I would really like someone like, say TheAwfulToad to take apart this video by redpillvegan about Virta Health indicating, for example, their study shows little or no benefits above weight loss. I say TAD because you claim to be an expert on statistical significance. And as far as I can see it RPV's argument is that the Virta Health study is insignificant statistically.
Nice to see you here, andy. And I mean that sincerely, since I'm banned from Healthy Eating and can't discuss these things with you there
I'll watch the video in a bit and report back. There are several other experts here too (including a highly-qualified nutritionist) so it should be lively discussion!
Sarah Hallberg has an annoying voice, doesn't she?
RPV doesn't mention anything about statistical significance, but it'd be pretty hard to see an effect of that magnitude, on a large number of people, turning out to be statistically insignificant. I'd have to get a copy of the original paper to check. The p-value will be in there somewhere.
I have to say, I'm not particularly impressed by Virta Health's results, which are only marginally better than those achieved by Dr David Unwin ... who basically just tells people to eat proper food, avoid carbs where possible, and don't fear the fat. Virta also have a particularly irritating habit of quoting ranges from the mean as '+/-' instead of giving the SD value.
I suspect the difference boils down to (a) their client base and (b) the somewhat different medical climate in the US and the UK.
To take the second point first: in the US, a doctor is at high risk of getting sued off the face of the earth if he does something non-standard, even if that non-standard procedure has a positive outcome. That can happen in the UK, but the GMC tends to close ranks and protect erring doctors, whereas in the US, they'll be thrown under the bus to protect to profession. Virta Health are walking a tightrope. Of course they prescribe statins. Of course they keep people on their blood pressure medication and their diabetes pills. Of course they say all the right things about LDL. If they didn't, every adverse effect would be blamed on recklessness, and they'd be shut down. They're selling a medical product, and they have to comply with the rules and regulations about "best practice". I'm frankly surprised they're allowed to operate at all.
If you read the books and articles written by Phinney and Volek, their advice is much more straightforward, and they dismiss the value of pills and the causative role of LDL in CVD.
Now look at the people Virta Health are dealing with. They're basket-cases. Mostly morbidly obese and taking any number of pills for the broader issues associated with metabolic syndrome. They've probably been diabetic for years. Any improvement would be a miracle.
If you look at Unwin's subjects, they tend to be just barely diabetic, at least according to their HbA1c numbers. In other words, their bodies are not too badly damaged by glucose toxicity. These people invariably have excellent results: at the last count, Unwin is getting something close to 100% of patients with HbA1c<48mmol/L (although some remain above 42mmol/L after 21 months - I think it's about 30%).
The point is that once your pancreas is damaged, it will not repair itself. You stop diabetes early, or you've lost your chance. This point is made very clear by the paper I posted in the HE thread some time back. There's a scatterplot showing that the worse people were to begin with, the worse their prognosis on LCHF (or on anything else for that matter - anyone claiming to reverse beta-cell destruction needs to have some extraordinary evidence).
As for the weight loss aspect: you cannot lose weight without restoring glycemic control. It's physically impossible. The point here is that glycemic control is subject to brittle failure, like all homeostatic loops. Your body has some incredible ways of delaying or mitigating this failure, but ultimately physics and math says that failure will happen eventually.
A low-fat low-GI diet works not because it's low-fat, but because it's low-GI. Backing off away from the saturation point can be enough to restore glycemic control, although the fact that low-fat low-calorie protocols always show a less-impressive weight loss than LCHF suggests that it's suboptimal.
I've had an ongoing argument in the diabetes thread about whether obesity is the CAUSE of diabetes. It clearly is not, because taking a diabetic patient and sending him into ketosis produces an instant improvement in blood sugar control - in fact it couldn't really do anything else, simply by the nature of the underlying biochemistry. A diabetic can be put into remission within a matter of days on LCHF, long before he has lost any significant weight. Obviously, his HbA1c will show no change for months, but his dynamic blood glucose control will be (roughly) within the expected normal range.
Piling on weight is actually your body's last-ditch attempt to maintain glucose control when faced with a persistent high-GI/high-carb diet; it's been shown that diabetics who gain weight easily actually have a better chance of survival than those who remain thin(ner).
Finally ... it's worth pointing out (again) that LCHF is completely on board with the "whole foods plant-based" concept. We just don't eliminate healthy, tasty food for no good reason.
Aaargghhh!! Watching this video made me want to pull my hair out!! So frustrating I stopped halfway through, sorry I find misrepresentation, or partial analysis, or wilful distortion of "statistics" intensely annoying. .. I know so very little about the mechanics of keto, and could not eloquently explain it to save my life.. but I do know my own experience. I would be very interested to read more details of how the study itself was conducted, as I cannot understand if the participants were generally severely or morbidly obese, how did they manage to lose so little over the course of a whole year? Were these people really properly following a keto lifestyle for a year? I must look up the study. -- very much enjoyed reading TAT's response.
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