I have been able to achieve remission of type 2 diabetes by doing keto. My doctor is impressed, but still somewhat dubious. He showed me the following article from JACC Journals claiming that a low carb diet doubles the risk of major adverse cardiovascular events.
Does anyone have a good response or analysis of these claims that I can share with my doctor?
Thanks.
“Association of a Low-Carbohydrate High-Fat Diet With Plasma Lipid Levels and Cardiovascular Risk”
How to respond to my doctor?
vwerner
(Werner)
#1
kib1
(KM)
#2
I’m hoping someone will hit this with a double barrel shotgun, but the first thing I noticed was that 1. this appears to be based on loose criteria of what constitutes LCHF with one dietary survey of 24 hours in 12 years. 2. The starting group defined as lchf has almost a 500% increase in diabetes risk out of the gate for some reason and is significantly more overweight than the control group. To me this implies a high glucose diet, and makes me question whether the group was actually lchf to begin with. Either way they are at a much higher risk for metabolic disease. They also smoke more and exercise less. They’re also a smaller group, approx 1/5 of the total sample size.
What I’m getting out of this is that yes the test group, assigned after a vague 24 hour dietary epidemiological survey, may be sicker over 12 years than the control, but they clearly also started out that way. Whether they started out LCHF is a lot less clear.
So my question … Why soooooo much analysis, reams of it, on such a poor and skewed initial sample?
Funding support and author disclosures
Dr Brunham has served on advisory boards for Amgen, Novartis, HLS Therapeutics, and Ultragenyx. Dr Iatan has served on advisory boards for Novartis and HLS Therapeutics and receiving honoraria from Novartis and Sanofi.
My advice is heretical. You will never win this argument. There is simply too much vested interest in prescribing medication, muddying the waters of science. Nod, smile, thank your doctor for your statin, drop it in the garbage.
clackley
(Cathy)
#3
Congratulations on your successful dietary changes and resultant reversal of diabetes!!!
What is important to me is not what my doctor thinks but what I think. I respect my doctor a ton. He is highly respected in his profession. However, he did doubt keto for me some 15 years ago but I had more reading and understanding of that topic than he did.
My doctor is my health consultant and it is my responsibility to make the dietary decisions on a daily basis with the information I had from him and many other sources.
Pjam
(Peter - Don't Fear the Fat )
#4
Ask to see evidence of a link between lipids and cardiovascular risk. I think there’s no proven link. Usually most markers, like triglycerides, greatly improve!
also, I’m amused by the term ‘remission of type 2 diabetes’. They have trouble saying ‘reversed type 2’.
They know conventional medicine success rate with diabetes is very poor. Meds is all they’ve got!
ctviggen
(Bob M)
#5
That study is pretty much garbage. They had one dietary questionnaire in > 11 years. It looked mainly at markers like ApoB and LDL, and not hard endpoints.
Here are a lot of studies from Virta Health:
Janie
(Jane)
#6
You could ask him to prescibe a CAC scan to check the condition of your arteries (or pay for it yourself). Or just ignore him since trying to convince him is a waste of your time IMO.
robintemplin
(Robin)
#7
I don’t tell doctors I am keto…I just say I have cut out sugar and processed food. Period.
They always say good job!
vwerner
(Werner)
#8
Thanks so much for taking the time to reply and look at the study. I know it’s unlikely that I’ll change my doctor’s point of view but still want to take a shot, for the sake of other patients that may cross his path and just possibly to get him to think about these issues.
Unfortunately though it does seem that most LCHF/ Keto friendly doctors had to have a first hand experience of the near miraculous potential of LCHF/Keto before they were able to change their perspective.
Really glad I found this forum!
Alecmcq
(Alec)
#9
Frankly, if that’s the best study that your Dr can come up with, it just goes to show the “strength” of the evidence for what he is suggesting. It is utterly pathetic.
- This is poor epidemiology. Association does not equal causation. This paper proves literally nothing. We know that this type of study is riddled with confounders, not least the standard healthy user bias.
- 1 day of a self-filled food questionnaire for a decade long study is just so stupid as to be laughable. Take a look at their data for calories consumed on the standard diet and low carb… they are saying the average for std diet is 2000 calories, and for the low carb it is 1450. This tells me that people are telling porkies… these averages are just too low to be accurate data.
- Extremely poor definitions of what is a low carb high fat diet. I could consume 200g of carbs, and that would be considered a “low carb diet”. Ridiculous. The average “low carb” diet person consumed 23% of their calories from carbs.
- Authors conflicts of interest. From the report (down at the bottom so nobody reads it): “Dr Brunham has served on advisory boards for Amgen, Novartis, HLS Therapeutics, and Ultragenyx. Dr Iatan has served on advisory boards for Novartis and HLS Therapeutics and receiving honoraria from Novartis and Sanofi”. This alone is sufficient to just dismiss this study.
The terrible thing here is that your doctor thinks this is valuable research: it indicates his complete lack of understanding about research and what it means. Personally I would be looking for another doctor: this one is dangerously bad.
echo2080
(Rossi Luo)
#10
305 LCHF and 1220 SD individuals completed an enrollment assessment concurrently with lipid collection, 30 of the 305 LCHF had ASCVD events.
Then ask your doctor: why do the 30 LCHF still risk their lives to continue on low carb diet?
John_Bradshaw
(John Bradshaw)
#11
Have a look at these documentaries on the subject.
That sugar film
Turning science upside down
https://www.youtube.com/watch?v=-18NVEvYkgI
Doctor’s low carb transformation with Dr. David Unwin
The origins of the anti-meat message
https://www.youtube.com/watch?v=8e1hoIFzn4Y
Are we blaming salt for what the sugar did?
Fat Chance (2017)
EssentialNutritionCh
(Fernando Urias)
#12
Buy your doctor a copy of The Clot Thickens by Dr. Malcolm Kendrick.
The Clot Thickens: The enduring mystery of heart disease https://a.co/d/6HhbjRL
EssentialNutritionCh
(Fernando Urias)
#13
Dr. Malcolm Kendrick conclusion is that eating a high carb diet lowers your life expectancy by 20 years.