[Lloyd]

It is 20 months for me on moderately low carb. I expect to stay on it for the rest of my (hopefully long) life, even if there is a cure for T2. It controls my weight.

-Lloyd

[RedRD]

Originally Posted by Lloyd

It is 20 months for me on moderately low carb. I expect to stay on it for the rest of my (hopefully long) life, even if there is a cure for T2. It controls my weight.

-Lloyd

Good for you, Lloyd. If it is working for you, then have at it!!! It does not work for all, and some of us trust having variety in our diet. Again, you do what works for you -

[yannah]

after a month very low carb, my dieting issues were cured. I lost my need to eat. I will have no trouble keeping this up the rest of my life. I just have to make sure I eat enough. It was a very wierd thing, when i went low carb, at first it was so hard, then a couple weeks later, it was easy. unlike any diet I have ever tried.

[BlueSky]

Originally Posted by yannah

.... when i went low carb, at first it was so hard, then a couple weeks later, it was easy. .....

I think the problem with a lot of the naysayers is that they didn't persist with low-carbing for long enough. Until that adjustment has been worked through, yes, reducing carbs is difficult. Weight was never an issue for me (aren't I lucky ) and I reduced carbs purely for better glycemic control. It has worked very well. And while I cheat a lot, I would never go back to eating cereals, bread and potatoes.

[bunbury]

Hi, I've been lurking for a while and this is my 1st post to this excellent forum. I was DX'd T2 in mid-2006 but didn't take it seriously until early 2007. I then switched to my doctor's recommended diet (low-glycemic, low-fat brown pasta/rice etc) and saw my numbers rise. In June 2007 I switched to low carbs (maybe 40 grams a day) and am still fine tuning it - and my A1C fell from 7.6 to 5.5% in 3 months. It took me about a month to get used to life on low-carb. Best of all, most of the neuropathy I was experiencing has either gone or is greatly reduced. My Blood Pressure has gone from high to normal and my lipid profile as gone from high to very good (OK, it could get better).

Next A1C is tomorrow - it may show a slight rise because I get spikes in response to hard exercise and travel (and there's been a lot of both in the last 4 weeks). Fingers crossed.

Bunbury

[fgummett]

Originally Posted by ErikaA

...it strikes me that your diet is primarily successful because you have found it easier to comply. So I'm thinking that the best diet in the case of successful weight loss (which I'd think is imperative for type 2 diabetics with high IR), is simply the diet that they can stick to (as long as you aren't sky high with carb abuse).

But I'm curious as to the prolonged effects. When you achieve healthy weight range, will you continue to eat that low carb?
Your breakfast is higher in calories than I eat in an entire day and I'm a very active person. Will you at some point be forced to reduce how much you eat in order to achieve further weight loss?
What about the concerns of bowel cancer and IBS and various other diseases? Will a lack of grains in your diet prove detrimental in some way that you are not currently monitoring?

You are correct Erika I plan to stick with what works for me... the fact that I am finding it easy and even pleasurable to eat this way is a big bonus but far from my main motivation. I feel in control of my own body after 25 years of struggle with my weight. I am no longer hungry all the time (and it was ALL the time)... I don't ever want to lose that feeling. You know that smile that creeps over your face when you wake up to a perfectly normal BG reading... I get the same each day when I test my urine and see ketones

I believe that - for me at least - it is easier to eat very low carb than say allowing myself 100g CHO / day. Apart from anything else it sure makes shopping and cooking a breeze.

My son is nearly 18 and I don't force him to eat any specific way although I do talk to him about what I read and experience - after all he shares my genes. He likes pasta, so last night for supper I cooked up cubed chicken breast and steak in some bacon fat, added some seasonings and spices (salt, pepper, curry powder, chilli powder), a splash of red-wine and some full-fat cream made a very rich sauce with the natural juices. He had his on a moderate amount of green spaghetti, me with just some plain Romaine leaves, some grated Parmesan cheese over the top, and a glass of dry red wine to wash it down. Maybe a couple of pieces of dark-chocolate or mature cheddar afterward. Anyone think I am depriving myself yet?

For me it is a very weird feeling but I also now have to discipline myself to eat meals... I make a point of a good breakfast and supper but sometimes forget lunch altogether.

In the long-term I really don't know yet. I can't see me ever going back to eating many carbs... I'll probably increase my intake of green leafy veg - so far I mostly just eat plain Romaine lettuce. I expect that as my weight continues to drop so will the IR and my need for exogenous insulin, although I can't say yet if I will ever be off it altogether.

As for long-term health concerns about eating a higher proportion of fat and protein... all I can say is that the media, food industry and even many of our health-care providers have really done a number on us with unfounded paranoia about this type of food. From my reading I strongly suspect that the current low-fat diet paradigm may be far from harmless or even blameless in the current obesity and diabetes epidemic.

[fgummett]

Welcome to DF bunbury! Yet another low-carb success story... we seem to have quite a few around here, even just in this thread... pretty soon the health-establishment won't be able to ignore it anymore

---

Originally Posted by RedRD

...what surgery did you opt for?

I had a Vertical Sleeve Gastrectomy.

Originally Posted by RedRD

And your diet works for you, but would not for many people (for many different reasons). I know that my diet also would not work for many people, again for many different reasons. Which is why I am not forcing it on anybody, or being so ridiculous to suggest that it would work for everybody and is the only way to eat.

I would rather say that my diet may not work for everybody rather than "not for many people"... just look around here on DF.

Do you see anyone here "forcing it on anybody, or being so ridiculous to suggest that it would work for everybody"..? For myself I repeatedly say such things as

Originally Posted by fgummett

Yes I freely accept that it may not be the best way for everyone...

[Lloyd]

Originally Posted by RedRD

Good for you, Lloyd. If it is working for you, then have at it!!! It does not work for all, and some of us trust having variety in our diet. Again, you do what works for you -

I don't know where you got the idea there was no variety in eating moderately low carbohydrate. You are mistaken.

I simply avoid about 10% of the foods I used to eat, and weigh everything.

-Lloyd

[Subby]

Originally Posted by REDLAN

perhaps before people start getting tooo excited and hailing this as the definitive proof that low carb diets are the answer to diabetes, maybe they ought to check out the abstract on Pubmed first...

-snip-

Only 58% of the study group made it to the end of the study. Bearing in mind this study only ran for 24 weeks, this does not bode well. High dropout rates do characterise ketogenic diets - they aren't tolerated particularly well. High dropout rates matter because they can bias the study's findings. What matters is why they drop out - it could be because they couldn't tolerate the diet, it could be because the diet didn't improve or maybe even worsened their control, it could be because they experienced significant weight regain. The point is that very often people drop out because the treatment does not work/makes things worse/or has unpleasant side effects. This effect can bias the results by making the treatment appear more effective because you are only measuring the people for whom the treatment work i.e. those who stay in.

This is a disingenuous line of argument. The dropout rate was for the ENTIRE study group, no differentiation between the ketogenic or the low calorie group. For all you know all the dropouts were in the low calorie group. Your implicit focus on ketogenic diets as singularly problematic is not founded on information here. It's speculation.

Regardless of which, you'd need to contextualise your argument in term of typical drop out rates in order to make any meaningful point here. For all we know, it's a typical drop out rate for any dietary test.

The second bit concerns the weight loss - compare the 2. after 6 months the ketogenic diet group lost almost twice as much weight as the low GI group (11.1kg versus 6.9kg) There is nothing unusual in this result - low carb diets produce dramatic weight loss in the first 6 months, followed by more rapid weight regain. After 12 months however there is very little difference between a low carb diet and a standard low fat one.

The problem for the study in claiming that it is the ketogenic diet that causes the improvement in HBa1c is that weight loss is strongly correlated with improvement of symptoms for type 2. The differences in HbA1c reported by the study could be solely due to the differences in weight loss reported by the 2 groups.

Firstly, if the ketogenic diet caused improvement in A1c because it caused weight loss, then to all intents and purposes the ketogenic diet caused the improvement of A1c. Why is that invalidated by being a short chain of events?

Secondly, while a connection appears to be established between becoming less overweight and improving A1c, there is again, no foundation to the claim that it's the sole reason that the ketogenic diet is being effective. Again, this is just speculation on your behalf.

The sole point you present to negate all of these potential benefits is that there is "very little difference between" low/non low carb diets at the one year mark, a statement you don't source in the slightest (nor articulate to a meaningful degree). And lets take for a moment it's true, that the two diets end up with the same results for both weight and for all diabetic indicators at the 12 month mark. What about short term gains? In the event the ketogenic diet results in a much faster normalisation of A1c, why is that invalidated?

Actually, you do cite a source in a moment, lets talk about it there...

When it came to comparing low-fat versus low-carb diets, they concluded that 5 out of the six studies that were eligible for inclusion were at high risk of bias - i.e. poorly designed and implemented - and therefore no firm conclusions could be drawn. If however you take time to read the results section, you will discover that long term (12+ months) there was little difference between low-fat and low-carb for either weight loss, or blood glucose control.

The only salient part of the "results" section would be "(b) Studies that assessed low-fat diets versus moderate fat or low-carbohydrate diets", yes?

There is no such assertion about the 12+ month mark, here.

They did however discuss (briefly) the results achieved by Nielsen...

Actually you put in the link for the abstract there, I'd like to quote the only sentence pertaining to the Nielson trial:

Recently, some small-scale studies discussed the importance of dietary composition and low-carbohydrate diets in the management of type 2 diabetes mellitus (Boden 2005; Nielsen 2005). Low carbohydrate diets appeared to have a significant effect on decreasing HbA1c and weight reduction. However, more research is required on larger populations and with a strict control group.

Hardly an indictment. Rather a note of interest, I would say. The number of issues you take up with low carb diets is NOT born out by the Cochrane report. For them it's just not on the map yet to include, due to inadequate testing.

I'm not a low carber, by the way. I do have an interest in the subject and I do think your post seems rather... biased, and verging on dubious at points, which is ironic seeing that you keep referring to "unbiased" information to back you up!

[RedRD]

Originally Posted by fgummett

Welcome to DF bunbury! Yet another low-carb success story... we seem to have quite a few around here, even just in this thread... pretty soon the health-establishment won't be able to ignore it anymore

---

I had a Vertical Sleeve Gastrectomy.

I would rather say that my diet may not work for everybody rather than "not for many people"... just look around here on DF.


Do you see anyone here "forcing it on anybody, or being so ridiculous to suggest that it would work for everybody"..? For myself I repeatedly say such things as

Nitpicking about my wording, Frank. Not surprised that you would do that, though. At least in response to something w/which you don't agree.

And I'm just not referring to those of us on DF. We are not the only dabetics in the world. Or are we?

And if you repeatedly say that, why do you continue posts such as these?

[REDLAN]

Thanks some criticism

always useful helps to tease out the arguments

The dropout rate was for the ENTIRE study group, no differentiation between the ketogenic or the low calorie group.

Yes this is true they do quote the dropout rate for the entire group, which is not very helpful. And you are right I have made the assumption that it was mostly in the ketogenic diet group - The reason for this is that from reading past studies, dropout rates for low carb diets are typically higher than for low fat diets - the israeli study oft quoted displays this characteristic. From reading about ketogenic diets used in children to control epilepsy the authors comment about the high drop out rates. The authors of this study allude to the fact that the high drop out rates is mostly in the ketogenic group with

The diet is not easy for everybody. "This is a therapeutic diet for people who are sick," says Westman.

It is I believe a reasonable assumption - The problem for high drop out rates in a study is that it makes the study results much less reliable. When at the end of 6 months nearly half you cohort regardless of which arm has disappeared this is an issue. It is the highest dropout rate for a diet that I have seen.

Firstly, if the ketogenic diet caused improvement in A1c because it caused weight loss, then to all intents and purposes the ketogenic diet caused the improvement of A1c. Why is that invalidated by being a short chain of events?

because at the 12 month mark weights between the 2 tend to equalise, and so do HBa1C values. The advantage for the ketogenic diet is lost. This is borne out by the studies cited by the Cochrane report as being the best available.

Westman claims...

"Low glycemic diets are good, but our work shows a no-glycemic diet is even better at improving blood sugar control,"

Really???

would the ketogenic diet produce better blood sugar control if there was no weight loss? This study can not answer this crucial question. The reason it matters is because a) ketogenic diets are hard to stick to, and b) they tend to produce the same weight loss at the 12 month mark as a low fat diet (which is easier to follow).

if the improvement is driven by weight loss alone, then you would be better sticking to a diet that is easier to follow, and produces similar results.

Improvement of Hba1c with weight loss in type 2 is not a speculation it is well known that weight reduction causes an improvement in blood glucose control. And it correlates extremely well - greater weight loss correlates with better glucose control.

The only salient part of the "results" section would be "(b) Studies that assessed low-fat diets versus moderate fat or low-carbohydrate diets", yes?

There is no such assertion about the 12+ month mark, here.

from the cochrane report, and the section that looked at dietary advice that did not differ in intent to lose weight.

Hockaday 12 months mean changes in Hba1c were not significant.

Milne at 18 months the difference in HBa1c between the 2 was 0.1% in favour of the low carb group.

Like I said these results unreliable as they are suggest that there is little difference between low carb or low fat. If you are able to draw a different conclusion then please feel free.

The point of quoting Nielsen is that this researcher has managed to run a cohort using a low carb intervention which has shown sustained weight loss, and sustained and significant improvement in Hba1c. He/she doesn't have a proper control group, which is a shame,as it could be very good evidence in favour of a low carb diet. The 44 month length is significant too.

What about short term gains?

The problem I have with this study is that it is all about short term gains. However people do not have diabetes for just 6 months.

In the event the ketogenic diet results in a much faster normalisation of A1c, why is that invalidated?

the dropout rate is the issue. If it is no better than a low fat diet at 12 months, which is easier to follow, why would you want to start your patients on a ketogenic diet when half would dropout before 6 months, and you'd have to start again with some other intervention? Wouldn't it be better to start everyone on the low fat diet to start with? Unless that is you can show that lowering the amount of carb really does improve glucose control all on it's own, which this study doesn't do and nor do the cochrane ones either.

This is what the cochrane report calls for - it's very disappointing, and I think somewhat scandalous that there isn't better research to answer such a basic question as to what kind of diet would be best to treat type 2 diabetes.

[RedRD]

Good stuff, RedLan.

[EdnBama]

Originally Posted by fgummett

Basically when I listened to the advice of the "experts" I not only failed to lose weight, but I actually gained more.

I'm still unclear on your point here. Are you saying that you complied with the diet and yet still gained weight?

[EdnBama]

Originally Posted by Subby

This is a disingenuous line of argument. The dropout rate was for the ENTIRE study group, no differentiation between the ketogenic or the low calorie group. For all you know all the dropouts were in the low calorie group. Your implicit focus on ketogenic diets as singularly problematic is not founded on information here. It's speculation.

Regardless of which, you'd need to contextualise your argument in term of typical drop out rates in order to make any meaningful point here. For all we know, it's a typical drop out rate for any dietary test.

Not really disingenuous. Whereas patients are assigned randomly to test groups, drop outs are self-selected, which affects the representativeness of the sample group.

[fgummett]

Originally Posted by EdnBama

I'm still unclear on your point here. Are you saying that you complied with the diet and yet still gained weight?

Yes I am saying exactly that... also my BG control was not as good nor my lipids.