Dr. Peter Brukner - 'LOW CARB: Guidelines and Position Statements'

I thought I might just give a little overview David just spoken about one the American Diabetes Association guidelines I thought it might be quite interesting for us to to review sort of guidelines that are out there by the various organizations and to see how they're approaching the whole lowcut well if they're approaching the löwe can be summative so how are they approaching the low carb issue so what I'm going to do is say in the next not that long now it's look at three different areas if you like the diabetes groups are the National diabetes groups the heart groups and the dietitians and I'm going to do this for the sake of of keeping it within sort of an hour or two I'm going to look at the Australian groups and in depth in in deference to our two international visitors the English or the British groups and the American groups and just have a look at what those organizations are doing or have done at the moment and the way they're addressing the low carb situation okay so let's start with the diabetes bodies the various bodies around around the world we'll start off in Australia and in 2018 the diabetes Australia produced this position statement on low carbohydrate eating for people with diabetes so let's have a look what they are what they had to say so it's a few motherhood statements to start with low carb eating's gained popularity some people have found it useful you know some people have found it useful low carb diets are popular because they're relatively easy to follow and heavily promoted in the media that's the only reason they're popular low carb eating is also gaining interest for some people with diabetes there's one option to help lose weight and to assist in managing their blood glucose levels so the language is very interesting though you'll find a common theme through all these two position statements for language is very yes you'll see the next thing for people with type 2 diabetes there is reliable evidence that lower carb eating can be safe and useful that's good or people with any type of diabetes who wish to follow a low-carb diet should do so in consultation with their diabetes health a team because they need the business and people with diabetes considering low-carb eating are encouraged to seek personalized advice from an accredited practicing dietician probably the last thing you would want to do if you had diabetes and people with diabetes considering low-carb eating should be aware of possible side effects such as tiredness headaches and nausea and seek advice and we've all had those haven't we constantly you know constant falling asleep all the time and seek advice from their health care team if concerned and then finally has no side effects like our body may not be safe and not recommended for children pregnant or breastfeeding women people at risk of malnutrition don't know what that means really people with kidney or liver failure know that goes against the what David just said well those are the history of disordered eating so you have to say it's not exactly a strong endorsement so in summary diabetes Australia recognizes that low-carb eating can be an effective way of reducing blood glucose levels and achieving weight loss however low-carb eating is not suitable for everyone including children people with type 2 diabetes is one people with type 2 diabetes with specialized nutrition requirements doesn't everyone with type-2 diabetes have a specialized nutrition route me anyway at this stage there is not enough evidence of benefits or safety of low carb eating for people with type 1 diabetes I don't know what they're ready but they can't find any evidence of that and you've got to get in the saturated fat Benish your fat intake includes mostly unsaturated fats and only small amounts of saturated fats so that's diabetes Australia they've addressed the issue but you have to say I haven't widely not wild enthusiasm there what about our friends in there in the UK I thought I just put up a typical English scene here scene from from a recent picture of London with a guess ometer in the background and yeah just a typical London scene really what about diabetes UK now in 2017 you earlier they put out a statement on low-carb diets for people with diabetes so let's see what they had to add that to say in response to many inquiries from people with diabetes etc etc diabetes UK has produced this information to clarify our position on carbohydrates based on their evidence-based nutrition guidelines as the total amount of carbohydrate eaten has the biggest effect on the rise of blood glucose levels some experts have argued that everyone with diabetes should follow a low carbohydrate diet however this call for low carb diets is based on opinions rather than robust science unlike the guidelines for the last 40 years which of course have been very robust science I can't have any be able to find them but I'm sure if I could find them they'd be very robust so there's a theme here isn't there there's a recurring theme weight management should be the primary nutritional strategy restricting the calorie intake can lead to weight loss and there a variety of ways to achieve calorie restriction and weight loss so what they're trying to say is that low-carb is just one of the many ways of restricting calorie intake some people with type 2 diabetes may choose to follow a low-carb diet in order to lose weight and to manage their blood glucose the implication that well you've been idiot if you did but you may choose to do that there is evidence to suggest that low-carb diets are safe and effective so at least we've got got that far but in the short term for improvements there is no clear indication that they're superior to other approaches in the long term individual studies have looked at the effectiveness of low carb diet than the management of type 2 diabetes and reported inconsistent differences in glycemic control weight blood lipids in blood pressure between diets low in carbohydrates and diets high in carbohydrates yes inconsistent some of them are incredibly effective and some of them are just very effective recent systematic reviews and meta-analyses including people with type 2 diabetes report that although low carb diets may lead to significantly greater weight loss and improvements in hba1c and liberty over the short term there was no greater advantage over the longer term when compared to other diets and they list for references there of the many many references they for some reason just picked out for which happens to support what they say Studies on very low carb ketogenic diets have suggested that these may not be sustained and sustainable over a medium to longer term as carbohydrate intake in the different diets within studies often converge towards a more moderate level that's a bizarre statement really isn't it anyway we won't go there so their recommendations at the end of their route their statement on low carbohydrate should not die it should not be regarded as a more superior or a better approach than other strategies as consistent evidence shows that total energy intake is the main predictor for weight loss there we go calories in calories out where are you Gary yeah when considering a low carb diet as an option people with diabetes should be made aware of possible side effects such as the risk of hypoglycemia common side effect and should be supported to manage such risks people who want to follow a low-carb diet should ensure that their fat intake comes Manny from unsaturated sources while limiting saturated fat intake they should also include foods in high in fiber dr. Mason any comments on that finally there's no currently no strong evidence to recommend it low carb as an option for people with type 1 diabetes we would argue with that and I'm sure Troy Stapleton would would argue with that and there are serious concerns I love this one serious concerns about low carb diets for children with diabetes due to effects on growth therefore low carb diets should not be recommended for children with diabetes probably the most important people that need a high carb diets so that that really sort of disturbed me that that bit about the kids so they had some references there so I wouldn't have a look at that the references and the main reference they use is this case series of endocrine and metabolic consequences due to low carb diets and there was a case series the illustrator the carbohydrate restriction and growing children can lead to anthropometric all deficits and a higher cardiovascular risk metabolic profile further fatigue and low enjoyment of sports was reported so there's a bunch of of cases from medical practitioners that had negative negative comments what they said further further on in that article the likely mechanism is a carbohydrate restriction without compensating energy intake throughout the macronutrients fat and protein leads to a deficit in total energy intake so it really had nothing to do with the fact that was low carb it was just the fact that they didn't compensate by by having increased energy but Diabetes UK sort of didn't quite get that I don't think whereas we know that there are a number of other studies this one from David Ludwig's group showing exceptional glycemic control of type 1 diabetes with low rates of adverse events reported a community of children and adults who consumed that was the type 1 type 1 grit study and then our own wonderful gesture tan came up did a systematic review and show that 8 out of 9 studies reported on main change in hba1c in type 1 diabetics so really it's very much selective evidence and not even good quality evidence so diabetes UK with some other organizations put out these evidence-based guidelines for the prevention and management of diabetes so they're supported by the dieticians and by primary care Diabetes Association and the Association of British clinical diabete ologists all got together and support of this and I won't go through that that a whole thing but you can see there in my dodgy patent associated with reduced risk in general populations included Mediterranean - vegetarian and vegan the Nordic healthy diet and moderate carbohydrate restriction I think about severe in a very low carbohydrate it's all this moderate carbohydrate description what's happening at the moment in the UK is that there is a joint Scientific Advisory Committee on nutrition with NHS England and Diabetes UK they've commissioned a working group to review the evidence on lower carb diets for adults with type 2 diabetes and they do to report their findings next year 2020 and they'll make recommendations based on that on that review so that should be very interesting to typically look at the composition of that working group David's already mentioned Roy Taylor who has done that research on on low calorie diets and diabetes and I think you know I don't know what you think day over there's a reasonable chance that these people might might come up with with some good good results however this scientific this is ACN Group Scientific Advisory Committee on nutrition recently put out something on saturated fat and health and the results of that don't inspire me with a lot of confidence that they'll get it right about about low carb this is what Zoe Hart meant to say about a few aspects of that that review when reviewing the draft report so he found the SA see and had done five things to try to make a case against saturated fat and they presented duplicator studies and the studies that simply reported other studies which gave the appearance of there being more evidence supporting it they left out some studies all of which found evidence of no effect they presented non significant results as significant they look for in reported a fixed effect methodology when the random effects methodology concluded there was no significant findings and they know what evidence that didn't suit them so that doesn't really inspire me that but hopefully this next committee will do a do a better job as we know the diabetes there's an alternative diabetes group in there in the UK which is diabetes Co UK which is not the official group which is Rydia a la and low carb group that's incredibly popular they have a low-carb program that you're probably all familiar with at Cost selling 90 pounds to do this program and they've had over 400,000 people do this low-carb program they have 300,000 people on their diabetes form so this is the alternative side of ladies in the UK I think numbers numbers talk what about there's a an interesting consensus report that came out a combination of the European Association for the study of diabetes EE ASD and the American Diabetes Association which David referred to they put put out a statement last year saying that low carbohydrate diets produce substantial reduction in hba1c at three months and six months with diminishing effects at twelve and fourteen no benefit of moderate carbohydrate restriction was observed so the American Diabetes Association is interesting they they have this document called the standards of medical care in diabetes and they updated that last last December and one of the chapters was a lifestyle management and what they said in that was that there are a variety of eating patterns acceptable for the management of diabetes the Mediterranean dietary approach the - and plant-based diets are examples of healthful eating patterns that have shown positive results research indicates that low carbohydrate eating plans may result in improved life see Mia I know the potential to reduce anti hyperglycemic medications for individuals with type 2 diabetes good as research studies on some low-carb eating plans generally indicate challenges with long term sustainability it's important to reassess in individualized meal plan guidance the meal plan is not recommended this time for women who are pregnant or lactating people with or at risk for disordered eating or people who have renal disease should be used in caution with people taking sglt2 inhibitors which we agree with there was inadequate research in type 1 diabetes to support one eating plan over another and that's so sad that they they come to that their conclusion and in their summary they just had a single line saying a variety of eating patterns are acceptable for the management of type 2 diabetes thus David I would mentioned they've all recently in in April or May this year published a consensus report and David referred to that and there are some very good names on that that author lists lorises Lo and bill sat the ANSI and so on and not surprising with good people there they came up with some much better results these are the consensus recommendations from that consensus report firstly a variety of eating patterns etc fine secondly we should cook we should focus on key factors such as non starchy vegetables and choosing whole foods over highly processed foods or pretty good this is what David referred to reducing overall carbohydrate intake has demonstrated the most evidence for improving glycemia now that is a as David mentioned a remarkable statement in the first time that any of these official organizations have said anything like that and that reducing overall carbohydrate intake with low or very low carbohydrate eating plans is a viable approach drilling down into that consensus statement there's a couple of other interesting paragraphs in there that I wanted to show you firstly despite a lot of the other organizations saying there is insufficient evidence for low carb programs they've actually said these eating patterns are element the most studied eating patterns for type 2 diabetes I've obviously found a lot of studies that these other organizations haven't and interests me about saturated fats they say most of the trials using a carb restricted eating pattern did not restrict saturated fat from the current evidence this Eddie Patton does not appear to increase overall cardiovascular risk again quite a different statement to all the others so I think it's been a pretty exciting development as David David pointed out so a lot of difference between the Australian UK and the American Diabetes Association's all right let's talk about the Heart Association's and I'll rush through these fairly fairly quickly as I know you all want to get to lunch not that we're hungry anymore but you know that's let's talk about the different Heart Association's in the three in the three countries firstly you will start with the Americans the American Heart Association has diet and lifestyle recommendations on their on their website and it's to eat an overall healthy dietary pattern the usual thing variety of fruit veg life at dairy skinless poultry nuts and legumes non pickled vegetable oils limit saturated fat sodium red meats and so on one of the diets that fits this pattern is the dash approach and most healthy eating patterns can be adapted based on calorie requirements and personal and cultural food differences all pretty pretty depressing stuff really that probably hasn't changed in the last 30 or 40 years recently the American College of Cardiology and the American Heart Association have put out a guidelines on clinical practice guidelines and there are they're quite interesting if we look at the recommendations for nutrition and diet number one our diet emphasizing intake of vegetables fruit legumes not whole grains and fish replacement of saturated fat with dietary monounsaturated and polyunsaturated a diet containing reduced amounts of cholesterol and sodium can be beneficial and a where they get those references from but that's not the consensus as part of a healthy diet is reasonable to minimize intake you're processed meats refined carbohydrates and sweetened beverages and finally as part of a healthy diet the intake of trans fat should be avoided they also go on to say long-standing dietary patterns and focus on low intake of carbohydrates and high intake of animal fat associated with increased cardiac and non cardiac mortality rate in one meta-analysis low carbohydrate diets were associated with a 31% higher rate risk of all-cause death with increased cardiac mortality rate remarkable how you can find one paper among literally dozens that shows that result this was the popular that study the Eric the atherosclerosis risk in community study and 18% increase in mortality rate with low carbohydrate diets using animal derived protein and fat sources but plant sources were associated with lower moths healthier ate so the vegans are everywhere in conclusion a diet high in fruit vegetables and whole grains as best fish legumes and poultry are the preferred sources of protein minimizing consumption of trans fat added sugars red meats sodium and saturated fats is also important so the American Heart Association what about in Australia well some of you may have seen the headlines recently that the astre the Heart Foundation Australia has come out with some some revised guidelines and there was some publicity here you can see healthy hearts nice and cheesy why full fat milk is back in favor new advice from the Heart Foundation on meat dairy and eggs what was that advice was in I think came out in August Gary Jennings is their chief medical adviser we've introduced a limit on meat limit of less than 350 grams a week but unprocessed beef lamb pork and veal that's about 1 to 3 lean red meat meals a week processed or deli meats should be limited people should get most of their heart healthy protein not sure what heart-healthy protein is but heart-healthy protein from plant sources such as beans lentils and tofu as well as fish and seafood the smaller amount of eggs and lean poultry heart-healthy it is more about combination of foods so they would rather we had tofu and red meat as far as deer he goes we removed our restriction there no apologies for having had a restriction on there for 40 years and condemning us all to horrible skim milk for 40 years we removed our restriction on healthy isn't that kind of them on any full fat milk cheese and yogurt well the evidence was mixed this type of dairy was found to have a neutral effect any studies show a positive effect but they just say a neutral effect it doesn't increase or decrease your risk of heart attack however that's if you're normal but if you serve a high cholesterol or heart disease at the window we're still want unflavored reduced fat milk yogurt and cheese and eat less than seven eggs a week who eats more than seven eggs a week they're all in trouble watch those tickers now this is my favorite line butter cream ice cream and dairy based reserved desserts are not recommended as heart-healthy so they've leaked butter and cream with ice cream and dairy based desserts in the one sentence as if they're all the same bizarre they contain higher fat and then at the bottom we now advise people with type 2 diabetes to eat fewer than seven eggs per week as growing evidence suggests an increased risk with eating more eggs bizarre anyway so initially I got really excited when I saw a list you know this headlines about you know they're the heart foundation unless in improving dairy and so on when you drill down to it it's still pretty pretty compromised oh I know the last thing eating more plant-based foods like vegetables fruit and whole grains and healthy proteins like fish and seafood with smaller amounts of animal-based foods or cutting down on highly processed junk foods is the key to good heart health their recommendations based on that evidence plenty of vegetables variety of healthy protein sources especially fish and seafood legumes nuts and seeds smaller amounts of eggs and lean poultry can also be included if choosing red meat make sure the meat is lean and limit to one to three times a week unflavored milk yogurt and cheese those with high blood cholesterol though should choose reduce fat lip varieties etc etc for people who would benefit from LDL lowering dietary intervention they don't actually say who that is or whatever but apparently there are some people who would benefit we've got to work that out choosing reduced fat and unflavored milk yogurt and cheese and less than seven eggs a week is recommended anyone all right that's Australian Heart Foundation what about our our British friends Oh I don't know how that's popped in there honey ours must be from another talk I gave anyway um the British Heart Foundation healthy eating a balanced diet plenty of fruit and veg plenty of starchy foods you like that the British Heart Foundation plenty of starchy foods I oven have obviously haven't heard David's lecture about what a starch is bread rice potatoes and pasta can you believe that try to eat plenty of bread rice potatoes and pasta because that'll give you a heart attacks and we'll have lots of business yes some milk and dairy products some meat fish eggs beans another non dairy and only a small amount of foods and drinks high in fats and sugars choose options in a lower in fat salt and sugar whenever you can and then they specifically talk about high protein or high fat diets as if they're the sort of same thing and Acton's you know is eg Atkins that's just a high protein diet what do they say about that - high protein diets work what do you may lose weight quickly at first there's no evidence these diets are any more effective in the long term high fat diets can be unhealthy - well fats are important too much fat will unbalance the diet take care if you've got high blood pressure processed meats like bacon and sausages come in the diet is high in salt etc etc alright last but not least I'm saving the best to last our friends the dietitians all right let's start in the in the in the US where the Academy of Nutrition and Dietetics is their main dietitians professional body they don't actually have a particular low carb policy or position statement unlike all the other organizations we've talked about they do I had to look through their website and they have this on children need carbohydrates in recent years several fad diets what they're referring to there have recommended the reduction or even elimination of carbohydrates from our everyday diets but I such low carb diets good for a child while a reduction of certain types of carbohydrates such as added sugars may be beneficial for our children's growing bodies removing all carbohydrates well you can't remove all carbohydrates anyway so it's a nonsensical statement really they do her page on what is the ketogenic diet the cuter Jenny diet is quite restrictive research supports the eating pattern for epilepsy when managed along with the health team since its treatment can be very complex but of course nothing else would work even works for epilepsy however through gosh the keto diet as a tool for weight loss and other health benefits the jury is still out well I'm not sure who is in their jury but they're not a jury that I'd like to be judged by I can assure you and finally they love the Mediterranean diet make it Mediterranean you've probably heard that the Mediterranean diet can make your heart healthier protect against cancer and even help you live longer but did you know it's also a great pick for kids anyway alright let's let's go to England shall we and oh sorry - your idea who those drunk people are terrible all right the BDA the association of UK dietitians in November 2018 they put out this position statement on low carb diets for the management of type 2 diabetes in adults when I go through it all but the BDA believes that low carb diets can be effective in managing weight improving glycemic control and cardiovascular risk in people in the short term less than 12 months this is probably due to the accompanying reduction in energy intake and subsequent weight loss more research is needed to determine the effect of long-term adherence over 12 months more research is needed to identify the best dietary pattern to ensure good glycemic control weight loss is still the cortisone of münster of type 2 diabetes there insufficient evidence insufficient evidence how many RCTs were there 62 there is insufficient evidence to indicate that low carbohydrate diets are a superior or better approach to other strategies for weight loss and subsequent weight maintenance in the long term you just wonder who comes up with these statements it's amazing when considering a low carbohydrate diet option people with diabetes who are on certain drugs including insulin should be made aware of possible side effects what the side effects are the insulin or the side of exit anyway and people type 2 diabetes who choose in other words you know you idiots who choose to follow a low carbohydrate diet should be supported by a dietician unless probly the last thing you want to be well spent [Music] sorry Nicole we do have a low carb diet ition in the audience all right and last but not least I know it's nearly lunchtime now good old dia the dieticians Association of Australia and in November 2017 they put out this statement on low-carb high-fat diets for diabetes low carbohydrate high fat diets have recently reemerged having last been popular in the 1970s and have caught the attention of some members of the scientific community in the public dieticians want to make the management of diabetes militant welders easier and strive to provide the best possible advice to the public as the nutrition science continues to invert to evolve so what about the low-carb high-fat is it really the best if you have diabetes and is it sustainable fascinating questions that are DOA acknowledges that there is no one best diet for managing type-2 diabetes there are a range of beneficial nutrition interventions which may be recommended by a practicing dietician APD's are trained in taking into account factors such as person's nutrition needs well I would hope so background and preferences and then tailor medical nutrition therapy to an individual there are a range of carbohydrate intakes that can assist with diabetes management yes some will make them worse and some more make them better anyway a low carbohydrate high healthy fat diet may be used by some nutrition professionals in the short term or they will expel them from the DEA but that's another matter to achieve particular health goals this approach would be for everyone but for some people it might be worth trying with support from an APD who doesn't believe in it to ensure nutritional adequacy to help identify healthy and protein and fat sources and to assist with long-term adherence it's important to remember though that the efficacy and safety of low carbohydrate diets has not been examined in the longer term there are no clinical trials of two years or more examining the health effects clarity is needed provided the definition or description of low carb diets that have in some studies been associated with weight loss or improved metabolic profile what we do know is that eating a wide variety of nutritious foods in the right amount it's crucial to optimal health and the best diet for anyone is you can maintain one you can maintain over the long term lastly daa recommends people with diabetes seek advice and ongoing support and monitoring from a health professional such as a dietician alright enough of these position statements where we add what's happening what can we deduce from all of these well what does it mean it means low carb certainly on the agenda I mean two or three years ago there were no position statements on low carb so they didn't felt the need so all these organizations have felt the need to make a comment on low carb because of us all these organizations have been forced to address the issue albeit reluctantly as you can see from their from their language they're prepared to admit the low carb diets are safe and the low carb diets may be effective but they all say they're not shown to be safe in the long term they all talk about potential health risks kidney cardiovascular they're still concerned about saturated fat they say there's no evidence for type one and remarkably they say that's dangerous for children so while we've made some progress there's still a long way to go but I think with people like rod and David and Gary Taubes we can do it thank you very much

Channel: Low Carb Down Under

Views: 31,834

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Gold Coast 2019, #LowCarbGC, Peter Brukner, A Fat Lot Of Good, SugarByHalf, Diabetes, Heart Foundation, Dietitians Association of Australia, @DAA_Feed, Cardiology, Low Carb High Fat, LCHF, Ketogenic Diet, Carbohydrate Restriction, Diabetes Australia, TypeOneGrit, Diabetes UK, SACN, American Diabetes Association, AHA, Dietary Guidelines

Id: ZYPCSaP2mkM

Length: 32min 51sec (1971 seconds)

Published: Sat Feb 15 2020