Dec 2014 update: New research on the Low Carb Diet in general practice

[NoCrbs4Me]

It just seems to me that a lot can be gleaned from looking at insulin response/levels in addition to blood glucose levels. An abnormal insulin response shows up before abnormally high blood glucose levels show up. Also, on page 8 of the article the effect of low carb diets on insulin response is discussed. It says 2 to 3 weeks of a standard high carb diet were required to see the true insulin response following a prolonged low carb diet.

 

[IanD]

A researcher in the low carb field was explaining to me that there is some evidence that diabetic controll can improve on the diet without weight loss
This hasn't been my experience particularly- Have any of you found this to be true ?

I initially lost weight from 12st 8 lb to 11st 12lb - BMI 27 to 25. That was 7 1/2 years ago. Since then its been between 12 & 12st 5lb. My control has been satisfactory all that time (HbA1c 6.0 - 6.5)

The disabling complications (developed on the DUK/NHS high carb, low fat diet ) that caused me to change diet have been completely reversed, with no hint of return.

 

[AndBreathe]

It just seems to me that a lot can be gleaned from looking at insulin response/levels in addition to blood glucose levels. An abnormal insulin response shows up before abnormally high blood glucose levels show up. Also, on page 8 of the article the effect of low carb diets on insulin response is discussed. It says 2 to 3 weeks of a standard high carb diet were required to see the true insulin response following a prolonged low carb diet.

Personally, I think I suffered from insulin resistance, as I believe my body now functions pretty well. The insulin resistance/fat storage argument is somewhat circular, in my view, in that almost by definition, one will impact the other.

I have stated on numerous occasions that I would be interested to understand my insulin production levels and responses far better than I do now, but the prospect of an OGTT, at this time, doesn't appeal in the slightest. I may have some bloods done in the coming months to explore insulin production (I will be overseas, and therefore having no impact on the NHS), but I don't think that really tells me a great deal without understanding my response profile at the same time. I'll decide nearer the time when I rock up for my (self-funded) HbA1c around March.

 

[IanD]

Personally, I think I suffered from insulin resistance, as I believe my body now functions pretty well. The insulin resistance/fat storage argument is somewhat circular, in my view, in that almost by definition, one will impact the other.

I have stated on numerous occasions that I would be interested to understand my insulin production levels and responses far better than I do now, but the prospect of an OGTT, at this time, doesn't appeal in the slightest. I may have some bloods done in the coming months to explore insulin production (I will be overseas, and therefore having no impact on the NHS), but I don't think that really tells me a great deal without understanding my response profile at the same time. I'll decide nearer the time when I rock up for my (self-funded) HbA1c around March.

Long ago, on another thread, a member did a DIY GTT. His 1/2 hourly BG readings were almost identical to my hourly readings after eating a one-off porridge b'fast, or a conventional cereal b'fast. That's an experiment I would only do again for research purposes.

 

[AndBreathe]

Long ago, on another thread, a member did a DIY GTT. His 1/2 hourly BG readings were almost identical to my hourly readings after eating a one-off porridge b'fast, or a conventional cereal b'fast. That's an experiment I would only do again for research purposes.

Thanks Ian - At my first, post-diagnosis review (I've only had the one), I voiced an interest to the nurse conducting the review. Based on my progress (in my signature) she was disinterested in sponsoring the test, but suggested I could easily replicate the test, if I really wanted to. I guess the want never came high enough on my list of priorities, or I would have done it by now.

I have done two or three 24 hour cycles of hourly testing, whilst eating in my now normal way, which showed some interesting results, but not the whole picture; for me. My finger-prick testing, even hourly (which was on the hour, each hour, not governed by eating or drinking) doesn't support my HbA1c as I rarely seen anything to support an average of 5.4/5.5 (using the last 2 results of 31 and 32 respectively, but I clearly have some spikes I haven't been able to capture.

At some stage, when Abbott open again to new customers, I will have a couple of Libre sensors, for a look over the longer period. I'm sure that will be fascinating.

@Southport GP - Apologies if we're meandering off-track here.

 

[jack412]

You make a good point -for type two diabetes, insulin resistance is probably key. Here is an interesting study in exchange
Mary C Gannon123*† and Frank Q Nuttall13†’Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition Nutrition & Metabolism 2006, 3:16 doi:10.1186/1743-7075-3-16
However in my practice the average person with diabetes on our trial had a BMI of 34 and lost 9KG while their diabetes was sorted.

this is worth a look at, as you know c-peptide = insulin levels and how it rises in the prediabetic range and drops off when diabetic

www.youtube.com/watch?v=9BFRi-nH1v8

 

[NoCrbs4Me]

Thanks Ian - At my first, post-diagnosis review (I've only had the one), I voiced an interest to the nurse conducting the review. Based on my progress (in my signature) she was disinterested in sponsoring the test, but suggested I could easily replicate the test, if I really wanted to. I guess the want never came high enough on my list of priorities, or I would have done it by now.

I have done two or three 24 hour cycles of hourly testing, whilst eating in my now normal way, which showed some interesting results, but not the whole picture; for me. My finger-prick testing, even hourly (which was on the hour, each hour, not governed by eating or drinking) doesn't support my HbA1c as I rarely seen anything to support an average of 5.4/5.5 (using the last 2 results of 31 and 32 respectively, but I clearly have some spikes I haven't been able to capture.

At some stage, when Abbott open again to new customers, I will have a couple of Libre sensors, for a look over the longer period. I'm sure that will be fascinating.

@Southport GP - Apologies if we're meandering off-track here.

I am on the last day of my first freestyle libre sensor and I recommend it for any type 2 that can afford it. Fascinating results.

 

[AndBreathe]

I am on the last day of my first freestyle libre sensor and I recommend it for any type 2 that can afford it. Fascinating results.

Abbott are not open to orders from new customers at the moment. I had planned to let the launch wrinkles be ironed out, the "invest" around now, with a view to using it both here and when I go back to the Tropics in January. I may have to wait until I come back to UK now though.

I'll be a complete scan-junkie when I get going. I just know it.

 

[NoCrbs4Me]

Abbott are not open to orders from new customers at the moment. I had planned to let the launch wrinkles be ironed out, the "invest" around now, with a view to using it both here and when I go back to the Tropics in January. I may have to wait until I come back to UK now though.

I'll be a complete scan-junkie when I get going. I just know it.

You will not be disappointed, unless you get a wonky sensor. I've got two weeks of data and a food/exercise diary to match up in Excel. As a scientist it was very interesting to experiment on myself.

 

[Southport GP]

It just seems to me that a lot can be gleaned from looking at insulin response/levels in addition to blood glucose levels. An abnormal insulin response shows up before abnormally high blood glucose levels show up. Also, on page 8 of the article the effect of low carb diets on insulin response is discussed. It says 2 to 3 weeks of a standard high carb diet were required to see the true insulin response following a prolonged low carb diet.

Good point Prof Roy Taylor of Newcastle University makes another. He noticed that many folk have abnormal liver function tests, notably GGT levels for years before diabetes itself becomes evident He says there is a 'long silent scream' from the liver before we become diabetic.
It's important to look at what predicts diabetes as in these folk the sacrifices of being low carb may pay the best dividends .
It's for this reason I am currently looking at publishing on this subject.
In practice I agree with the World Health Organization which was going on about abdominal obesity a decade ago All doctors were sent tape measures. It was a long time till I understood how important mine was !!!

 

[Southport GP]

Have they successfully done a GTT, when you say 'sorted'?

Sorry Douglas that was sloppy late night responding
With the advent of HbA1c most doctors have just about stopped doing GGTs
By sorted I should have explained that patients with previously diabetic results >47 mmol/ mol ended up with normal or pre-diabetic results The average dropped from 52.4 to 42.4 over about a year

 

[douglas99]

But, you would expect that, simply from the lack of carbs to cause any response.
Surely it would be worth trialling glucose response, to see if any reversal has been seen in your patients?

 

[AndBreathe]

But, you would expect that, simply from the lack of carbs to cause any response.
Surely it would be worth trialling glucose response, to see if any reversal has been seen in your patients?

What difference would that make to how they lived their lives or the treatment they could expect? My personal thoughts would be that could be of limited scientific value without a starting metric.

 

[andcol]

By sorted I should have explained that patients with previously diabetic results >47 mmol/ mol ended up with normal or pre-diabetic results The average dropped from 52.4 to 42.4 over about a year

Oh I am surprised you didn't see a bigger drop than that although if your starting average was only 52 then that isn't much of a drop that can be made. Did you find those at the highest HbA1c results dropped to about the same levels as those that were just over the threshold.

I know that seeing people reduce and sustain an improved HbA1c is not the norm for most GPs and their patients but for me that drop is just not great enough. Any thoughts on how to improve the value further

As the distribution is not likely to be normal and more log-normal the mode and median are generally far more useful than the mean. I would expect these to be clearly into the "normal" range. The median for a log-normal distribution is equivalent to the mean for a normal distribution (where mean=mode=median)

 

[douglas99]

What difference would that make to how they lived their lives or the treatment they could expect? My personal thoughts would be that could be of limited scientific value without a starting metric.

It seems to make a difference to those who have reversed their diabetes on the Newcastle diet.

As to living their lives, if they are content to stay on LCHF, as you are, it would make no difference at all.

However, I don't quite see how you don't believe Southport GP hasn't documented his starting metric, if you read his study in full, and I can't see how even 'limited' value would be dismissed by anyone, as a way to reverse diabetes?

 

[Lamont D]

Good point Prof Roy Taylor of Newcastle University makes another. He noticed that many folk have abnormal liver function tests, notably GGT levels for years before diabetes itself becomes evident He says there is a 'long silent scream' from the liver before we become diabetic.
It's important to look at what predicts diabetes as in these folk the sacrifices of being low carb may pay the best dividends .
It's for this reason I am currently looking at publishing on this subject.
In practice I agree with the World Health Organization which was going on about abdominal obesity a decade ago All doctors were sent tape measures. It was a long time till I understood how important mine was !!!

I had a fatty liver and abnormal liver function test results and scans for scarring and scelrosis amongst other problems. For over a decade since before the turn of the century!
The only advice I got was give up alcohol ( which I had) but it wasn't that! To eat a 'healthy' diet (eatwell plate) with plenty of carbs!! And to do more fitness! ( I was walking approx 10 miles a day with work and leisure!

The change was low carbing. Or as few carbs as poss.
Now after only a year. Amongst other great outcomes. Fatty liver gone, no scarring, just healthy! Liver function test, brilliant. Normal!
It was the carbs and sugars that was damaging me.
The evidence is there, why are they still advising the wrong 'diet'?
No logic at all!!

 

[douglas99]

I've an open mind, that's why a GTT after a low carb diet is important to show that T2 is reversed, and not simply masked by the lack of any carbs
This should be as big as the Newcastle diet, if shown, and proven, correctly.

 

[Southport GP]

Oh I am surprised you didn't see a bigger drop than that although if your starting average was only 52 then that isn't much of a drop that can be made. Did you find those at the highest HbA1c results dropped to about the same levels as those that were just over the threshold.

I know that seeing people reduce and sustain an improved HbA1c is not the norm for most GPs and their patients but for me that drop is just not great enough. Any thoughts on how to improve the value further

As the distribution is not likely to be normal and more log-normal the mode and median are generally far more useful than the mean. I would expect these to be clearly into the "normal" range. The median for a log-normal distribution is equivalent to the mean for a normal distribution (where mean=mode=median)

Drilling down into our data
The average reduction in HbA1c if we just take those with a starting result of >47 mmol/mol the T2DM, was 16 mmol/mol this is better than would be expected from the best drug we have -metformin And as an average I was pleased with it. I have preliminary interest from Practical Diabetes in publishing the longer term follow up we have done then you can all judge for yourselves

 

[AndBreathe]

Drilling down into our data
The average reduction in HbA1c if we just take those with a starting result of >47 mmol/mol the T2DM, was 16 mmol/mol this is better than would be expected from the best drug we have -metformin And as an average I was pleased with it. I have preliminary interest from Practical Diabetes in publishing the longer term follow up we have done then you can all judge for yourselves

Have you considered doing any comparative work with pre-diabetes, or does the percentage progression to T2 seem too uncertain for you to conduct a robust study? in you experience, how do pre-diabetics receive and react to their pre-diabetic status?

 

[Southport GP]

Have you considered doing any comparative work with pre-diabetes, or does the percentage progression to T2 seem too uncertain for you to conduct a robust study? in you experience, how do pre-diabetics receive and react to their pre-diabetic status?

Just today I submitted the low carb and the liver study It has taken two years and an hour every day for the past six months so I need a breather for a while before I start a new thing !
The point about diagnosing someone as pre-diabetic it that it brings with it a good chance ,a hope of not becoming diabetic that seems to galvanise folk into dietary action
I find most loose weight and as well as improving HbA1c results enjoy improved blood pressure and the feeling they have taken control of their own health a bit .
It depends how the information is handled - I feel it's better treated as an opportunity rather than a threat.