BDA gives positive review of Low Carb Program app
The British Dietetic Association has come out in support of the NHS-approved Low Carb Program App after releasing a positive review of the platform.
The three-page report provides a comprehensive overview of the Low Carb Program; a structured education and behaviour change programme for people with type 2 diabetes, prediabetes and obesity launched in 2015. Users of the Low Carb Program have access to video lessons, handouts, recipes and a moderated online support forum.
The review has been written by Paula Gallon, Specialist Diabetes Dietitian, Solihull Community Diabetes Service on behalf of the BDA Diabetes Specialist Group.
Key findings from the BDA Report include:
- The Low Carb Program gives clear video explanations of what type 2 diabetes is and a positive message about changing lifestyle for improving control of type 2 diabetes, with a wealth of practical advice and tips.
- The Program accounts for a variety of dietary preferences and eating habits including vegetarian and vegan.
- Increased vegetable intake is encouraged and recipes and tasty cooking methods included.
- The Program is very clear about reducing sugary and processed foods.
- The Program encourages cooking from scratch at home and increasing healthy whole foods such as lean protein sources, vegetables, pulses, nuts and seeds.
- The Program offers practical advice for the real world such as portion size guidance, snacks, alcohol, sugary drinks and desserts, eating out and takeaways.
- The Program acknowledges that change takes time and the program includes small goals and behavioral tips.
- The Program provides recipes rich in fibre.
- Although there may be an issue of cost, availability of foods and finding ingredients for the recipes in areas of food poverty, it is possible that some of the costs could be cancelled out by saving on takeaways, snack foods and processed foods.
- The review concludes that “Following the program will support individuals to improve the quality of their diet, lose weight and likely improve their diabetes control.”
Peer-reviewed research outcomes published in the Journal of Medical Internet Research in 2018 have proven that the Low Carb Program is effective in improving glycaemic control, weight loss and reducing hypoglycaemic medications in patients with type 2 diabetes.
The paper evaluated the one-year outcomes of 1,000 people in the UK who engaged in the Low Carb Program. At one-year, the average member loses 7.4kg and reduces their HbA1c by 1.2% with 39% of patients lowering their HbA1c below the threshold for a diagnosis of type 2 diabetes. Additionally, 40% of people eliminate at least one medication from their treatment regime and one in four people place their type 2 diabetes into remission, saving the NHS over £835 per patient, per year in medication prescriptions alone.
The Low Carb Program has disrupted and redefined the landscape of type 2 diabetes management, with Dr Campbell Murdoch, Chief Medical Officer at DDM leading the authorship of a Demedication Protocol in the BJGP earlier in July as a direct response to the thousands of patients within the platform.
The Low Carb Program App is available via the NHS library and it currently carries a ‘No Badge’ status, which means it meets NHS quality standards for safety, usability and accessibility. It also has QISMET approval for all programme streams meaning it can be prescribed on the NHS. For information and advice about providing free access to your patients through the NHS, click here.
Commenting on the review, Charlotte Summers, Chief Operations Officer at DDM said: “The Low Carb Program is scalable, engaging and effective. It’s used globally by health agencies, governments and individuals and we are encouraged to see that the BDA also recognise the benefits of the Low Carb Program to help patients improve their diabetes control.”
The BDA review of the Low Carb Program commented on several areas as “problematic”. Here are the assertions from the review together with responses from the Low Carb Program’s Chief Dietitian, Tara Kelly, RD.
|Response from Diabetes Digital Media
|“The assertion is made that not all calories are equal and that the hormonal response to carbohydrates promotes weight gain. Low carbohydrate diets are promoted as having better adherence than other diets as being the most effective for weight loss and treatment of Type 2 diabetes. The course also claims that low carbohydrate diets increase energy and brain function and can reduce other medical conditions such as Crohn’s, Alzheimer’s and Parkinson’s Diseases.”
|“We believe that people with Type 2 diabetes should be given a choice in how best to manage their conditions. Until recently, low carbohydrate advice has not been widely provided on diagnosis as a treatment option for people with these conditions. Our published results and feedback from over 400,000 people on the program continually tell us that many people find the low-carb approach one which works for them. In saying this, we absolutely agree that the low-carb approach is not for everyone and encourage people to find a diet and lifestyle which works for them.
“Please refer to the recently published ADA nutrition therapy report, which concluded that “reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.”
“In terms of claims made about Crohn’s, Alzheimer’s and Parkinson’s we have commented previously how a diet high in sugar and refined carbohydrates may be associated with Alzheimer’s disease. We do not intend to suggest that a low-carb diet will improve Crohn’s or the other diseases mentioned.”
|“There are also some problematic statements related to fats. The program tells people to ignore advice given by other healthcare professionals on fats and states that there is no evidence that high cholesterol levels cause heart disease. The program defines healthy sources of fats such as nuts, seeds, olive oil, oily fish and also full-fat dairy fatty cuts of meat and the skin on chicken.”
|“There is consensus that the previous advice in relation to total fat intake is outdated. The LCP suggests avoiding ultra-processed foods containing trans fats completely and the focus should be on eating fat from whole, unprocessed foods where possible. We are continuously reviewing our content in line with the most recent evidence-base and as recently as three weeks ago we updated some of our modules.”
“Only last month, a BMJ analysis described how maintaining general advice to reduce total saturated fatty acids will work against the intentions of the guidelines and weaken their effect on chronic disease incidence and mortality as well as how recommendations fail to take into account considerable evidence that the health effects of saturated fat varies depending on the specific fatty acid and on the specific food source.” https://www.bmj.com/content/366/bmj.l4137
|“The program claims that the diet reduced triglycerides and increases HDL. The BDA policy statement on low carbohydrate diets in type 2 diabetes states that there is some evidence to show that low carbohydrate diets affect these blood lipids in the short term, although this may be linked to weight loss. However, both low-fat and low-carbohydrate diets have also shown positive results in reducing CVD factors in type 2 diabetes. More research is needed to confirm these short-term effects, as well as to demonstrate any longer-term effects.”
|“We agree that low fat and other styles of diet may also reduce CVD risk factors and improve symptoms of type 2 diabetes and other conditions. We encourage choice and options and feedback tells us many of the people following the Low Carb Program find this a preferred style of eating due to satiety and choice of foods which are not suitable on low-fat diets. Many diets work, adherence is key and the program aims to keep people engaged by providing on-going support, recipes and lifestyle articles, as well as peer- and behavioural mentor support on the Low Carb Program forum.
“We agree that long-term studies on blood lipids in those following a lower-carbohydrate diet are required and we are actively working with research institutions and leading academic partners in the UK and around the world with a hope to continue to collect longer-term data in this area. As with any new dietary approach, it will take some time for longer-term evidence to build and we feel if a person has found a dietary approach which works for them, safely, then we will not discourage them in continuing to follow this approach based on a lack of long-term evidence.”
|“Intermittent fasting is another problematic area. It is claimed that resting the pancreas through intermittent fasting improves insulin sensitivity, and that high carbohydrate diets can cause individuals to feel hungrier for the rest of the day. There is no strong evidence for intermittent fasting and there may be concerns about client groups with distorted eating.
|“The BDA review makes some valid points and we are continually open to constructive feedback and always learning and improving the program. The scripts often use analogies to make the scientific evidence simpler for the lay person to understand
“When it comes to intermittent fasting, we believe there is evidence for this approach and feedback tells us people find it a very easy and simple way to improve their health. In saying that, we know fasting is not for everyone – education and choice are most important.”
|“Care also needs to be taken by people making large changes to their diet who are taking any medications which could cause hypoglycaemia. This would also be the advice for anyone considering major dietary changes such as traditional slimming group and the program starts by asking participants to consult their GP and provides a handout detailing those medications which could potentially cause a hypo.”
|“The BDA review rightly points out the potential risks of making a significant change to diet, especially when taking certain medications.
“Patients referred to the Low Carb Program would be supported by their healthcare professional team, which mitigates this risk. Of the 415,000 patients enrolled into the Low Carb Program, there has not been one reported adverse effect.
“In addition, our modules are careful to continuously remind people to speak to their local healthcare professional team and provides a useful guide for doctors and diabetes nurses on de-prescribing drugs safely. We take the safety of those on the program very seriously.”