The Livin La Vida Low-Carb Show

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Dr. Annika Dahlqvist is the woman who got the Swedish government to recognize low-carb alongside low-fat in their dietary recommendations. Swwweeeeet!

Hello and welcome to the Internet’s #1 podcast for the truth about the amazingly healthy low-carb lifestyle, “The Livin’ La Vida Low-Carb Show With Jimmy Moore!”

In today’s episode, our host Jimmy interviews courageous Swedish doctor Annika Dahlqvist, who quite literally put her career on the line to advocate a low-carb diet in Sweden because she believed so strongly that it was best for her patients. Dr. Dahlqvist got her low-carb conviction through personal experience after trying it for herself with outstanding results. Starting at 80Kg (176lbs) she lost an average of 1 kilo (2.2lbs) a week over the course of several months until she reached her dream weight and, more importantly, felt better than she ever thought possible!

In the end, the government investigation in Sweden spurred on by Annika’s insistence on the health benefits of livin’ la vida low-carb found that a low-carb, high-fat diet (LCHF) is just as valid as a low-fat approach. The Swedish government now promotes low-carb alongside low-fat in their official health guidelines! Way to go Dr. Dahlqvist!

Listen to this incredible woman talk about the struggle and the sweet taste of victorious vindication.

LINKS MENTIONED IN EPISODE 107
- Dr. Annika Dahlqvist’s official blog (in Swedish)
- Dr. Dahlqvist’s low-carb diet recommendations (in English)
- Dr. Dahlqvist’s explanation for using a low-carb diet for health (in English)
- Swedish National Board of Health and Welfare web site
- Njurunda Family Practice where Dr. Dahlqvist had to resign
- Professor Christian Berne’s web site
- Related blog post: “If The Atkins Diet Works As Well As Low-Fat, Then Why Not Recommend It?”

We are always looking for volunteers to transcribe Jimmy’s interviews. Can you help? Please post in the comments!

To read Dr. Dahlqvist’s recommended “carbohydrate tight” diet as well as documents of support (including a copy of the letter from the Swedish National Board of Health and Welfare declaring low-carb, high-fat “in accordance with science” and “well tried”), just click the following link!

Dr Annika Dahlqvist´s Dietary recommendations:

You may eat:
Dairy products: Milk, yogurt, cheese, cottage cheese, feta cheese, sour cream, cream, butter, mayonnaise (preferably organic products). Do not pick low fat or products with added sugar.
Beef, pork, lamb, chicken, fish, shrimp and shellfish. Don´t cut off the fat!
Spices, (avoid additives), salt by taste
Vegetables (especially those that grow above the soil)
Oils: rapeseed (Canola), olive and linseed (organic, extra virgin)
Coconut oil (organic, unprocessed)
Egg (organic, has better omega 3/omega 6-ratio)

Don´t eat (or eat as little as possible of):
Potatoes, chips, French fries
Rice and products containing rice
Corn/maize and cornflakes
Products made of grain/cereals like bread, crackers, porridge, pancakes and other products rich in starch
Highly processed sausages, cured meats and pâtés with lots of additives
Candy, buns, cakes and sodas. Anything with added sugar
Margarines
Omega 6-rich oils like corn oil, sunflower oil, soybean oil, peanut oil

Christian Berne’s letter to the Swedish Board of Health and Welfare regarding Dr. Dahlqvist and her low-carb dietary recommendations:

AKADEMISKA Uppsala 2007-12-13
SJUKHUSET (The Uppsala Academic Hospital)
Torsten Mossberg
medicinalråd (medical adviser)
Enheten för behörighet och patientsäkerhet
(Department for authorization and patient safety)
SOCIALSTYRELSEN
(The Swedish Board of Health and Welfare)
106 30 Stockholm
Diarie(Journal) number: 44-112267/2005
Regarding registered physician Annika Dahlqvist’s advice concerning “Low Carbohydrate” diet. In regard to weight reduction and “wellbeing” documented in a background material covering Low-Carbohydrate diet.
Question: Is this treatment in accordance with science and well-tried experience?
The answer to this question is yes, reserving the fact that the scientific basis in the form of randomized controlled trials is much narrower than it is regarding diets with a higher content of carbohydrates and that long time trials (> 1 year) is lacking.
Furthermore, considering the aforementioned reasoning, it’s especially important that some of the practitioner’s self-evident principles of the trade are met. Any kind of intervention, whether it be related to drugs or lifestyle changes such as dietary advice, should be followed by a thorough, regular follow-up and record keeping of the patient’s healthiness and physical data(such as weight and waist measurement), how the patient has apprehended the advices given and the level of appliance thereof. Regarding patients with type 2 diabetes and/or overweight often combined with dyslipidemia or high blood pressure, surveilling HbAlc, blood lipids, blood pressure, P-creatinine and microalbuminuria is crucial. Since the longtime effects of this method are unknown there may be strong reason to recommend following-up over time using a national quality registry such as the National Diabetes Registry, that documents all of the above variables and can be used in local quality follow-up.
This advisory opinion is not the place for detailing the extensive literature research that I’ve used as a basis for my conclusions. Some relevant reviews are listed below. Substantially, they’re briefing randomized controlled trials aimed at weight reduction for the obese and a sprinkling of trials using subjects with type 2 diabetes. One of the systematic reviews (2003) concluded that the evidence to support recommending a low-carbohydrate diet was insufficient but there was no evidence for it being harmful in the short run at least. It has been difficult to prove that the carbohydrate share alone has had an effect on the weight reduction since several trials has ascribed to a coincidental total energy reduction as an essential cause for the weight loss. One reservation has been that upon consuming a larger share of saturated fat in the diet one is liable to get a minor increase of LDL cholesterol, something that has been observed in longer trials, and emphasizes the responsibility to follow-up patients with relevant sample-taking over time.
Observing the swedish diet debate can lead to the comprehension that the scientific basis can be retrieved in the tabloid papers, debate articles by laymen and in popular books on so-called fad-diets. A research into scientific medical literature (see references) however indicates that a number of randomized controlled trials and reviews of low-carbohydrate diets are found in leading journals with a high impact such as New England Journal of Medicine, Diabetes, Annals of Internal Medicine, JAMA and American Journal of Clinical Nutrition. Even if the literature so far is much more scares than the one documenting the effects of todays commonly recommended diet it shows that there is a serious scientific evaluation and debate going on about the possible positioning of carbohydrate restriction in the treatment of overweight and type 2 diabetes.
To sum up, with reservation for a narrow scientific basis, a lack of long time trials and trials that evaluates the effects on patient related effect measurements (cardiovascular diseases and for diabetes microvascular diabetic complications), a low carbohydrate diet can today be said to be in accordance with science and well-tried experience for reducing an overweight and type 2 diabetes the motivation being that a number of trials has shown effects in a shorter run and that no evidence for it being harmful has emerged in systematic literature researches performed so far. There’s no scientific support yet for treatments in excess of 1 year. A thorough evaluation of long time treatment results is therefore an important demand on the practitioner.
effect measurements
Christian Berne, professor, överläkare (senior physician)
Sektionen för endokrinologi och diabetesvård
(The section for endocrinology and diabetic care)
Specialmedicin (Specialized medicine)
OTM-divisionen (The OTM division)
Akademiska Sjukhuset (The Academic Hospital)

Systematic and other reviews
Nield L, Moore HJ, Hooper L, Cruickshank JK, Vyas A, Whittaker V, Summerbell CD. Dietary advice for treatment of type 2 diabetes mellitus in adults. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004097.
Westman EC et al. Low-carbohydrate nutrition and metabolism. Am J Clin Nutr 2007;86:276-84.
Nordmann AJ et al. Effects of Low-Carbohydrate vs Low-Fat Diets on Weight Loss and Cardiovascular Risk Factors A Meta-analysis of Randomized Controlled Trials. Arch Intern Med. 2006;166:285-293.
Parikh P et al. Diets and Cardiovascular Disease. An Evidence-Based Assessment. J Am Coll Cardiol 2005;45:1379-87
Kennedy RL et al. Nutrition in patients with Type 2 diabetes: are low carbohydrate diets effective, safe or desirable? Diabet. Med. 22, 821-832 (2005).
Bravata DM. Efficacy and safety of low-carbohydrate diets. A systematic review. JAMA 2003;289:1837-1850.
Quote from briefing: “There is insufficient evidence to make recommendations for or against the use of low-carbohydrate diets, particularly among participants older than age 50 years, for use longer than 90 days, or for diets of 20 g/d or less of carbohydrates.”

The letter sent to Dr. Dahlqvist from the Swedish Board of Health and Welfare:

Socialstyrelsen (The Swedish Board of Health and Welfare)
Torsten Mossberg
Medical adviser
Enheten för behörighet and patientsäkerhet
(Department for licensing and patient safety)
Licensed dietitian N N

Matter regarding dietary advice to patients with diabetes type 2 and/or overweight

Informer: licensed dietitians N N and N N
Concerned personnel: licensed physician Annika Dahlqvist
Report arrived to
Socialstyrelsen: 2005-12-06
Notification
The informers are questioning Dr Annika Dahlqvist’s advice to patients with overweight and patients with diabetes type 2 and means that the safety of the patients is endangered.

Background

Dr Dahlqvist is recommending chiefly patients with overweight but also patients with diabetes type 2 a diet low in carbohydrates but rich in fat and proteins. The carbohydrate contents is recommended to make up only as little as 10 percent of the total dietary energy content with a corresponding increase of the dietary contents of fat and protein. These diet recommendations shall be compared with those found in the Swedish Nutritional Recommendations(SNR) and in Socialstyrelsen’s current national guidelines for care and treatment of diabetes mellitus. These recommendations specify that carbohydrates should make up 50-55 percent energy and that fat should not exceed 30 percent energy.
Inquiry
Socialstyrelsen has studied correspondence between Dr Dahlqvist and Swedish dieticians, dr Dahlqvist’s blog and a set of data consisting of scientific articles and reports on the subject of diet and treatment of overweight and diabetes. Furthermore, Socialstyrelsen has consulted professor Christian Berne, the section for endocrinology and diabetic care at the Academic Hospital in Uppsala, moreover medical expert in the present revision of the national guidelines for care and treatment of diabetes mellitus. Socialstyrelsen has asked professor Berne to comment on this issue: Is treatment with a carbohydrate tight diet to patients with diabetes 2 in accordance with science and well-tried experience?

Professor Berne writes inter alia the following (advisory opinion attached):
“The answer to this question is yes, (i.e. the treatment is in accordance with science and well-tried experience (clarification by Socialstyrelsen)) reserving the fact that the scientific basis in the form of randomized controlled trials is much narrower than it is regarding diets with a higher content of carbohydrates and that long time trials (>1 year) is lacking.

Furthermore, considering the aforementioned reasoning, it’s especially important that some of the practitioner’s self-evident principles of the profession are met. Any kind of intervention, whether it be related to drugs or lifestyle changes such as dietary advice, should be followed by a thorough, regular follow-up and record keeping of the patient’s healthiness and physical data (such as weight and waist measurement), how the patient has apprehended the advices given and the level of appliance thereof. Regarding patients with type 2 diabetes and/or overweight often combined with dyslipidemia or high blood pressure, surveilling HbA1c, blood lipids, blood pressure, P-creatinine and microalbuminuria is crucial. Since the longtime effects of this method are unknown there may be strong reason to recommend following-up over time using a national quality registry such as the National Diabetes Registry, that documents all of the above variables and can be used in local quality follow-up.”

Furthermore professor Berne summarizes:

“To sum up, with reservation for a narrow scientific basis, a lack of longtime trials and trials that evaluates the effects on patient related effect measurements (cardiovascular diseases and for diabetes microvascular diabetic complications), a carbohydrate tight diet can today be said to to be in accordance with science and well-tried experience for reducing an overweight and type 2 diabetes the motivation being that a number of trials has shown effects in a shorter run and that no evidence for it being harmful has emerged in systematic literature researches performed so far. There’s no scientific support yet for treatments in excess of 1 year. A thorough evaluation of long time treatment results is therefore an important demand on the practitioner.”
Assessment
According to 1§ 2 chap. Law (1998:531) regarding practice within health and medical care whoever is a member of the staff shall perform their labor in accordance with science and well-tried experience. A patient shall be given competent and careful health and medical care that fulfills these requirements.
Dr Dahlqvist recommends in her treatment of patients with overweight and to patients with diabetes type 2 a diet that substantially deviates from the one recommended in the Swedish Nutritional Recommendations (SNR) and the current national guidelines for care and treatment of diabetes mellitus. The “carbohydrate tight” diet dr Dahlqvist is recommending can thus be said to deviate from science and well-tried experience as expressed in aforementioned recommendations and guidelines.

Socialstyrelsen accedes to professor Berne’s statement and assesses that dr Dahlqvist’s recommendations of a “carbohydrate tight diet” to patients with overweight and patients with diabetes type 2 can be considered to be in accordance with science and well-tried experience.

From 4 chap.2§ Socialstyrelsen’s regulations (SOSFS 2005:12) regarding management systems for quality and patient security emerges that there shall exist routines for how methods (for diagnostics and treatment) shall be applied, continuously followed-up and revised on demand. From 5 chap.1§ in the same regulations it emerges that there shall exist routines for regular auditing of the adequacy and efficiency of the methods, the routines and the care processes in order to achieve the goals.

Socialstyrelsen wishes to emphasize that, in connection with treatment of a patient with a diet that has scarce scientific documentation compared to the commonly recommended diet, it is essential with a thorough follow-up of the patient. Against the background of the fact that results from long time treatment with “carbohydrate tight diet” is lacking the Socialstyrelsen wishes to emphasize the importance of conducting long time randomized controlled follow-ups/trials and that these have approval from a science ethics review board.
Decision
The matter does not bring about any further actions by Socialstyrelsen.

The decision has been made by unit commander Staffan Blom.
Medical adviser Torsten Mossberg has been presenter.

According to Socialstyrelsen’s decision

Torsten Mossberg

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