| I’m curious about this as I have loved ones with T2D. What makes this work groundbreaking? It seems like one doctor talked about how at his practice he started telling people to go low carb and noticed they were improving. But his data doesn’t compare the 27% of his patients who opted in to the low carb diet to those who chose another option. The low carb diet has been around for a while? Has there not been a RCT looking at how it works for treating diabetes? He makes an argument on why RCTs aren’t so good that is unconvincing to me. > However, when it comes to actual clinical implementation, RCTs have a problem. So many variables have been removed that the studies no longer represent real people leading ordinary lives outside of a tightly controlled trial. For example, in our National Health Service (NHS) clinic, very few patients with hypertension do not have a weight problem. Many of them are also on drugs for joint pain, reflux or depression. This is why the results seen in RCTs often do not roll out into real-world, clinical practice. For this to occur we need interventions that have a high degree of ‘external validity’—approaches for that better represent the ‘ordinary’ people who populate our clinics. Away from the carefully controlled conditions of clinical trials, results can be very different in the messy, complex world of everyday general practice. I noticed that he mentioned a RCT on the low carb diet showing good results and read it, but it seems to be p-hacked. They don’t even mention the mean change in weight between the two groups, but only the percent that achieved a 5 or 10% reduction in weight at some point during the study. The also said that 55% of patients lost weight and 45% gained weight. https://nutrition.bmj.com/content/bmjnph/6/2/326.full.pdf |