[fgummett]

Wow Erika, seems like you and I have very different issues to try and manage.
As above, I'm hoping that HelenM may have some suggestions for you. I understand she also trains hard and eats high-carb.
So it seems that you need carbs but they drive your BS up. I'm thinking that low-GI/complex/unrefined carbs should be more manageable - avoiding the refined sugars especially HFCS and starchy food - when eaten along with fat and protein to slow their digestion and BS spike. As you say... spacing the carbs out through the day should also help to manage the BS spikes.
To be frank (hah!) I really don't know, but I wish you well and please keep us updated as you figure out what works best for you
I'm sure this has been asked but are you sure it is Type 2 and even if it is I really don't think that the standard response of low-fat diet and Metformin applies in your case. Have you considered insulin; which could give you much more flexibility with your training regime than a pill.

[ErikaA]

Originally Posted by fgummett

I'm sure this has been asked but are you sure it is Type 2 and even if it is I really don't think that the standard response of low-fat diet and Metformin applies in your case. Have you considered insulin; which could give you much more flexibility with your training regime than a pill.

Well I really don't think it's type 2 since I am not insulin resistant... but I don't have antibodies for type 1 either. So my med file says type 2. And well we don't get to choose our meds... i just take what the doc prescribes. I am not in a high risk category as yet... we only caught the diabetes by coincidence in a general health screen.

But I'm more than happy to share how I manage as an athlete. And what my diet was and is. I don't know that I have much to offer to those that need weight loss tips except that I exercise heaps and don't eat too much... and low carb can help weight loss.

[PERKDOUG]

Originally Posted by ErikaA

But I'm more interested in the idea of how people do on low carb if they are trying to maintain weight and are extremely active.

I can think of 2 simple options:

1. Go Eskimo and simply eat more fat to give you the calories you need. On another web site there is a guy named "Charles the meat eater", he eats fatty meats only, (really hard core LC) and does marathons as I recall. Many people going "low carb" just can't overcome the mainstream brainwash that a lot of fat will kill you. They end up over eating low fat proteins and shorting themselves on fat calories. I see this often on the Forums here. The excess protein is converted to glucose and plays havoc with your BS giving LC a bad rap. Proper low carb in my opinion is simply kicking out most of the carbs and replacing them with fats, protein need not change.

2. Graze small portions of carbs throughout the day using your meter and trial and error to determine a protocal that does not overly elevate your blood sugar. This works for some people. This might involve a nibble of something every 10 to 20 minutes. It is a lot of trouble snacking all day though. But it is an idea for you.
Others may have better ideas.

Good luck!

[PERKDOUG]

Originally Posted by REDLAN

The problem really though for the low-carb supporters is the lack of evidence

Redlan, regarding weight loss I can point you to more rubust evidence, at least in my opinion, that LC beats Low fat by a mile. The evidence comes from weight loss clinics that actually take in obese patients to induce weight loss. The clinics are described in Taubs "Good Calories Bad Calories" in greater detail than this post can allow. To be brief, these clinics after utter failure using starvation and low fat diets started the low carb approach with great success. The stratagies varied from hard core 800 cal/day to over 2000 cal/day with 20 g/day to 50 g/day carbs. The success of these clinics has escaped the press and most academic journals. One has to wonder why some of these researchers you point to have not analyzed the records of these clinics. This data involves thousands of patients over many years. The trials you cite usually (not always) involve a hand full of test subjects overseen by a biased researcher for a few weeks.

Here I must bring in a little Texas/Researcher humor.
In Texas during the "Oil Boom" of the 80's there appeared in Texas bumper stickers saying "If you ain't oil, You ain't S***"

For weight & type 2 reseachers the bumper sticker reads
"If you ain't Low Fat you ain't S***" which of course means you don't get anymore money for research if you ain't Low Fat.

I hope my kook humor does not offend. The Forum should lighten up. This is not a war. It is at most, an educational debate.

[Harold]

Originally Posted by fgummett

A few selected quotes from my posts in this thread... I'll let you judge for yourselves how extreme my position is:

Those sound like disclaimers. However my remark was not directed for you only or all low carbers, just the fanatical ones.

[REDLAN]

Redlan, regarding weight loss I can point you to more rubust evidence, at least in my opinion, that LC beats Low fat by a mile.

Yes please

I've not read Taubes (and have no intention of buying his books) - however I understand that he first off challenges the diet-heart hypothesis, which is rather easy to do, as the evidence to support the notion that saturated fat intake causes heart disease is non-existent. He then goes on to hypothesis that carbohydrate is the cause of the current obesity/health crisis, which is where myself and Taubes stop agreeing with each other.

now onto to this "robust" evidence and why it isn't very robust at all, and why it does not get included in the kind of reviews that I cite.

The problem with the Cochrane report that I cited and the reason that only a few test papers with a handful of papers were included were because the studies were of too poor quality to be included.

In the original 2004 paper only 36 papers out of a total 287 papers were considered to be of high enough quality to be considered. These 36 papers covered only 18 studies. In the 2007 update an additional 68 papers were reviewed and NONE of them were considered to be of high enough quality to be included.

Why wouldn't a chart study (i.e. analysis of treatment by a clinic) be considered to be high enough quality to be included? The reason is simple - clinic studies automatically suffer from selection bias. There is selection bias in the people that present at the clinic, and there is selection bias in the treatment that the clinician decides to give that patient. Secondly there are no controls - there is nothing to measure the treatment you are offering, and this is perhaps the most important reason why clinic studies are considered to be too biased to be used.

Analogy....

There have in the past been many treatments suggested for the common cold, such as taking vitamin C. Once symptoms develop, a cold typically clears up in around 3 days. The average person normally seeks treatment when the symptoms are the worst, and buys flu magic powder no 9 (or whatever the latest remedy is called), and low and behold they get better in around 3 days. How they discovered that colds typically take around 3 days to clear up was by running studies in which they gave one half magic flu powder no 9, and the other half a placebo, and lo and behold they found it made no difference. The notion that vitamin C improved recovery times was slain this way.

So here you are, you've been struggling with your weight, and diabetes, and so you get recommended to go to a clinic, who show outstanding results (selection bias), you go there and they recommend a low carb diet (another selection bias) - the clinic does not recommend any other kind of diet - and low and behold you start losing weight, and your diabetes improves. You are hailed as a success by the clinic, and your results get published as clinic study, and the low-carb diet is hailed as the cause.

But was it the low-carb diet?

It could be something very much akin to the placebo effect. On your own, without the support of the clinic, you struggled. Maybe your calorie counting was off, maybe you had days when you slipped. You go to the clinic, you have faith in the doctors and specialists, your really believe the treatment will work. You don't want to let down your doctor, you're also aware of the financial investment in you going, so you try really hard, you stick to the diet, and don't deviate - you lose weight.

now what if the clinic you went to specialised in a low-fat diet instead?

The only way to be sure it wasn't some psychological effect from the doctor-patient relationship, is to run a control - one half (randomly assigned) gets the low-carb diet, the other half get the low-fat diet. If they turn out the same, then...

Clinic studies never have a control, and so will never meet the criteria for studies such as the cochrane review. They are simply too open to bias to give a reliable answer.

and finally...

The trials you cite usually (not always) involve a hand full of test subjects overseen by a biased researcher for a few weeks.

I think that's rather inflammatory, and without justification. The Cochrane Collaboration have a good international reputation for providing systematic reviews of randomized controlled trials.

[fgummett]

I agree with you REDLAN that the Cochrane Collaboration review process is thorough and effective at weeding out "poor science". I also made some comments in an earlier post about why, just about, any diet trial is likely to be flawed. For me that leaves my own experience; with many years of failure on the low-fat or calorie restricted type diets, against instant success without hunger cravings within hours of reducing carbs to almost nil. Clearly what works for me is hardly a scientific study and may not apply to everyone.

What limited evidence there is however, seems to show that low-carb is at least as effective as low-fat in weight loss, and may even come out ahead in other health markers such as lipids.

You echo a vital point that Gary Taubes makes, "the evidence to support the notion that saturated fat intake causes heart disease is non-existent." I agree with this statement, and surely you agree on just how much of the establishment "science" is predicated on the opposite view - heck we hear it from every newbie here on DF. This cannot be stated enough, in my opinion.

I have this impression that you are not swayed by hyperbole and conjecture - rather having the plain facts to speak for themselves - not accepting assumptions at face value. So I wish I could persuade you to read the Taubes book or at least any of his writing or video-presentation available on-line... I'm sure you can find them but if not I'll gladly provide links. I would really value your insight into any errors of logic that he makes, because I find it quite compelling and well-reasoned. The book itself is a hard slog (for me at least) as it has so many facts and quotes - the last hundred pages or so are an extensive set of page notes and bibliography. It is not a "diet" book, and he makes a conscious effort to present the data in an objective way... although clearly he also feels the need (as I do) to redress the balance against the weight of the establishment.

[fgummett]

Originally Posted by Harold

Those sound like disclaimers. However my remark was not directed for you only or all low carbers, just the fanatical ones.

Perhaps, but I don't see that as a bad thing AND I am genuinely interested in the differences between women and men - most of the research around heart diseases, obesity etc.. is based on trials using men only, and there do seem to be important differences in such things as lipid levels as markers of CVD.
I also freely admit that what is working so well for me may not apply equally to everybody here.

I thought I was one of the fanatical ones

[REDLAN]

Hi Frank, if you have some links from Gary Taubes then I would like to see them. Make interesting reading/viewing at the very least.

I have this impression that you are not swayed by hyperbole and conjecture - rather having the plain facts to speak for themselves - not accepting assumptions at face value.

I'm very suspicious of hyperbole - I've found that those that have the need to shout the loudest, are usually the most wrong.

I'm not so sure though about being able to point out where his logic is wrong. However, book writers trying to gather evidence to prove a point, have a habit of falling victim to something known as confirmation bias.

Everybody suffers from confirmation bias - bought a new car recently? Are you aware that owners of new cars spend more time reading articles that describe their new purchase positively than they do the negative ones?

Those gathering evidence to support an argument, will often accept pieces of evidence that support their theory while rejecting those that don't. They tend to be more critical of evidence that challenges their theory, while often accepting lower standards for evidence that supports it. At the end of their search they end up with what appears in their eyes at least to be ironclad evidence supporting their hypothesis.

This is why medical research uses RCT's (randomised controlled trials). RCT's do 2 main things.

1) they attempt to eliminate or reduce bias. Double-blinding is a means by which researchers prevent pre-conceived ideas from clouding the measurement and collection of data.

2) The purpose of an RCT is not actually to prove the hypothesis. It is designed so that it can DISPROVE the hypothesis if the hypothesis is false. This is what significance testing is all about - and what is meant by testing the null hypothesis.

The scientific endeavour hinges upon the notion that no hypothesis can ever be proven to be correct, it can only be disproven. A hundred studies supporting a hypothesis are rendered obsolete by one well designed and executed study that disproves the hypothesis.

So when looking for evidence the best evidence is RCT's - although these can be biased if performed incorrectly. Generally the bigger and the longer the study runs for the better it is. Even stronger evidence can be obtained by organisations such as the cochrane collaboration reviewing a group of RCT's and producing a meta-analysis of the results.

[fgummett]

Sure REDLAN here you go:

This is an 2002 New York Times article : What if It's All Been a Big Fat Lie..?

A similar article, I believe published in Science, and either submitted for, or winning the 2001 Science in Society Journalism Awards... here reprinted at the National Association of Science Writers : The Soft Science of Dietary Fat...

And a video'd presentation : Big Fat Lies with Gary Taubes, 02/06/08 Stevens Institute of Technology...

You are of course right about "confirmation bias" - Taubes freely admits that the "carbohydrate hypothesis" is no more proven than the "fat hypothesis", and he makes a plea in the book for both of these to be rigorously tested and this debate settled.

Even if he is proven wrong, this experience has reinforced to me the lesson of; never taking at face-value any "facts" that I am told by "experts"... unless those facts can be backed up with true scientific method.

[REDLAN]

Hi Frank, I read the article - it's quite long and quite interesting.

Gary Taubes uses some interesting ideas. Most of his argument is quite reasonable and he is open about where there is a lack of evidence.

I for instance agree about the role of fat (or rather it's lack) in the causation of heart disease - best for me not to comment on this section, as I will be suffering from confirmation bias

Now onto some things that need critiquing, and perhaps give some insight into how some notions gain credence, when they shouldn't, and this one is a biggie...

In particular, that we are in the midst of an obesity epidemic that started around the early 1980's, and that this was coincident with the rise of the low-fat dogma.

This kind of evidence is used over and over again. It is extremely unreliable. The rise in obesity since the 1980's coincides with the recommendation of a low-fat diet. I wonder what else has risen since 1980?

home computers, the internet, car buying, home ownership, gym memberships, standard of living, health care, average lifespans, educational standards etc. etc.

The point is there are a million things that have also risen since the 1980's, and may correlate with the rise in obesity, but does this mean that any of them have caused it?

After this he then goes onto demolish the low-fat camp, and this piece of evidence is my favourite.

In the intervening years, the N.I.H. spent several hundred million dollars trying to demonstrate a connection between eating fat and getting heart disease and, despite what we might think, it failed. Five major studies revealed no such link.

There is no link between fat consumption and heart disease. These failure of these studies destroy the diet-heart hypothesis, but still the myth continues.

Mixed in with this there is a very lengthy discussion about the competing hypothesis which Taubes calls "endocrinology 101" Taubes admits that this discussion is actually only a hypothesis, and that there isn't any proof. There isn't any proof, because it hasn't as yet been tested properly.

These kind of discussions catch people out (confirmation bias again). When you read it, you go on to assume that the hypothesis (even though not confirmed) to be true and accept it as factual. This kind of thing happens very often when medical studies are published in the media. The press release often focuses on the hypothesising of the lead researcher rather than what the study actually showed (which is usually much less interesting).

On the last page Taubes goes on to discuss studies that have received funding to compare whether low-carb diets really do work and are better than equivalent low-fat ones.

I searched on Pubmed for the authors

I could not find Willett, Blackburn and Penelope Greene listed., but I did find a paper by Foster, Klein and Hill, and here it is...

A randomized trial of a low-carbohydrate diet for ...[N Engl J Med. 2003] - PubMed Result

This trial is clearly not the 5 year trial mentioned by Taubes in the article. A large 5 year RCT trial of a diet would be pretty definitive. The study is a small and short (1 year) study. It found...

The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year.

My understanding is that this result is pretty typical of studies that compare low-fat diets to low-carb diets. The low-carbers initially lose weight faster than the low-fat dieters, but they end up at more or less the same weights after 1 year (the reason is because of more rapid weight gain by the low carbers in the remaining 6 months).

With this kind of evidence if it is repeated by better quality studies would be a pretty big nail in the coffin of the "endocrinology 101" supporters - if high carb diets are obesogenic, then surely the last result you would expect is for a low-carb and a high carb diet to produce the same weight loss after 1 year. This is the null hypothesis in action. This is how RCT's are supposed to work. They are designed such that they will show a null result if the hypothesis is false.

[fgummett]

Thanks REDLAN... an objective review just as I expected

Taubes does say (in his book?), that with the additional time and research he has refined and even changed some of his earlier points as made in these articles.

I just looked at the trial you cited - I don't have access to the full text - and I must admit a suspicion about the researchers' impartiality...

CONCLUSIONS: The low-carbohydrate diet produced a greater weight loss (absolute difference, approximately 4 percent) than did the conventional diet for the first six months, but the differences were not significant at one year. The low-carbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease. Adherence was poor and attrition was high in both groups. Longer and larger studies are required to determine the long-term safety and efficacy of low-carbohydrate, high-protein, high-fat diets.

...once again we see, even with an on-par weight loss, that low-carb has "a greater improvement in some risk factors for coronary heart disease" - but does the final sentence (my italics) imply that the low-fat diet has already been proven to have "long-term efficacy and safety"..?

I wonder about the low-carb weight gain in the later 6 months of the trail - did they perhaps follow the Atkins regime of increasing carbs after the induction phase?

I would like nothing better than to see fully-funded long-term RCTs to decide this debate... but I suspect that there is more money being poured into drugs to combat "overeating behaviours" than these simple changes in diet.

[REDLAN]

I would like nothing better than to see fully-funded long-term RCTs to decide this debate...

second that one