Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care

Unwin, David; Tobin, Simon; Murray, Stephen P.; Delon, Christine; Brady, Adrian

doi:10.3390/ijerph16152680

Cited by 58 publications

(72 citation statements)

References 28 publications

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“…While the effects of the diet on hepatic steatosis are thought to be both rapid and substantial [72], with animal studies [73] and post-hoc analyses in human trials [74] suggesting ketosis improves or prevents fatty liver, prospective randomized evidence is currently lacking. Similarly, reports of reductions in blood pressure and antihypertensive medication usage in observational studies and non-randomized trials are encouraging [75,76], but need to be assessed in prospective controlled trials. Conversely, there is good trial evidence that in patients with metabolic syndrome, adopting a low carbohydrate ketogenic diet is superior to other dietary strategies at improving lipid profiles [27,77].…”

Section: Clinical Effects Of Nutritional Ketosismentioning

confidence: 99%

“…We (D.U.) have described these changes in a cohort of 128 patients with type 2 diabetes on a low-carbohydrate diet for an average of two years [75], where there was a reduction in systolic and diastolic blood pressure of 10.9 and 6.3 mmHg, respectively, despite a 20% reduction in anti-hypertensive medication usage. The risk of hypotension mandates cautious and frequent monitoring of patients' blood pressure and vigilance for symptoms of postural hypotension.…”

Section: Early De-prescription Is Importantmentioning

confidence: 99%

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Low-Carbohydrate Diets in the Management of Obesity and Type 2 Diabetes: A Review from Clinicians Using the Approach in Practice

Kelly

Unwin²,

Finucane

2020

IJERPH

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Low-carbohydrate diets are increasingly used to help patients with obesity and type 2 diabetes. We sought to provide an overview of the evidence for this treatment approach, considering the epidemiology and pathophysiology of obesity and diabetes in terms of carbohydrate excess. We describe the mechanistic basis for the clinical benefits associated with nutritional ketosis and identify areas of practice where the evidence base could be improved. We summarize the key principles which inform our approach to treating patients with low-carbohydrate diets. The scientific controversy relating to these diets is real but is consistent with the known challenges of any dietary interventions and also the limitations of nutritional epidemiology. Secondly, notwithstanding any controversy, international guidelines now recognize the validity and endorse the use of these diets as a therapeutic nutritional approach, in appropriate patients. Thirdly, we have found that early de-prescription of diabetes medications is essential, in particular insulin, sulphonylureas, and sodium-glucose cotransporter (SGLT2) inhibitors. Fourthly, we encourage patients to eat ad libitum to satiety, rather than calorie counting per se. Furthermore, we monitor cardiovascular risk factors frequently, as with all patients with obesity or diabetes, but we do not necessarily consider an increase in low-density lipoprotein (LDL)-cholesterol as an absolute indication to stop these diets, as this is usually related to large LDL particles, which are not associated with increased cardiovascular risk. In the absence of large randomized controlled trials with cardiovascular and other hard endpoints, adopting a low-carbohydrate diet is a legitimate and potentially effective treatment option for patients with diabetes or obesity.

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Section: Clinical Effects Of Nutritional Ketosismentioning

confidence: 99%

Section: Early De-prescription Is Importantmentioning

confidence: 99%

Low-Carbohydrate Diets in the Management of Obesity and Type 2 Diabetes: A Review from Clinicians Using the Approach in Practice

Kelly

Unwin²,

Finucane

2020

IJERPH

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“… 1 Obese patients suffer from insulin sensitivity reduction and insulin resistance formation due to the decrease of insulin receptor density in fat, thus causing hyperinsulinemia, which plays an important role in the occurrence and development of cardiovascular and cerebrovascular related diseases and neurological diseases of patients, and weight loss may constitute an important part of comprehensive treatment for patients with Type-2 diabetes. 2 - 5 It is recommended in the guidelines for obesity that appropriate 5 - 10% weight loss can achieve significant metabolic improvement. Compared with 10% weight loss, 5% weight loss seems to be easier and has better compliance.…”

Section: Introductionmentioning

confidence: 99%

Study on the Correlation between Metabolism, Insulin Sensitivity and progressive weight loss change in Type-2 Diabetes

et al. 2020

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Objective: To observe the changes of lipid metabolism, blood glucose level and insulin sensitivity in patients with Type-2 diabetes after progressive weight loss of their body weight, so as to lay a theoretical foundation for diabetes treatment and education in the future. Methods: One hundred obese patients with Type-2 diabetes (BMI ≥ 25 kg/m2) who visited the endocrinology department of our hospital from April 2017 to April 2018 were given diabetes health education, diabetic diet, exercise and other measures to control their weight. The changes of blood glucose, blood lipid, insulin level and insulin release test before weight loss (T1), and at the time points of weight loss reached 5% (T2), 10% (T3) and 15% (T4) were recorded respectively to understand the influence of progressive weight loss on relevant indexes of patients. Results: With the decrease of body weight, the differences of TC, TG, LDL-C and HDL-C at different weight loss points were significant (p < 0.05), and the changes of fasting blood glucose in 5% and 10% weight loss were significant (p = 0.02). The 2h postprandial blood glucose showed the most significant difference when the weight loss reached 15% (p = 0.00). There was no statistical difference in the change of glycosylated hemoglobin among different weight loss points (p = 0.08). When the weight loss reached 10%, the blood insulin level was significantly lower than that before the weight loss, while the insulin level was not significantly changed when the weight loss reached 15%, but the peak of secretion was shifted forward. It is suggested that insulin sensitivity gradually increases with weight loss. Conclusion: Obese patients with Type-2 diabetes can benefit from weight loss, with abnormal blood glucose and lipid metabolism improved, insulin resistance relieved, and insulin sensitivity increased. doi: https://doi.org/10.12669/pjms.36.7.3027 How to cite this:Kong DX, Xiao Y, Zhang Z, Liu Y. Study on the Correlation between Metabolism, Insulin Sensitivity and progressive weight loss change in Type-2 Diabetes. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.3027 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Prescribing T2D medication in the context of a carbohydrate-restricted diet was the subject of a useful British Journal of General Practice review 25 that states the diet is safe with metformin, the most commonly prescribed antidiabetic medication. In addition to deprescribing antidiabetic medications analysis from the Norwood GP practice on hypertension, published separately, 24 shows that 20% of the antihypertensive drugs were also stopped due to significant improvements in BP.…”

Section: Discussionmentioning

confidence: 99%

Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years

Unwin

Khalid

Unwin

et al. 2020

BMJNPH

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BackgroundIn a single general practice (GP) surgery in England, there was an eightfold increase in the prevalence of type 2 diabetes (T2D) in three decades with 57 cases and 472 cases recorded in 1987 and 2018, respectively. This mirrors the growing burden of T2D on the health of populations round the world along with healthcare funding and provision more broadly. Emerging evidence suggests beneficial effects of carbohydrate-restricted diets on glycaemic control in T2D, but its impact in a ‘real-world’ primary care setting has not been fully evaluated.MethodsAdvice on a lower carbohydrate diet was offered routinely to patients with newly diagnosed and pre-existing T2D or prediabetes between 2013 and 2019, in the Norwood GP practice with 9800 patients. Conventional ‘one-to-one’ GP consultations were used, supplemented by group consultations, to help patients better understand the glycaemic consequences of their dietary choices with a particular focus on sugar, carbohydrates and foods with a higher Glycaemic Index. Those interested were computer coded for ongoing audit to compare ‘baseline’ with ‘latest follow-up’ for relevant parameters.ResultsBy 2019, 128 (27%) of the practice population with T2D and 71 people with prediabetes had opted to follow a lower carbohydrate diet for a mean duration of 23 months. For patients with T2D, the median (IQR) weight dropped from of 99.7 (86.2, 109.3) kg to 91.4 (79, 101.1) kg, p<0.001, while the median (IQR) HbA1c dropped from 65.5 (55, 82) mmol/mol to 48 (43, 55) mmol/mol, p<0.001. For patients with prediabetes, the median (IQR) HbA1c dropped from 44 (43, 45) mmol/mol to 39 (38, 41) mmol/mol, p<0.001. Drug-free T2D remission occurred in 46% of participants. In patients with prediabetes, 93% attained a normal HbA1c. Since 2015, there has been a relative reduction in practice prescribing of drugs for diabetes leading to a T2D prescribing budget £50 885 per year less than average for the area.ConclusionsThis approach to lower carbohydrate dietary advice for patients with T2D and prediabetes was incorporated successfully into routine primary care over 6 years. There were statistically significant improvements in both groups for weight, HbA1c, lipid profiles and blood pressure as well as significant drug budget savings. These results suggest a need for more empirical research on the effects of lower carbohydrate diet and long-term glycaemic control while recording collateral impacts to other metabolic health outcomes.

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Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care

Cited by 58 publications

References 28 publications

Low-Carbohydrate Diets in the Management of Obesity and Type 2 Diabetes: A Review from Clinicians Using the Approach in Practice

Low-Carbohydrate Diets in the Management of Obesity and Type 2 Diabetes: A Review from Clinicians Using the Approach in Practice

Study on the Correlation between Metabolism, Insulin Sensitivity and progressive weight loss change in Type-2 Diabetes

Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years

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