Science journalist Ann Fernholm wrote an excellent opinion piece in one of Sweden’s major newspapers, Aftonbladet.
Any evaluation of LCHF for diabetes will no doubt show the same thing as SBU (The Swedish Council on Technology Assessment) concluded in their review in 2010: a better outcome for blood sugar and weight than with today’s dietary advice. It’s what previous studies have shown, it’s what all logic tells us and it’s what I see in my patients daily.
That diabetics are still given the advice to eat a lot of carbs is a disgrace for the healthcare system.
Here’s the full article by Ann Fernholm, translated to English:
Evaluate LCHF As a Treatment for Diabetes
Letter to the Editor: Nutrition researchers’ dogmatic defensiveness prevents progress and costs the taxpayers many billions of dollars.
OPINION The dietary advice that many diabetics receive from healthcare professionals is outdated and useless. Dogmatic defensiveness in the world of academic science prevents progress and this costs the taxpayers many billions each year.
Results from a scientific study that should have created big headline news all around Sweden were published last summer. The study, Look AHEAD, is the biggest longitudinal evaluation that’s ever been done, following lifestyle recommendations for diabetics through the past decades. Thousands of people were closely monitored to follow a low-calorie, low-fat diet and to exercise. They lost weight and during all the years of the study, weighed less than the control group.
BUT. After nine years the researchers terminated the study prematurely. The weight loss had no significant impact on morbidity and mortality from cardiovascular disease. The results clearly showed that the lifestyle consultations that diabetics had been given as part of their health care regime had been a waste of time and money.
In my book “A Sweeter Blood” I examined the scientific foundation for low-fat diets. The belief that a low-fat diet would be heart-protective, rests on an assumption that scientists made in the 1950’s: that the total cholesterol level is the most important measure of health. The decision was never scientifically based, but has since the 1970’s completely dominated all types of dietary guidelines. Even type 1 diabetics (juvenile diabetes) have been advised first and foremost to avoid fat, despite the fact that high cholesterol isn’t even part of their medical problems. According to dietitians, even type 1 diabetics should fill their plates with carbohydrates, even though the science clearly shows that high blood sugar causes cardiovascular disease.
Diabetics, regardless of type, run a 2-3 times greater risk of suffering cardiovascular disease compared to a healthy person. A major European study from 2004 showed that almost seven out of ten people affected by cardiovascular disease had either diabetes or were pre-diabetic. Molecular-biology research also has shown that high blood sugar levels drive inflammation in the arteries, which leads to atherosclerosis. That the Look AHEAD intervention failed may therefore be most easily explained by the fact that a low-fat diet, which is per definition a diet rich in blood sugar-raising carbohydrates, makes the diabetic’s blood sugar fluctuate too much.
The fear of fat that was born in the 1970’s seems to have made many physicians completely forget that diabetes was once called “sugar disease”. If the diabetics of the 1920’s had received today’s dietary advice they would soon have died. The fact is that the current dietary guidelines for diabetics require that physicians prescribe drugs that inhibit the effect that the carbohydrates have on blood sugar.
Unfortunately, today’s heated diet debate shows us that many researchers and physicians will continue to shun calories, fat and cholesterol more than anything else. Hundreds of diabetics on an LCHF diet testify that a strict low-carbohydrate diet has a dramatic effect on their blood sugar and health. Many lose a lot of weight and are able to discontinue medications. But leading nutritional researchers dismiss their stories as anecdotal. Their dogmatic defensiveness is an obstacle to progress.
Type 2 diabetes is one of the major diseases of our time. Aside from all the suffering, the costs in Sweden alone amount to 0.5-1 % of Sweden’s gross national product. A mind-boggling amount of money. In order to resolve the diet debate the government needs to invest in high quality studies. We need funding of high quality scientific studies that without preconceived notions will evaluate what lifestyle guidelines best protect diabetics’ hearts. Allocating $15,000,000 would be a drop in the bucket in comparison with what health care costs. For Sweden’s 365,000 diabetics, on the other hand, this could mean the difference between a life in health and a premature death.
Ann Fernholm’s blog (In Swedish)