Low carbohydrate diet to achieve weight loss and improve HbA_1c in type 2 diabetes and pre‐diabetes: experience from one general practice

Abstract

Patients with diabetes have long been exhorted to give up sugar, encouraged instead to take in fuel as complex carbohydrate such as the starch found in bread, rice or pasta (especially if ‘wholemeal’). However, bread has a higher glycaemic index than table sugar itself. There are no essential nutrients in starchy foods and people with diabetes struggle to deal with the glycaemic load they bring. The authors question why carbohydrate need form a major part of the diet at all. The central goal of achieving substantial weight loss has tended to be overlooked. The current pilot study explores the results of a low carbohydrate diet for a case series of 19 type 2 diabetes and pre‐diabetes patients over an eight‐month period in a suburban general practice. A low carbohydrate diet was observed to bring about major benefits. Blood glucose control improved (HbA1c 51±14 to 40±4mmol/mol; p<0.001). By the end of the study period only two patients remained with an abnormal HbA1c (>42mmol/mol); even these two had seen an average drop of 23.9mmol/mol. Weight fell from 100.2±16.4 to 91.0±17.1kg (p<0.0001), and waist circumference decreased from 120.2±9.6 to 105.6±11.5cm (p<0.0001). Simultaneously, blood pressure improved (systolic 148±17 to 133±15mmHg, p<0.005; and diastolic 91±8 to 83±11mmHg, p<0.05). Serum gamma‐glutamyltransferase decreased from 75.2±54.7 to 40.6±29.2 U/L (p<0.005). Total serum cholesterol decreased from 5.5±1.0 to 4.7±1.2mmol/L (p<0.01). This approach is easy to implement in general practice, and brings rapid weight loss and improvement in HbA1c. Copyright © 2014 John Wiley & Sons. Practical Diabetes 2014; 31(2): 76–79

Association of dietary intake and BMI among newly diagnosed type 2 diabetes patients attending diabetic clinics in Kampala

“…High protein intake has also been reported to have other positive health outcomes including effects on total cholesterol and triacylglycerol and better lipid results which encourages the recommendation of high protein intake to patients with type 2 diabetes [34]. The finding that a higher intake of carbohydrate is associated with higher BMI and that lower intake is associated with lower BMI has been documented in majority of prospective experimental studies [13,14,35]; which reported weight loss effects of low carbohydrate diets. However, a study in Korea [10] did not find any association between carbohydrate intake and obesity.…”

An evidence‐based approach to developing low‐carbohydrate diets for type 2 diabetes management: A systematic review of interventions and methods

“…Eighteen studies were randomized controlled trials, 17,21-37 three were non-randomized controlled clinical trials, 15,38,39 16 were single-arm intervention studies, 16,[18][19][20][40][41][42][43][44][45][46][47][48][49][50][51] two were retrospective case series analyses, 14,52 and two were case reports. 53,54 Thirty-four studies [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][32][33][34][36][37][38][43][44][45][46]…”

Low calorie and low carb diets for weight loss in primary care

“…In 2012, he began to offer dietary advice11 recommending that newly diagnosed patients cut down or avoid not just sugars but also starchy carbohydrates like bread, pasta, rice, and potatoes. Instead, he encouraged them to eat green vegetables, meat, fish, eggs, and nuts as well as whole fat dairy products and olive oil.…”

“…He now monitors more than 100 patients who have been on a low carb diet for over two years and has published some results 11. He recently launched a free video course for doctors (www.dietdoctor.com/low-carb/for-doctors).…”