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Study finds low-carb diets have potential to drive diabetes remission


Morgan Liotta


14/01/2021 3:05:30 PM

But one expert says that while ‘diet change is part of the story, carbohydrates are not the only sentence in this book’.

Healthy food and blood glucose monitor
The new study was the first systematic review to examine the safety and efficacy of low-carb diets in adults and to assess remission rates of type 2 diabetes.

A new study investigating the efficacy and safety of low carbohydrate diets and very low carbohydrate diets for people with type 2 diabetes, found those who adhered to a low-carbohydrate diet after six months had the greatest health improvements.
 
The first systematic review to examine the safety and efficacy of such diets in adults and to assess remission rates of type 2 diabetes examined the combined effects of 23 international clinical trials involving 1357 participants. Additional data from five of those clinical trials on markers of blood sugar status was also included.
 
Those who followed a diet containing less than 26% of daily calories from carbohydrates achieved greater rates of type 2 diabetes remission than those who followed other diets traditionally recommended for managing the disease.
 
Building on existing research, the study authors concluded that a low-carbohydrate diet can help to achieve greater weight loss and is more effective in reducing diabetes medication and improving blood glucose control.
 
In further developments, it showed the low-carbohydrate dietary approach to be effective in driving type 2 diabetes into remission, suggesting such diets could be considered an effective alternative, while monitoring and adjusting diabetes medication as needed.
 
However, Dr Gary Deed, Chair of the RACGP Specific Interests Diabetes network, has some hesitancy.
 
He told newsGP that although the new research shows some promising results, the issues of translating clinical trials to clinical efficacy is an important factor.
 
‘Diet change is part of the story, but carbohydrates are not the only sentence in this book,’ he said.
 
‘Where is the lifecycle of diabetes for patients that were placed into remission? If the diabetes is longer term does this method work, and if so, in which patients does the remission last longer than the allotted timeframe of the trials?’
 
He also highlighted that low-carbohydrate diets are not a panacea for the ‘many issues’ that arise when a person has diabetes.
 
‘Remember, people develop diabetes and it is not purely a carbohydrate-intolerance condition as some have labelled it,’ he said.
 
‘There are complex pathophysiological processes affecting not just carbohydrate metabolism, with implications for multiple systems in the body, let alone a person’s lifestyle and mental health.
 
‘Not all people can sustain a complex dietary change – and it is not because they lack will power – the many social determinants that affect health play a complex web of effects in all of our lives.’
 
Dr Deed said it is also important to use the term ‘remission’ rather than ‘reversal’ in this context, particularly when the study criteria are unclear.
 
‘[The term] “reversal” has implications that mean the pathophysiological process that led to diabetes correcting itself completely,’ he said.

Dr-Gary-Deed-Diabetes-hero.jpg
Dr Gary Deed warns that low-carbohydrate diets are not a panacea for the many issues that arise when a person has diabetes.

Citing the study’s ‘moderate to low certainty evidence’ that patients adhering to low-carbohydrate diet for six months may experience remission of diabetes without adverse consequences, Dr Deed believes this may not be the case.
 
‘Further remitting of weight loss may be related to further onset of hyperglycaemia and the type 2 diabetes returning,’ he said.
 
‘It is important to note that people with impaired glucose parameters below the diagnostic criteria for diabetes accompanies an elevated cardiovascular risk – that must also not be ignored.
 
‘Thus, persons who have the glucose reduced by dietary and weight change may not have fully eliminated there risk factors for heart and vascular disease … so the word “reversal” is prone to misunderstanding by people not fully being aware of the underlying risks.’
 
The RACGP’s diabetes general practice handbook, for which Dr Deed is clinical editor, states that the total amount of carbohydrates consumed may be the major dietary factor that contributes to high blood glucose levels after eating.
 
Dr Deed recommends an individual approach to monitoring patients’ diets.
 
‘My advice is that ad hoc adjustment of dietary carbohydrates without addressing whole-of-health eating plans is prone to causing nutritional imbalances and or deficiencies,’ he said.
 
‘The quality and quantity of carbohydrates needs to be worked out with each indifferent patient related to their lifecycle stage of diabetes and current medication/lifestyle, etc.
 
‘It may need careful advice – an accredited practicing dietitian is always advisable – especially if there is a need for self-monitoring of blood glucose levels and use of medications that can induce hypoglycaemia.’
 
He also cautions that a low-carbohydrate diet may cause risks in some patients who are utilising sodium-glucose co-transporter-2 (SGLT2) inhibitors, raising risks of a potentially fatal euglycaemic diabetic ketoacidosis (DKA).
 
The study authors anticipate the new research will assist both healthcare providers and patients to better understand how a focus on dietary approach can be used to treat type 2 diabetes, by examining the evidence on the effects of low-carbohydrate diets against clinical targets.
 
But also Dr Deed says a holistic approach is needed, in which GPs are central.
 
‘GPs can support [patients with diabetes] to individually address their health problems in a sustainable and patient-focused way,’ Dr Deed said.
 
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Dr Lynette Dorothy Allen   15/01/2021 1:14:17 PM

Life without Diabetes by Professor Ross Taylor Professor of Medicine and Metabolism at Newcastle University UK is an excellent book on this topic published 2020.He has been working in the area since 2006 and raises the concept of a personal fat threshold and once no more fat can be stored in fat cells under the skin it spills over into the abdominal cavity and then the main organs


Dr Penelope Elspeth Figtree   12/04/2021 8:57:13 AM

I am disappointed that Dr Deed chooses to diminish the huge significance of low carb diets..This science shows what I and many other GPS are finding that low carb diets are the most exciting t thing we have ever done in medicine. We are STOPPING drugs easily and that includes insulin . My record is 140 units in 24 hours and that patient 18 months later is only on metformin with HBAIC of 5.8%. This is the rule most patients get off most diabetic drugs in days. Another pTke t of mine was on insulin for 30 years and is now only on 7 units of Lantus a day. ( was on novorapid plus Lantus 60). These studies back what we low carb gps see everyday. It is so easy and SAFE. Why Dr Deed insists on making this some sort of difficult and challenging process with many dangers and ponders on whether it’s remission or reversal is incredible to me. The danger comes only from too many drugs so stop them!!!


Dr Elizabeth Fraser   13/04/2021 8:43:47 PM

Hard to argue with decades of woeful dietary advice to PWD in 1000 characters, but here goes. After 4 decades of the low fat dietary experiment (no randomisation, no control group, no informed consent), the results are in. With standard therapy (low fat diet and pills) for T2D you are more likely to die than achieve remission. After 3 yrs studying the science and implementing LC with patients, I have yet to find an objection to LC that is evidence-based. Not every one wants to give up the convenience of bread or breakfast cereals, but those patients who get it deserve support from well-informed GPs who know how to de-prescribe. Hint: it's not that hard. Bring on CGM for all PWD/prediabetes! Diabetes is a far more potent predictor of CV risk than LDL. Finally, the Captain Cleave argument: “For a modern disease (eg T2D) to be related to old-fashioned foods (eg meat, eggs, dairy) is one of the most ludicrous things I have ever heard in my life."


Dr Ronald Schweitzer   14/04/2021 10:16:07 PM

How very disappointing by Dr. Deed. If a new medication had even the remotest possibility of doing what low carb can do to put diabetes into remission, we'd all be prescribing it left, right and centre. Don’t worry about the side effects, or that not everyone can take it – “prescribe it” would be yelled from the rooftops. But because it's dietary, and not fitting with the dominant dietary dogma of the past 40 years - the very dietary dogma which got us where we are – let’s just ignore the evidence. Dr. Deed says "a holistic approach is needed" - but the holistic approach Dr. Deed describes seems to not include the low carb approach: “Those who followed a diet containing less than 26% of daily calories from carbohydrates achieved greater rates of type 2 diabetes remission than those who followed other diets traditionally recommended ” How can a GP not offer a low carbohydrate approach, which "after six months had the greatest health improvements." Not offering this is immoral.