CrossFit | Low Carbohydrate Diet to Achieve Weight Loss and Improve HbA1c in Type 2 Diabetes and Pre‐Diabetes

Low Carbohydrate Diet to Achieve Weight Loss and Improve HbA1c in Type 2 Diabetes and Pre‐Diabetes

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ByCrossFitJune 20, 2020

Question: Does a real-world low-carbohydrate diet, provided by general practice physicians, lead to meaningful improvements in glycemic control?

Takeaway: This 2014 study indicates a simple low-carbohydrate diet that does not emphasize calorie restriction can lead to glycemic improvements sufficient to reverse diabetes in a significant share of subjects. While this study fails to meet the standards of a rigorous clinical trial, it nonetheless provides additional evidence that a low-carbohydrate diet may be an effective tool for reestablishing metabolic health.

Prior to the discovery of insulin, carbohydrate restriction was a primary course of treatment for diabetes (1). Previous research, including research highlighted on CrossFit.com, has repeatedly indicated excess carbohydrate intake is a cause of obesity and diabetes, and a reduction in carbohydrate intake can improve glycemic control and in some cases resolve diabetes entirely (2). This small trial tested the impact of a low-carbohydrate diet in a general practice environment in Southport, U.K.

Nineteen diabetic patients were recruited in the course of general clinical practice. All patients were diabetic and chose to enter the trial when asked (i.e., were self-selected).

At enrollment, patients were given a diet sheet describing a low-carbohydrate diet that emphasized removing sugars and grains as much as possible while consuming vegetables, protein, and fats. Patients were told to eat as dictated by hunger and not to deliberately reduce calorie intake. An example diet sheet is posted below.

An example of the dietary advice sheet provided to patients

Of the 19 subjects, 18 completed the eight-month study period; the one dropout chose to discontinue the diet based on taste preferences. Among the 18 remaining subjects, mean weight loss was 8.6 kg, with all 18 losing weight. Mean HbA1c decreased from 51 mmol/mol to 40, and 16 of 18 patients were no longer diabetic at the study’s conclusion. Mean blood pressure decreased (systolic: 148 to 133 mmHg; diastolic: 91 to 83 mmHg), as did total cholesterol. As a result of these and other improvements, seven of 18 patients were free of all medications by the end of the study.

Qualitatively, subjects consistently reported improved well-being and energy levels while on the diet. Subjects similarly reported they were not hungry while following the diet, with multiple subjects surprised they had lost weight given the absence of hunger.

These results are consistent with those reported in a previous 44-month study, which found a similar 1.1% improvement in HbA1c among 16 diabetics following a low-carbohydrate diet for 44 months (3).

The authors of this study argue their results support mechanistic evidence indicating carbohydrate restriction reduces fat content in the liver and pancreas, which then supports the restoration of function within these organs and with it glycemic control (4).

This trial has significant limitations: It used self-selecting subjects, dietary compliance was not tracked, and there was not a control group. As such, it fails to meet the standards of a rigorous clinical trial and cannot provide insight into the specific impact of a low-carbohydrate diet on diabetes progression relative to other diets.

It instead provides real-world evidence that a low-carbohydrate diet, without deliberate calorie restriction, can lead to significant improvements in glycemic control in a majority of compliant subjects. In many cases, these improvements will be sufficiently large to reverse a diagnosis of diabetes. This provides additional support for the use of a low-carbohydrate diet in clinical practice, particularly given the inability of standard-of-care approaches to support a durable return to metabolic health. Additional research will continue to help us understand the generalizability, consistency, and potency of these effects across a variety of diets, treatment designs, and populations.

Comments on Low Carbohydrate Diet to Achieve Weight Loss and Improve HbA1c in Type 2 Diabetes and Pre‐Diabetes

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Julian Festor
June 21st, 2020 at 12:15 pm
Commented on: Low Carbohydrate Diet to Achieve Weight Loss and Improve HbA1c in Type 2 Diabetes and Pre‐Diabetes

Traduction :) (désolé pour les fautes d'orthographe)

Un régime avec peu de glucide pour la perte de poids et pour améliorer le HbA1c chez le diabétique de typé 2 et les pré diabétiques.


Question abordée : Est ce qu’un régime faible en glucide et qui est faisable prescrit par des médecins généralistes peut mener à des améliorations significatives du contrôle de la glycémie ?


Conclusion Rapide :

Cette étude de 2014 indique qu’un régime simple et faible en glucide qui ne met pas en avant la restriction calorique peut mener à des améliorations glycémiques suffisantes pour inverser le diabète chez un nombre significatif de sujet. Tandis que cette étude ne respecte pas les standards d’une étude clinique rigoureuse, elle donne des preuves supplémentaires qu’un régime faible en glucide peut être un outil effectif pour rétablir la santé métabolique.


___


Avant la découverte de l’insuline, la restriction en glucide était l’un des principaux traitements contre le diabète. Des recherches préalables mis en avant sur CF.com ont montrées de manière répétée qu’un excès en glucide était une cause de l’obésité et du diabète et qu’une réduction de glucide peut améliorer le contrôle glycérique et même résoudre entièrement des cas de diabètes.
Cette petite étude a testé l’impact d’un régime pauvre en glucide en Angleterre.

19 patients ont été recrutés dans une clinique de médecine générale. Tous les patients étaient diabétiques et était volontaire pour l’étude.


A l’inscription, les patients ont reçu une feuille décrivant le régime pauvre en glucide l’importance d’enlever les sucres et les céréales autant que possible tout en consommant des légumes, des protéines et du gras. Il a été dit au patient de manger à leur faim et de ne pas délibérément réduire les calories ingérées.


Sur les 19, 18 ont terminés l’étude sur 8 mois. 
Sur les 18, la perte de poids moyenne était de 8,6kg. Tous ont perdu du poids.

Le HbA1c moyen a diminué de 51mmol.mol à 40 et 16 des 18 patients n’étaient plus diabétiques à la conclusion de l’étude.

La pression sanguine moyenne a diminuée et le cholestérol total aussi.

A la fin de cette étude, 7 des 18 patients n’ont plus eu besoin de médicaments à l’issue de l’étude.


Qualitativement, les participants ont tous indiqué un meilleur bien-être et plus d’énergie. Les sujets ont également rapportés qu’ils n’avaient pas faim pendant le suivi de ce régime et plusieurs sujets ont été surpris d’avoir perdu du poids malgré l’absence de faim.


Ces résultats concordent avec une étude faite sur 44 mois.


Les auteurs de l’étude argumente que ces résultats supportent la preuve que la restriction de glucide réduit le gras dans le foi et dans le pancréas ce qui support en retour la restauration de ces organes et donc le contrôle de glycémie.


L’étude a des limites importantes. Elle a utilisé des volontaires. Leur rigueur n’a pas été suivi et il n’y avait pas de groupe de contrôle. Elle ne répond donc pas aux standards d’une étude clinique rigoureuse et ne donne pas d’aperçu sur l’impact spécifique d’un régime pauvre en glucide sur la progression du diabète par rapport à d’autres régimes.


En revanche elle donne des preuves venant du monde réel q’un régime faible en glucide sans restriction calorique peut amener des améliorations significatives sur le contrôle de glycémie chez la majorité des sujets qui suivent la prescription. Dans beaucoup de ces cas, ces améliorations ont suffit à inverser le diagnostique du diabète. Cela nous donne donc un argument supplémentaire supportant l’utilisation d’un régime pauvre en glucide dans la pratique médicale particulièrement si nous prenons en compte l’incapacité des standards de soin actuels à soutenir un retour à la santé métabolique. Des recherches additionnelles continueront à nous aider à comprendre la généralité, la constance et la puissance d’effets à travers une variété de régime, de format de traitement et de population.

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Stephen Bone
June 21st, 2020 at 11:59 am
Commented on: Low Carbohydrate Diet to Achieve Weight Loss and Improve HbA1c in Type 2 Diabetes and Pre‐Diabetes

I would also suggest readers with Diabetes (type2) should realise that Heart disease is the same thing as diabetes. I found out after 6 months research that most people are un-diagnosed diabetics see https://www.amazon.co.uk/Diabetes-Epidemic-You-Joseph-Kraft/dp/1425168094 the only true method is a Kraft Test. Diabetes is not the problem it is just a symptom of the real Disease "Insulin Resistance". you can not treat a symptom with Medication. My heart consultant and GP do not have a grasp of the correct science as well as most of the medical profession. If you read Dr Jason Fung you will understand the real science. One of the biggest problems is that LDL cholesterol is actually ok it is actually required to repair your body from bacteria, inflammation, and foreign viruses. It gets it bad reputation because it is always at the scene of the crime and should actually be viewed as the fire men at the scene of a fire.

My advice (but research it first with Ivor Cummins and many of his associates linked to him) is keep off Statins also.

https://www.youtube.com/watch?v=wnI9kaszQeo If you don't want Increased GGT levels or Liver disease, keep off Statins

Dr David Unwin is also a good source for information on diabetes (2) and how his patients have reversed it.

Insulin resistance is caused by high carb food and therefore only reversed by diet.

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Stanley Nasraway
June 21st, 2020 at 12:55 pm

Although contrary to the narrative championed by CrossFit, the overall preponderance of evidence demonstrates reduced mortality and cardiovascular complications with statins. I've listened to Fung on podcasts, and YouTube; he is a very good speaker, and I generally agree with the idea of lowering insulin surges, and I agree too with the idea of reduced carbohydrates. Of note, when searching for his research on PubMed, he has published a single case report in BMJ related to diet, intermittent fasting and Type 2 Diabetes Mellitus. Not a dedicated academician, doing the hard work of finding truth thru research. Be aware that his website promotes his side hustle of nutrition consulting; having a side business is fine, just be aware that there can be a conflict of interest. He is not completely objective, and he doesn't do the hard work of research, himself.

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