Re: Data on negative outcomes of High Protein Low Carb diets (was diabetes treatments of yesterday)

"GysdeJongh" <jongh711@xxxxxxxxx> wrote in part:

"Jim Chinnis" <jchinnis@xxxxxxxxxxxxxxxx> wrote in message
news:ib7ai3tcj9bruvo6d9vmvfc41b95maa7vn@xxxxxxxxxx
"randy@xxxxxxx" <randy@xxxxxxx> wrote in part:

Here's some recent data on negative outcomes of "Low Carb, High
Protein" diets.

I appreciate the posted information from studies.

A major difficulty that runs throughout this set of studies is the very
strong likelihood of what is called residuals confounding.

Hi Jim Chinnis,
my comment is on this article :

Eur J Clin Nutr. 2007 May;61(5):575-81. Epub 2006 Nov 29
Low-carbohydrate-high-protein diet and long-term survival in a general
population cohort.
PMID: 17136037

I still find this an interesting study because it contains a lot of
participants , they were followed over a large number of years and they were
just observed.They were not forced to eat or do anything :) They were not
forced to eat a special diet , they were not forced to exercise and they
were not ill when the study started.In the study the authors corrected for a
large number of effects.

So why do you think some people ate low-carb, high-protein diets? The choice
of what to eat was made freely by the individuals, as you point out. I
suspect that those people differed in some ways from the ones who ate
high-carb, low-protein. I suspect a fair number may have had family
histories of DM (not controlled for), may have found controlling their
weights easier on low-carb (not controlled for), etc.

Although I find the discussion on this a little hard to follow, the paper
says that the diet scores were adjusted for total energy. If that means what
it seems to mean, it would artificially remove the weight-loss benefit of
the LC-HP diet, which might be a compensatory effect. I don't know.

So to make it as short as possible:
Take two groups of free living healthy people.
Group 1 eats high carbohydrate , low protein
Group 2 eats low carbohydrate , high protein
Both groups eat exactly the same amounts of Calories
Both groups eat exactly the same amount of fat
Both groups are equal on a number of other things (see below)
Group 2 dies first

To make it more technically and thus about confounding then :

Their LC/HP index is a ratio it runs from 2 till 20
2 means : High Carb _AND_ Low protein

20 means Low Carb _AND_ High Protein

The LC/HP index is corrected for :

Total energy

gender

age

education

smoking

body mass index

exercise

alcohol consumption

saturated lipids

un saturated lipids

Note that there are still even dietary factors not controlled for. For
instance, while the outcomes were adjusted for lipids consumed, they weren't
adjusted for nitrites/nitrates. I would guess that many extreme low-carbers
included preserved meats in their diets whereas not many low-proteiners did.
And research seems to show mortality effects of preserved meats.

Given all the things not controlled for and the difficulty of doing the
adjustments (each correction adds some noise to the result), I think the 22%
increase in mortality isn't outside the likely error of the model they used.

Page 580 the authors state :

Some limitations of the present study need to be considered. Foremost is
the issue of residual confounding. We could not identify, however, any such
factors.



This seems a reasonable conclusion to me

Well, of course they couldn't identify "such factors." The ones they
identified are the ones they used! Yeah, I guess they could mean that they
couldn't think of any they hadn't included but were unable to measure, but
that seems silly to me.

I think Alan S offered the best observation though: that these studies
excluded those with DM.

Thanks for the discussion Jim :)

Gys

Same to you, Gys.
--
Jim Chinnis Warrenton, Virginia, USA
.

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