sugar of any nutritional harm saying “no conclusive evidence demonstrates a hazard” yet the 200-page report had hudreds of articles re sugar causing higher risk of heart disease and diabetes. The FDA interpreted the evidence as inconclusive. Sugar – innocent until proven guilty, fat assumed guilty until proved innocent – so the existence of ambiguous evidence was considered sufficient reason to condemn fat in the diet, particularly saturated fat, while the existence of ambiguous evidence was simultaneously considered reason enough to exonerate sugar”.
July 10, 2008 @ 12:31 am
There is something a bit weird going on with the way in which these posts have appeared.
I apologise unreservedly for missing the dates between Anderson
July 10, 2008 @ 9:10 am
Dr Briffa
July 10, 2008 @ 9:36 am
Mike, I am a non-diabetic, follwoing this from the side lines, but I was struck by your line:
“A collection of individual anecdotes does not allow you to do this.”
I agree with this statement to a point, but the the thing about diabetics is that their condition may be so serious that there are immediate consequences to poor nutritional choice. They also have access to specialised and precise medical equipment to quantify and determine the state of their BG and the effects of vasrious foods upon it.
Thus, I would apply a great deal more credibility to the ‘anecdotal evidence’ of this group than, for example that of a group of dieters who can underestimate and ‘cheat’ on a diet with little immediate consequence, and who have no precise technical instrumentation (scales are crude), to quantify the effect of their diet.
What I am trying to say is that a diabetic has a more ‘scientific’ way of coming to his/her conclusion on nutritional than would a dieter.
Given the number of diabetics who have come to the conclusion that a ‘paleo diet’ is optimal for them, and given the objectives of DUK, don’t you think that DUK should be looking to resource some form of research in to this area or at least encouraging it?
July 10, 2008 @ 10:19 am
“Isn
July 10, 2008 @ 10:51 am
er mike, the ADA position statement recognises that low-carb or low-fat diets are useful for *weight loss* in short term (25 is a risk factor, even if BMI is a crude indicator.) Any eating plan in which calories in < calories burnt will result in weight loss.
Exercise is the other key factor, as not only aids weight loss be important for cardiac disease.
skeptictactoe – of course more diabetes research is needed -on every aspect of the disease – and D-UK have a role to play in that alongside all the other interested parties.
But to those (including Dr Briffa?) who think D-UKs advice is in need of urgent change then why not write it up and submit it for peer-review. Far bigger audience than this blog…..
July 10, 2008 @ 11:07 am
Cathy “The only thing this study proves IMO is that if you are going to eat a moderate or high carbohydrate diet, high fibre will improve glycaemic parameters over low fibre (but possibly leave you rather flatulent).”
Cathy, the study certainly says:
“For diabetic subjects MCHF diets compared to MCLF diets are associated with significantly lower values for: postprandial plasma glucose”
But then it also gives significantly lower values for “total and low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides.”
But wouldn’t you also agree with the other findings?
“HCHF diets compared to MCLF diets are associated with lower values for: fasting, postprandial and average plasma glucose; hemoglobin A1c; total, LDL-cholesterol, HDL-cholesterol and triglycerides.”
July 10, 2008 @ 4:30 pm
Mike Kelly
I mentione rotten fish – not fish.
There is the reverse problem that evidence which hold good for populations may be useless for individuals, and medicine has to treat individuals. It is nonsense to suggest that the diet which suits you is not evidence, at least in regard to you.
July 10, 2008 @ 11:20 pm
Superburger,
“”er mike, the ADA position statement recognises that low-carb or low-fat diets are useful for *weight loss* in short term (25 is a risk factor, even if BMI is a crude indicator.) Any eating plan in which calories in < calories burnt will result in weight loss.”
Duh.
There is no study in the world that would make them reverse course overnight.
The only legally and politically safe course for them is to very slowly shift position “as current science emerges.”
“Short Term” and “for weight loss only” are both meaningless qualifiers that will slowly be dropped.
Cigarette companies were in the same position – admitting to actively and knowingly killing people is not a way to keep your job.
July 11, 2008 @ 12:33 am
michael, so what your saying is that if the weight of evidence becomes greater (assuming it does) then the ADA, D-UK, etc, etc, will change their positions to reflect this?
Because that sounds like they will genuinley take on board new evidence, consider very carefully new science and generally do the right thing.
Couldn’t agree more – sounds very sensible. Good science always ‘shifts its position’ as and when evidence emerges.
(although, sometimes, a single piece of work can change the course of science – the british doctor’s study on smoking, watson and crick on DNA, jenner on smallpox, for example)
You cigarette smoking analogy seems a little unfair – there is plenty of honest peer-reviewed evidence for the D-UK position.
Sadly, dr briffa seems to prefer to imply that D-UK’s position is clouded by their relationship with drug companies and that there is already sufficient evidence for D-UK to change their position.
July 11, 2008 @ 9:30 am
Cathy, I’d just like to ask some questions and would appreciate honest answers to them:
Do you think your analysis of the Anderson review was accurate?
Are you still accusing the Anderson authors of dishonesty?
Are you still accusing the Anderson authors of statisitcal shenanigans?
Are you still accusing the authors of (38) and(41) of deliberately and fraudulently designing their studies?
Given the fact that the Anderson review provides an evidence base for DUK’s advice (albeit advice you don’t agree with) do you still think theyare ‘merely self-serving do-gooders’ that ‘actually do more harm than good’?
Are you still suggesting Ms Spears has blood on her hands?
July 11, 2008 @ 4:10 pm
>>You cigarette smoking analogy seems a little unfair – there is plenty of honest peer-reviewed evidence for the D-UK position.
Once you stop buying in to the “fear of fat” hypothesis, there are many studies that do not support their own conclusions.
This is fairly common in science, or any human endeavor.
There are some “well known truths” that color all thinking.
Social scientists call this an “Information Cascade.”
See Thomas Kuhn’s work on Paradigm Shifts:
http://en.wikipedia.org/wiki/Paradigm_shift
We saw it not that long ago with Ulcers – it was “well known” that the problem was acid, stress, and spicy food.
These “well known facts” were in fact false.
Helicobacter Pylori is the culprit, and the “acid, stress, spice” hypothesis was false.
Everything that doctors had learned about ulcers in school and practice was false.
No evil intent or conspiracy.
All the studies about acid reduction.
All the studies comparing alternate surgery techniques.
All the psychotherapy for stress.
All the bland cooking techniques.
ALL FALSE.
We may well see the implosion of the low-fat theory of heart disease. It is not getting good results in practice. Once that theory is no longer supported, the justification for high carb intake for diabetics is gone.
Nature Publishing Group’s “International Journal of Obesity” just published a chinese study comparing vegetable intake.
They found a correlation higher carbs = higher BMI.
Amazingly, they concluded it was the fat.
Here is a great discussion about how the facts were tortured to fit the current low-fat paradim:
http://www.proteinpower.com/drmike/obesity/another-china-study/
I will find the references to some other studies that found bad things about saturated fat in a high carb diet, and concluded it was the fat. The perfectly reasonable alternative, that refined carbs might be the problem was just not explored at all – it did not fit the paradigm.
July 11, 2008 @ 10:30 pm
>>Sadly, dr briffa seems to prefer to imply that D-UK
July 11, 2008 @ 10:44 pm
You are claiming that D-UK has its recommendations based on solid science and
July 12, 2008 @ 4:34 am
cathy,
“A very high fibre diet is essentially a high fat diet”
how so? Do no high fibre, low fat foods exist?
The smith paper is for obese people – not all were diabetic for a start – and the authors themselves are extremely cautious about reccomending the diet for long term use. And weight loss was the primary measured outcome. Do you think it fitted Anderson’s inclusion criteria?
But as i think I’ve repeatedly said, new work is interesting and important – and if and when a substantial new body of evidence is created maybe D-UK (and every other western diabetes association) will change their advice. That’s science.
But i still think dr Briffa is wrong to suggest that drug company links were the reason for D-UK to give the advice that they do.
re: submitting for peer-review
“This statement is either very na
July 12, 2008 @ 11:36 am
Cathy – “And he was also dishonest in the comment that his review included
July 12, 2008 @ 12:22 pm
Research can be interesting and lead to amazing insights, but most of the time they’re fairly useless epidemiological studies that don’t really give any answers…
The reality is that carbohydrates do raise blood sugar. It’s a simple fact. Anyone disagree?
If you’re insulin resistant/diabetic your blood sugar will rise to damaging levels when you eat “normal” amounts of carbs, even if you choose so called slow carbs. The body counteracts this by releasing huge amounts of insulin, or you need to inject insulin.
The problem here is that both high blood sugar and high insulin levels are damaging. I really shouldn’t have to point this out, but it seems like this gets ignored or forgotten a lot of the time, along with basic human biochemistry.
There is no way a high carb diet can be beneficial to a person with a damaged sugar metabolism. It’s a simple fact.
Mike Kelly, you said the following: “Ulf_s. I believe type 2 was only recognised as a separate disease in the 1930s. But you
July 12, 2008 @ 6:39 pm
Would Ross or somebody here explain to me how eating starchy foods can improve glycemic control?
Seriously.
My meter says that starchy food raises BG rapidly.
Any non-tiny portion of starchy food raises BG too high.
I must be missing something…
July 12, 2008 @ 11:10 pm
Ross, stop complicating the issue. carbohydrate restriction is the best treatment for diabetics – that’s it!
July 13, 2008 @ 4:08 am
Do you think your analysis of the Anderson review was accurate?
Are you still accusing the Anderson authors of dishonesty?
Are you still accusing the Anderson authors of statistical shenanigans?
Are you still accusing the authors of (38) and(41) of deliberately and fraudulently designing their studies?
Are you still suggesting Ms Spears has blood on her hands?
YES
July 13, 2008 @ 4:10 am
sue, i disagree. I think there is solid evidence to support D-UKs position at the present time.
Think the authors of the anderson metaanalysis are academics trying to look through a vast body of often confusing evidence and trying to come to some evidence based conclusions.
You disagree (which is fine). But i think you need to accept that the scientists who disagree with you are not fools, do not have a particular agenda (and acknowledge conflicts of interest where present), and also have a genuine interest in good evidence for diabetics.
When two competing ideas exist, it doesn’t mean both positions are honestly held, but sometimes one position has more evidence.
Accusing acadmics of dishonesty is a serious allegation. I strongly suggest you think about the allegation you make and admit it is unfair and unjustified.
July 13, 2008 @ 1:31 pm
>>Accusing acadmics of dishonesty is a serious allegation. I strongly suggest you think about the allegation you make and admit it is unfair and unjustified.
Correct.
Simple “confirmation bias” and groupthink is sufficient to produce this sad state of affairs.
Gary Taubes’ book lays out a compelling case.
Go read it.
July 13, 2008 @ 9:06 pm
superburger, the “solid evidence” you’re talking about is anything but solid, since it’s based on epidemiology. As you say the “evidence” is often confusing. Guess what? Epidemiology can’t prove anything! The “evidence” would likely be a lot more consistent if it came from carefully designed, properly conducted studies.
And please remember: whatever epidemiological studies “prove” is probably bogus if it goes against human biology…
superburger, do you agree that carbohydrates raise blood sugar?
If you do agree, would you please explain the basic biological mechanisms that make them healthy to eat for a diabetic? Why would/should a diabetic eat a lot of fruit, bread or pasta? (And I don’t mean references to epi. studies that may or may not include actual diabetics.)
July 14, 2008 @ 7:38 am
Sorry, make that “mostly based on epidemiology, junk science or reviews of them” on the second line…
July 14, 2008 @ 8:56 am
John Stone (back at 175, sorry, I have a job so big gaps inevitable)
Look up lutefisk. Not exactly rotten but it made me vomit every meal I’ve had since I was six; I’m pretty sure my last heave had my socks and underpants in it.
So, using your criteria, all Scandinavians should immediately cease eating the rotten gelatinous mess?
You can’t extrapolate from anecdote to treatment.
Personally, I think there are two separate arguments going on here; both highly interesting:
1) Is low-carb the best method of controlling diabetes?
Of huge personal interest to me and I keep a very close eye on the literature. There’s a lot of work yet to be done here especially as the ACCORD study showed just focussing on the surrogate markers (blood glucose, Hb1Ac, blood lipids etc.) may not indicate better outcomes for the real markers (Dying!!, blindness, Look Ma! No Kidneys!111!eleven).
2) Is D-UK deliberately giving bad advice when they know better and…
2a) Are they influenced by ties to Big Pharma.
I think the other commentators (Superburber et al) have done a good job showing that D-UK are advising consistent with the current evidence base and even if the advice they give turns out to be sub-optimal there is no reason to assume bad faith.
As for 2a I’m still confused over Dr. Briffa’s immunity to the influence of the pharmaceutical ties he points out in others.
Bit of a classic Tu Quoque there, but I’m reminded of an old interview with Mary Whitehouse where she was asked how she resisted the depraving influence of the films she reviewed. Apparently having Jesus in your heart protects you, I suspect I’m seriously screwed then.
July 14, 2008 @ 5:28 pm
Ulf_s
“And please remember: whatever epidemiological studies
July 14, 2008 @ 6:52 pm
Some comments about the ACCORD study: http://diabetesupdate.blogspot.com/2008/06/giant-step-backwards-misinterpreting.html
In short: the people in the trial were pretty sick from the beginning, were advised to eat a high carb/low fat diet and were put on just about every diabetes medication that is known to mankind. No wonder they dropped like flies…
July 14, 2008 @ 7:50 pm
#193: I certainly don’t…
But I do know that a diabetic shouldn’t eat large amounts of carbs, even if some studies claim they are terrific and good for you.
Why feed sugars to someone who can’t metabolise them properly…?
Can anyone of you who advocate a high carb diet please explain the thinking behind this? I simply do not get it.
I can measure my own blood sugar and see how carbs make it go up, so how can it be good for me to eat them?
July 14, 2008 @ 8:47 pm
Good stuff Ulf_s
But I note that the people in the study already being pretty sick is the opinion of the blogger and not one I picked up from the study (unless the assumption is that an American study automatically means sicker people?)
I haven’t seen a study with non-surrogate endpoints looking at carb content so I don’t feel I’m in a position to take a position. I’m handling my disease in such a way as to minimise my blood sugar without drugs but I’m not an evangelist for it. I COULD BE WRONG.
July 14, 2008 @ 10:12 pm
>>Why feed sugars to someone who can
July 14, 2008 @ 11:42 pm
#196: I don’t think I’ve ever seen a well-designed study which compares a traditional low carb/high fat diet with the new high carb/low fat diet that can actually show that the high carb diet is superior.
And this relatively new high carb diet is still what is recommended today. Isn’t it scary?
I’ll stick with the traditional advice until some other approach is proven to be healthier…
July 15, 2008 @ 12:25 am
New Israeli low-carb vs Mediterranean vs low-fat study
http://www.dailymail.co.uk/news/article-1035779/Atkins-diet-safe-far-effective-low-fat-says-study.html
“The low-carb diet was best for reducing levels of bad cholesterol, while all three diets had the same beneficial effect on liver and inflammation function, the researchers said. … The researchers concede that the study has some flaws. Around 85 per cent of the volunteers were men – and the effects could be different for women, they say.”
July 17, 2008 @ 9:00 pm
Dr Eades has posted up a link to a paper detailing the advantages of long-term low-carbing (44 months) for obese, type 2 diabetics:
http://www.nutritionandmetabolism.com/content/5/1/14
July 18, 2008 @ 9:53 am
I think the insinuations you make in this post about the motives of Diabetes UK are obscuring a valid point about their failure to review their advice in good time. The very fact that they continue to make recommendations in spite of the weight of evidence is a crime, regardless of the motives. I argue here that organisations in general (and I accept this is a broad term) pay far too little attention to the case studies that abound on the internet, and because of this, the notion of low carb diets as a better approach for diabetics has taken too long to get through.
August 2, 2008 @ 5:22 pm
Points scoring by trading study-based opinions is all fine and dandy… and about as useful as trading biblical quotations to support any view you hold. But the numbers of despairing, ill-informed poorly controlled diabetics pitching up at diabetes forums, doctors’ surgeries and into early graves tells its own story about the general advice being handed out: it’s broke. Fix it.
Sara Spiers hits the nail on the head when she frankly admits: “The diet recommended for people for diabetes is the same diet as recommended for everybody else a healthy well balanced diet including all of the food groups above in the correct quantities.”
The same diet as everybody else? Hang on. Haven’t you missed something here? There’s a clue in your organisation’s name. We’re not the same as everyone else in dietary matters.
Look at it another way. How would we regard official advice from a charity representing alcoholics that its subscribers imbibe the official number of units of alcohol recommended for everybody else?
It really is that obvious.
September 15, 2008 @ 9:48 pm
I have followed the arguments. I have to say that the bad advice meted out by DUK is only what is given out as a “good diet” for diabetics by the NHS dietitians! To compound the poor advice, no diabetic education is given in many areas and T2 diabetics are denied the wherewithal to educate themselves on how such dietary advice affects them. To wit, test strips! Give some basic education on testing properly i.e. at what times in relation to their meals, and it’s not rocket science for them to see how various foods affect them personally, because there is no “one size fits all”, some people can eat certain carbohydrates with little affect, whereas another person will find the same choice shoots their BGs sky high.
In the forum I run http://www.diabetes-support.org.uk/forum/Blah.pl? there is ample evidence that restricting starchy carbs benefits BG control. This is mirrored throughout the myriad diabetic forums across the internet. If so many (literally hundreds) diabetics are seeing the benefit of managing their carb intake then the evidence simply mounts against the dietary advice advocated by the NHS and DUK.
Dr Katharine Morrison (who’s presentation was cited earler) is a member of the same forum and her advice is for T1s also to manage their carb intake more carefully. Indeed, I find that eating less carbs = less insulin intake = better control. My Hba1c has been under 5.7 for the past 5.5 years which is pretty darn good for a T1!
I think it’s time some properly administered trials took place on 1. lower carbing and 2. efficacy of testing!
September 15, 2008 @ 10:23 pm
[...] is one of its roles, after all – and Dr John Briffa gives their dietary advice very short shrift here. And points out that the charity receives plenty of funding from the pharmaceutical sector. (The [...]
October 9, 2008 @ 2:41 pm
I’ve just been diagnosed with Type 2 Diabetes and had a long discussion with the Dietician this week. I too was advised to eat carbohydrates in each meal, as well as protein and low fat. It’s very confusing to know what is the best thing to do!
November 28, 2008 @ 6:12 pm
I would be wary of advice from any organisation working hand in glove with Big Pharma, and I see this on Diabetes UK’s website:
Corporate acknowledgments
Diabetes UK works with companies from a range of commercial sectors:
Alliance Pharmacy
Cambridge Health & Weight Plan
Canderel
Co-operative Group Pharmacy
DietFreedom
Eli Lilly
Everyclick
Exhibition Services
FEXCO MT representing Western Union
GSK
Heath Lambert
HBOS
Jelly Belly
Kellogg
February 24, 2009 @ 8:56 pm
And this is the page from which I got the Diabetes UK list of corporate acknowledgements http://www.diabetes.org.uk/Get_involved/Corporate/Acknowledgements/
February 25, 2009 @ 7:48 pm
[...] what happened here as a response to a perfectly understandable criticism of DUK’s woeful and dangerous dietary [...]
August 5, 2009 @ 9:19 pm
Diagnosed Type II in 2007, I’ve been asking HCPs to explain the reasoning behind the eat starchy carbs mantra without success.
I’ve been doing some research online and found a paper presented by Joan Walker of Leicester Royal Infirmary, at The Nutrition Society’s symposium in 1964 on Carbohydrate consumption in Diabetes.
She said that in 1955 when oral meds were first used, people with diabetes were told to restrict carbs to 110g – 150g , that during the first ten years of insulin it was 100g or 120g and that during WW2, UCH Diabetic Clinic published ‘Diabetes and Food Rationing’ recommending 100-185g, in 1941.
So I am wondering when it was decided that people with diabetes should high carb ?
At the same symposium, John Yudkin of the Nutrition dept of Queen Elizabeth College, UoL, presented a paper etitled Patterns and trends in carbohydrate and their relation to disease. He said that sugar not fat was the culprit giving people diabetes and heart disease.
Since WW2, the consumption of carbohydrates has increased hugely.
December 26, 2009 @ 10:25 pm