[ShottleBop]

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.

That would not be in accord with the experience of many low-carbers. As always, YMMV, but I have been eating to keep my blood glucose under control--not to lose weight.

[bunbury]

My personal experience was that I spent 6 months following my doctor's advice (low-fat, low-glycemic etc) and lost 7lbs from a weight of about 200lbs. My BG went up, my lipids went up, neuropthy worsened and I felt awful

I switched to low-carb and my BG and lipids improved a lot and quickly before the weight loss kicked in. The weight loss then followed and both lipids and BG continued to get better. Another 6 months on, I now feel great - and have shed another 28lbs.

Not scientific, I agree. But it works for me.

[ErikaA]

Originally Posted by bunbury

I switched to low-carb and my BG and lipids improved a lot and quickly before the weight loss kicked in. The weight loss then followed and both lipids and BG continued to get better. Another 6 months on, I now feel great - and have shed another 28lbs.

Not scientific, I agree. But it works for me.

Actually personal experience has perfectly valid contribution to science. But sometimes personal observation doesn't give enough data to help us understand why/how it is working. And unless someone is actually measuring exactly what you eat and drink and the effects, it is all slightly skewed by your own biases.

In my experience, I cannot eat as low carb as Frank does. My body starts cannibalising itself. Which is my own fault, but I really struggle to eat that much fat and protein. I can do it for a day and then I start skipping meals cos I just can't face it. So I can stick to low carb, but I just don't eat enough food.

But I definitely can't eat as much carb as is recommended by most dietitians and I only eat about half as much as my own dietitian recommends.

I am also not a snacker. The dietitian wants me to eat up to three snacks a day as well as meals. If I graze (ie eating all the time) I don't want to eat at all because I never get hungry. So my total food intake gets smaller everyday and I start losing weight again.

So I applaud successes based on finding what works for you. I'd just starve if I didn't work my diet around what works. I really like carb counting. Gives me a happy little feeling of control (sad I know ).

But I am very conscious of the fact that with such vast changes in diet and body (some of you are talking about losing half or more of your body weight), at some point your biochemistry alters to adjust and you may find that what works now is not going to be a life long thing. And it may be improving the markers that as diabetics you associate with health, but is it possible you are ignoring other markers of your own health in the pursuit of being the 'perfect diabetic'.

Not arguing against low carb because it really is the best way to eat for your diabetes. And quite effective in weight loss for whatever reason. But what is best for your diabetes and weight loss may not be perfect for your overall health in the long run.
I'd really like to know what possible health complications come of it. There are issues with most diets on offer, it's worth it to know what the bad side is of your diet so that you can do something about it (supplements or adjustments).

ie I'm lactose intolerant so I don't eat any dairy. And even if I do I can't digest it. So it is in the interests of my health that I avoid dairy. But my calcium intake has gotta be suffering from it.

Are there health issues from extreme low carbing that you are possibly ignoring or missing because currently the benefits are so huge?
Like the issue of kidney problems. Diabetes is a burden on your kidneys. High protein diets are a burden on your kidneys. I've read some posts suggesting that this is not a problem if your kidneys are fine. But will they continue to be fine if you burden them? And how will you know if it's not an issue until it's too late? And if it's a possibility what can you do within your diet parameters to avoid this issue?

[fgummett]

Erika, hopefully others will chime in, but for me the obvious dangers of staying obese with Type 2 far outweigh (hah!) anything that I may have overlooked in terms of other hidden long-term risks. I was already taking multivitamin supplements before the low-carb and surgery so that hasn't changed. I see my Doctors, and have blood and urine tests every 3 months. While there are many unknowns in my future, I am open minded and adaptable. I believe in arming myself with knowledge and making my own health decisions.

[fgummett]

Originally Posted by ErikaA

Diabetes is a burden on your kidneys. High protein diets are a burden on your kidneys.

You know... we all hear statements like this so often that we take them as truth but are they really?

I agree that poorly controlled Diabetes (Type 1 or 2) may cause kidney problems but what about well-controlled D..? My last A1C was 5.0%

The study I posted before (here...) was not even definitive that high-protein is a risk when the kidneys are already damaged, let alone that there is any concern with healthy kidneys.

Hey... maybe I am wrong and another study will prove different but in the meantime I prefer to have a healthy scepticism of unproven facts no matter how often they are repeated. But as above, I am hedging my bets and having my kidney function tested on a regular basis.

[ErikaA]

Originally Posted by fgummett

But as above, I am hedging my bets and having my kidney function tested on a regular basis.

I like hedging bets.

I work in biology at a cellular level. Never see anything outside of a petri dish. But in cancer research, an outstanding feature of most pathways is that over or under cranking things is often equally bad. Biological systems like equilibrium.

So I'm a fan of being cautious of any extremes. You will one day be a slim and slinky man and suddenly weight will no longer be the deciding factor in your health. So it's nice to think you are keeping doors open. And maybe the ketogenic diet will still prove perfect for you.

[Subby]

Originally Posted by EdnBama

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

That's an irrelevant statement. You still have no data pertaining to certain groups inside the "sample group".

[Subby]

As for your reply Redlan, well, as I stated I'm not a low carber wasn't interested in one camp or the other - and the reason for my post was not to argue one way or the other but to give some teeth back to your original heavy handed post in the hope less sophistry (in my mind) might be employed. The aim of that is not personal attack, but just to ward off potential BS, I hope you appreciate that. I'm not sure about where that stands. You continue to sound as if you are busy constructing points against low carb, many assumptions and basing points on data you claim is flawed - yet you take and run with in order to "score" points. At times you verge on saying low-carb versus other are virtually equalised. Then there is a general tenor of "win or defeat" for a diet, that I do not understand, and which seems very premature given the variable indications present about these dietary options. I don't get where you are coming from, myself.

[fgummett]

Originally Posted by ErikaA

:You will one day be a slim and slinky man and suddenly weight will no longer be the deciding factor in your health. So it's nice to think you are keeping doors open. And maybe the ketogenic diet will still prove perfect for you.

Thanks for that Erica. Yes I finally have something to look forward to after many years of struggling

[Lloyd]

Originally Posted by fgummett

I agree that poorly controlled Diabetes (Type 1 or 2) may cause kidney problems but what about well-controlled D..?

"Well controlled diabetes is the leading cause of nothing".

A quote from a famous endo.

-Lloyd

[PERKDOUG]

I have been on and supervised others on the low carb and ketogenic diets. Only fanatics like me can endure the ketogenic diet for more than a 2 to 4 weeks without sneaking a few carbs. Reading anything into these diet trials after more that a few weeks into the trials is a waste of time. Most if not all the test subjects cheat. The cheating progresses with time and the blood test markers (B.S. A1c ect.) converge as I would expect.

But don't give up!

We have our own low carb trials going on here as we blog.

Take for example Lloyd. Look at his numbers in his profile above this post. I believe he follows the low carb (~50g/day)but not the Ketogenic diet. Now correct me if I am wrong, it appears his numbers are not converging to what they were before the diet was undertaken. How can this be if the studies cited in this thread predict he will revert to his old numbers? The answer is simple, he can stay on the D*** diet. His case is not the exception, its the rule on DF. Now take many of the posts from Newbe's to the DF. Many show results of following the ADA high carb diet. What is their results in most cases? The septic tank of rising B.S., A1c's and triglycerides.
But I will go with Redlan on a very important point. These L C diets are not easy to stay on for long periods of time. But, at 50g/day of carbs, many of us can be successful!

These type threads are so much fun. Keep up the good work!

[Lloyd]

Originally Posted by PERKDOUG

But don't give up!

We have our own low carb trials going on here as we blog.

Take for example Lloyd. Look at his numbers in his profile above this post. I believe he follows the low carb (~50g/day)but not the Ketogenic diet. Now correct me if I am wrong, it appears his numbers are not converging to what they were before the diet was undertaken. How can this be if the studies cited in this thread predict he will revert to his old numbers? The answer is simple, he can stay on the D*** diet.

80 carbs a day.

I lost 35 lbs over an 8 month period, and have gained 1 pound back over the year following that

I consider it a "carbohydrate budget" rather than a diet.

The thing is, even if you don't lose weight, or much weight, it is going to help with glucose control.

-Lloyd

[REDLAN]

Originally Posted by Subby

You continue to sound as if you are busy constructing points against low carb, many assumptions and basing points on data you claim is flawed - yet you take and run with in order to "score" points. At times you verge on saying low-carb versus other are virtually equalised. Then there is a general tenor of "win or defeat" for a diet, that I do not understand, and which seems very premature given the variable indications present about these dietary options. I don't get where you are coming from, myself.

What I'm busy doing is critiquing the study, not low carb diets in particular. Being less sophisticated, this study is a flash bang wallop get a quick showey result, and then launch a press release hailing low carb diets as the answer to diabetes. Were the authors aware of the effect of weight loss on Hba1c? Were they aware that weights would tend to equalise at around the 12 month mark? Did they follow up and quantify dropouts?

The study conclusion would be better phrased as - 6 months in those able to stay on a ketogenic diet experience greater weight loss and better glucose control than those on a low GI low calorie diet.

Yes the 5 out of 6 studies in the Cochrane looking at low-carb versus low fat diets were at high risk of bias and yes the Cochrane report could not draw a reliable conclusion. However these studies were judged to be the best available, and they showed no/little difference - I did point out that the results were unreliable. I notice that other posters were happy to accept the results of the Westman study uncritically.

When researchers publish articles which are intended for general consumption, I expect the researchers to honestly appraise and discuss the results of their study. Not only interpreting the results, but also pointing out the limitations of the study. What I don't like to see is a press release which is thinly disguised marketing, which is what this press release mostly is - as a side issue did anyone notice who the sponsors for the study were?

My personal view on low carb versus low fat diets is that theoretically there should be an advantage for a low carb approach in improving symptoms for type 2. However I am aware through reading that this may not be so. That the effect of diet may mostly be through weight loss. If this is so then clearly the best diet is the one that produces the best long term weight loss, and is the easiest to stick to. Clearly within this there is a high degree of individual variation as evidenced by the responses. The Cochrane report does list what kind of study that is needed to answer this question, and until some better evidence comes along, or someone comes up with a better interpretation of the available evidence then I don't believe I am going to change my position.

[fgummett]

You make valid points as ever REDLAN. I guess it is easy to misinterpret any critique as being negative, when you do in fact seem to be just casting an unbiased eye over the article. As we have discussed before, the research is sadly lacking in definitive diet studies.

Couple of counter-points... Westman does clearly state

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

...which I read as contrary to the idea that he it is overplaying the result.

And while you are of course correct that, "the best diet is the one that produces the best long term weight loss, and is the easiest to stick to" -- all other measures of success being equal -- the Cochrane Collaboration review did find a significant improvement for Lipids (at least HDL and Trigs) in the low-carb trials. Surely that alone puts it at an advantage over low-fat?

---

It does seem that weight of "evidence" in the media and health establishment etc... is heavily stacked against low-carb eating. Perhaps this is why we jump on articles such as this; as proof of what many of us have already found to work for us.

[Lloyd]

Originally Posted by REDLAN

My personal view on low carb versus low fat diets is that theoretically there should be an advantage for a low carb approach in improving symptoms for type 2. However I am aware through reading that this may not be so. That the effect of diet may mostly be through weight loss.

Look at my A1c's for the past year, when I was no longer losing weight. Also, my Standard Deviation is 14.
I need to lose another 30 lbs yet.
-Lloyd