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Good News for LCHF

11/1/2013

13 Comments

 
PictureSalmon in basil-cream


While most of my recent posts have focused on the problems with studies, recommendations, and guidelines, I'm happy to say that there has been some very good news on the low-carb front over the past few weeks.




The American Diabetes Association's  position paper on nutrition recommendations for people with diabetes
When I initially read this document, I was disappointed by the statement, “Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes. Therefore, collaborative goals should be developed with the individual with diabetes.”  It was hard to reconcile that first sentence with my knowledge of carb restriction's dramatic effect on blood glucose response. However, upon further reflection, I now view the statements made in this paper as being far more permissive of low carb than in the past. The ADA no longer says that a minimum of 130 grams of carbohydrate daily are required to meet the brain’s energy demands; in fact, they seem to accept the possibility of even very-low-carbohydrate intake, as evidenced by the sentence, “Some published studies comparing lower levels of carbohydrate intake (ranging from 21 grams daily up to 40% of daily energy intake) to higher carbohydrate intake levels indicated improved markers of glycemic control and insulin sensitivity with lower carbohydrate intakes.” So while the ADA also approves vegan, Mediterranean, and low-fat diets for diabetes management, carbohydrate restriction is now considered just as valid an option, which is very encouraging for the doctors, dietitians, and other healthcare providers who take this approach.

Positive portrayal of saturated fat  in the British Medical Journal
Although not about carb restriction per se, in this article Dr. Asseem Malhotra explains that the blame for obesity, heart disease, and other health problems has been unfairly placed on saturated fat rather than excessive carbohydrate -- particularly sugar -- intake. Unfortunately, it looks like the full text is no longer available free of charge, so I hope you were able to read it in its entirety last week. It may be available again at some point. If anyone has a link to the full text elsewhere, feel free to leave it in the Comments section.

Diet article in The Consultant
A recent article by John Whyte, MD, in The Consultant comparing various diets  is encouraging on several fronts. First, the author correctly describes the Atkins diet as low in carbohydrates and high in fat rather than high in protein. The many benefits of low-carbohydrate diets are discussed, including dramatic weight loss, particularly in the initial phases, improvements in lipid profiles and blood glucose levels, and lower blood pressure. On the downside, low-carb diets are characterized as “fad diets,” and a study linking lower carbohydrate intake to greater all-cause mortality is cited (Of course, that study was observational, the reported carbohydrate intake was fairly high at more than 30% of calories, and  there were several limitations of the study, including the use of food frequency questionnaires to assess intake and misinterpretation of data regarding fat intake from animal vs. plant sources). However, the last sentence of the low-carb section sums up Dr. Whyte's overall feelings nicely:
“With these findings, in addition to the benefits of low-carbohydrate diets (not high protein, high fat content) on markers of cardiovascular risk, it is evident that low-carbohydrate diets could be considered in the lifestyle modifications of patients with diabetes.”

SUCCEED study comparing VLCKD vs. low fat diet in people with Type 2 diabetes 
 Researchers at the Osher Center for Integrative Medicine at the University of California San Francisco are recruiting people across the nation for the SUCCEED study, which will examine the effects of a very-low-carbohydrate ketogenic diet vs. a low-fat, conventional ADA diet on overweight people with Type 2 diabetes. Participants will take classes, have blood pressure checked and labs drawn to measure changes in biomarkers, and receive ongoing support and compensation over an eight-month period of time. You can contact the researchers  if you're interested and meet the criteria; however, be prepared for the possibility that you end up being randomized to the low fat rather than low carb group.

I've heard that there will also be further studies investigating the effects of ketogenic diets on cardiovascular disease, cancer, and neurological diseases like Parkinson's and ALS based on favorable early research.


All in all, I’m feeling optimistic about carbohydrate restriction becoming more accepted by doctors and other healthcare providers, governmental organizations, and society in general. However, there's still a lot of work to be done, not the least of which is changing the perception of low carb as a “fad” diet. As we well know, carbohydrate restriction is a way of life that offers long-term blood sugar and weight management via appetite regulation and hormonal control. Nothing faddish about that.





13 Comments
Steve Parker, M.D. link
10/31/2013 10:34:27 pm

My initial impression of the new ADA guidelines on diet was similar to your initial impression. Guess I need to scan them again. Or the ADA's paper was poorly written.

-Steve

Reply
Franziska Spritzler link
10/31/2013 11:49:59 pm

Oh, there are several things I don't like about the new ADA dietary guidelines as well. They're still very anti-saturated fat, for one thing. But the fact that they're now endorsing carb restriction as an option without a limit on time (as opposed to their previous statement that LC can be used for up to two years) or amount (as low as 21 grams per day) is a really big move for them. I feel I'm in a much better position to start my private practice using a VLC approach now that the ADA has given their approval.

Reply
Paul
11/1/2013 12:26:16 am

There's much more ground to break still but it's a very positive step in the right direction from the ADA.

Best regards

Paul

Reply
Franziska Spritzler link
11/1/2013 05:06:13 am

Absolutely! Thanks for your comments.

Reply
Dan Brown link
11/1/2013 11:36:54 am

I think the ADA Position Paper is a break-through document, a watershed. They've 'made the turn,' although not with dietary fats. But this Postion Paper was prepared by the RDs and CDEs, not the Medical doctors in the ADA. I address this in my column #155 published last Saturday, and follow up with 2 more columns last Wednesday and tomorrow morning. Take a look, if you have time.

Reply
Franziska Spritzler link
11/1/2013 02:10:11 pm

Thanks so much for your comments and for alerting me to your blog posts, Dan. I'm going to try to read all three this weekend.

Reply
Tim
11/1/2013 10:34:30 pm

Loved your analysis of the implications of this paper in your blog Dan, highly recommended!

Reply
Tim
11/1/2013 10:28:50 pm

In the past the ADA started with diet and then adjusted blood sugar goals to match the results of eating higher amounts of carbs. The result was goals that led to complications.

This statement, from the position paper: “Monitoring carbohydrate amounts is a useful strategy for improving postprandial glucose control. Evidence exists that both the quantity and type of carbohydrates in a food influence blood glucose level, and total amount of carbohydrate eaten is the primary predictor of glycemic response.” marks a sea change in the ADA's guidelines. This is "eat to your meter" which I have found to be the most useful strategy in formulating a diet in response to my own T2.

Unfortunately, It will take years for this message to filter down to MD's RD's and CDE's and for them to integrate this into their advice to patients, but In the end the science supporting LCHF will overwhelm the opposition.

Finally congratulations to you Franziska, your well written and well researched articles and papers certainly have played a part in this change of position by the ADA.

Reply
Franziska Spritzler link
11/2/2013 06:52:28 am

Thanks so much for your excellent comments and insight, Tim. I'm very encouraged by the ADA's acceptance of LC and excited about where this will lead. And of course I greatly appreciate your continued support/

Reply
Jan link
11/2/2013 04:30:51 am

It certainly has been a great week for LCHF, but the momentum needs to be kept up, and I'm sure it will be.

I like the look of the salmon and basil-cream meal you are showing.

All the best Jan

Reply
Franziska Spritzler link
11/2/2013 06:54:33 am

Thanks as always for your comments, Jan! Salmon with cream sauce is one of the best food combos around, in my opinion :)

Reply
Terry O'Rourke
11/2/2013 06:50:28 am

Thank-you for bringing this ADA position paper to my attention. I believe your second thoughts on the ADA's take on low-carb eating as a viable alternative for diabetics as closer to the truth. Large organizations also contain human characteristics; they are, after all, made up of people.

I think that the ADA , the AND, as well as the greater medical establishment has been wrong on its "initial" judgment regarding the benefits for diabetics using a low-carb approach. I realize that this initial phase, lasting for decades, was far too long.

When people and organizations have stubbornly adhered to an untenable position they often will make small steps in the right direction to start to resolve the cognitive dissonance they sense. This ADA position paper is a move in the right direction. We may look back, many years from now, and see this time as an inflection point that marks a dramatic change in our dietary understanding of diabetes health.

Reply
Franziska Spritzler link
11/2/2013 07:54:54 am

It's great to hear from you, Terry. Thank you very much for sharing your thoughts and providing further insight on this topic.

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