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Raised GGT levels, Diabetes and Non-alcoholic Fatty liver Disease (NAFLD):trail of low carb diet

Southport GP

Well-Known Member
Verified HCP
Messages
194
Location
Merseyside
Type of diabetes
HCP
Treatment type
I do not have diabetes
AT LAST!! after so much work over three years our article is to be published this September in Diabesity in Practice. the Editor has agreed for you all to have a pre-publication summary. this is part of my efforts to get recognition that the low carb diet is a valid choice -not just for folk with diabetes but also for some of those with liver problems. Also that this is a diet that works on the longer term -not just a few weeks. The summary:

Abnormal liver function tests are often attributed to excessive alcohol consumption and/or medication without further investigation. However they may be secondary to non-alcoholic fatty liver disease (NAFLD). NAFLD is now prevalent in 20-30% of adults in the Western World. Considering the increased cardiovascular and metabolic risk of NAFLD, identification and effective risk factor management of these patients is critical.

BackgroundExcess dietary glucose leads progressively to hepatocyte triglyceride accumulation (non-alcoholic fatty liver disease-NAFLD), insulin resistance and T2DM. Considering the increased cardiovascular risks of NAFLD and T2DM, effective risk-factor management of these patients is critical. Weight loss can improve abnormal liver biochemistry, the histological progression of NAFLD, and diabetic control. However, the most effective diet remains controversial.

Aim We implemented a low-carbohydrate (CHO) diet in a primary health setting, assessing the effect on serum GGT, HbA1c levels (as proxies for suspected NAFLD and diabetic control), and weight.

Design69 patients with a mean GGT of 77 iu/L (NR 0-50) and an average BMI of 34.4Kg/m2 were recruited opportunistically and advised on reducing total glucose intake (including starch), while increasing intake of natural fats, vegetables and protein.

Method Baseline blood samples were assessed for GGT levels, lipid profile, and HbA1c. Anthropometrics were assessed and repeated at monthly intervals. The patients were provided monthly support by their general practitioner or practice nurse, either individually or as a group.

ResultsAfter an average of 13 months on a low-CHO diet there was a 46% mean reduction in GGT of 29.9 iu/L (95% CI= -43.7, -16.2; P<0.001), accompanied by average reductions in weight [-8.8Kg (95% CI= -10.0, -7.5; P<0.001)],and HbA1c [10.0mmol/mol (95% CI= -13.9, -6.2; P<0.001)].

Conclusions We provide evidence that low-carbohydrate, dietary management of patients with T2DM and/or suspected NAFLD in primary care is feasible and improves abnormal liver biochemistry and other cardio-metabolic risk factors. This raises the question as to whether dietary carbohydrate plays a role in the etiology of diabetes and NAFLD, as well as obesity. Over the study period and given a choice not a single patient opted to start antidiabetic medication, losing weight instead. This helps explain why our practice is the only one in the Southport and Formby CCG to have static diabetes drug costs for three years running.
 
Excellent news @Southport GP. I know it has been a lot of hard work now fingers crossed with the growing evidence base around the government and NHS will start to change their healthy plate carbfest for all. I do wonder if it will happen as there are too many monetary agendas pulling behind the scenes and whether the country could actually afford to feed itself if we all reduced our cheap carbs and turned more to fat and proteins.
 

Wonderful news @Southport GP

In my own work, focusing on "business change", I am often found looking for the answer for the "what's in it for me" question, which is always asked by the subjects who need to make or execute the changes in question. I think your final sentence may just provide the answer some GP budget holders are looking for, to ease their thinking away from unquestioningly following the NICE guidelines. In this world, whether we like it or not, money talks, and lack of money screams.

Thank you.
 
So pleased for you
 

Well done!
This is brilliant!
 
Thank you, just what is needed but sadly I fear it will be a long time before it becomes the norm. I am a very untypical T2. Diagnosed when I went for my free NHS check with a glucose of 18.6mmol/L and an HbA1c of 10.4%. I had a BMI of 21.7. I was just under 70 years old, still working and on my feet all day. I got up early to do my horses before work and finished late after putting the horses to bed. I had to leave work as I never got time to eat or drink during the day and was unable to keep my glucose under control. I have never been overweight as an adult although I was a tubby pre teens. I had absolutely no symptoms and was gobsmacked when I got my results as I was a biomedical scientist so knew what the figures meant!

Once I left work and had time for research I found the LCHF diet and lost just over a stone and a half bringing my BMI down to 17.3. My glucose is a lot better now if I stick to the diet. My liver enzymes are in the normal range and my liver and pancreas scan was normal; no signs of a fatty liver or pancreas.
 
How do you respond to carbs? Do you eat lowcarb as your usual fare? I read somewhere from dr Stephan Guyenet or carbsanity that if one follows a strict lowcarb diet, with almost no carbs, even if you have no diabetes, the first time you eat carbs, you will get readings that make it seem like one is prediabetic. The body is not used to this amount of carbs, and will need some time to get adjusted, some days for instance. I will see if I can find that paper that mentions it .

Also I have tried to find people like you lately, very slim people or top atlethes with type 2 diabetes. Genes matter a lot it seems, some people have very low personal fat thresholds it would seem.

Look at this guy for instance, 25 year old american footballplayer, he had type 2 diabetes. That for me is quite amazing https://www.jamespatrick.com/category/recent-shots/ Wonder what Roy Taylor would say to him.

And Steve Redgrave, olympic rower, was diagnosed with type 2 for a large duration of his career, he could probably lose some kg of fat, but he does not look like the caricature of diabetes, just as your bmi of 21.7
 
Fantastic@southport GP.

By getting an article published in "diabesity in practice" - will the NHS take any notice.

I see that your medical practice has been the only one from your CCG NOT to have seen a rise in diabetes drug costs but why have the CCG (at least) not used you as a leading example?

Is your Practice holding monthly sessions as a group or on one to one basis with patients?

How much persuasion do the patients take to reduce the carbs? And increase the fats?
 
I'm one of those that fit into that category.
But my question to you is, why do I need carbs? Why should I eat carbs?
There is a lot of study going on in universities and sports about athletes having blood glucose issues after years of carb overloading.
A lot of this generation are not doing that now!
And diabetes and the likes have personal uniqueness in the patients diagnosis and treatment. You just can't put all types in one nice neat parcel!
 
Yes!
For once I am hoping the cash we have saved will cause some wider interest in our approach
 
We now have well attended bi-monthly group meetings- this week it was on 'speedy green smoothies'
As you might expect the carb reduction is just good sense -the fat increase is harder to get over but is so important.
 
Southport GP said:
Yes!
For once I am hoping the cash we have saved will cause some wider interest in our approach
Click to expand...

Well, experience in this field (Change) tells me it's significantly more likely to pique interest that a mere improvement in patient health.

Sadly in this day and age, altruism and philanthropy will almost always be over-ridden by hard commercial cash benefits, unless there's enough money around to make the financial difference completey immaterial.

I'm perhaps over-stepping the mark here, but does the savings you report having have made take into account the costs of running the trial/research? By that I mean the manpower allocated to seeing patients, any group support or any other activity that wouldn't otherwise have been occurring? I'm assuming any additional testing in order to gather data would have come from the practise BAU budgets.
 
Southport GP said:
We now have well attended bi-monthly group meetings- this week it was on 'speedy green smoothies'
As you might expect the carb reduction is just good sense -the fat increase is harder to get over but is so important.
Click to expand...

In terms of the fat increase, is that expressed with a label, for example "High Fat", or as "gap filling" or "enough fat to satisfy your hunger or arrest/prevent weight loss" where appropriate. When I talk to people about this sort of lifestyle eating, I often now talk about gap filling. The gap can relate to hunger (satiety) or energy. That's sometimes accepted better than talking about high fat or increased fat.

Trust me, I don't spend my life talking about the way I eat, but my body shape has changed and become significantly more defined since diagnosis, so there is interest. I rarely mention my diabetes diagnosis, I just talk about discovering I had become significantly carb intolerant. Only one person has ever asked the direct, "you mean like diabetes?" question. Typically, in a booming voice, at a social function.

He was lucky not to receive a fast track learning programme in castration!
 
nosher8355 said:
Well done!
This is brilliant!
Click to expand...
My interest in GGT and liver blood test results was that in a practice of 9000 patients well over a 1000 had an abnormal GGT result - for years I didn't really know how to advise my patients or what this meant.

The received wisdom was that they were drinking more than they let on, but I find most folk tend to tell me the truth.

Another puzzle was obesity - what to do? Then as you know I did a pilot study on the low-carb diet a couple of years ago the patients loved the diet, they lost loads of weight, came off meds and were very proud.
I noticed I could predict which patients would have lost weight -before they came in my room from the GGT result alone, so our new study was born.

This time were took a longer time frame - each patient was on the diet for over a year, very many have been on it for years now.
I agree with Prof Roy Taylor who feels for many patients liver problems pre-date diabetes by some years.

There is a window of opportunity for the low carb approach here because no one is sure what to do about the epidemic of fatty liver disease, no drugs so far, and no one knows which diet is best.
 

That is really wonderful post and it does give me a reason to look at things in a way that I have often thought.

Fatty Liver disease and non alcoholic FLD is what my wife suffers from, I myself have had scans and symptoms and was started but never kept on tablets for liver function tests.
I struggled to rid myself until low carbing. Now it's healthy and liver and kidney function are normal!
My wife has seen her improve since reducing her carbs.

Could the liver have more of a connection than is widely thought on diabetes especially T2, the reason I ask this is because, it is quite simplistic and of course every diabetic is unique, is that visceral fat causes quite a lot of symptoms concerning insulin production and insulin resistance. The liver causes dawn phenomenon and liver dumps when needed.
Could the liver be controlling insulin production, so that the pancreas just obeys the liver to how much it produces.

I ask because I'm interested to know and understand why I developed RH, since I have had a fatty liver for longer than I was diagnosed over fifteen years ago. And the message to my pancreas was to consistently over produce insulin to compensate.

If I'm wildly talking rubbish, let me down easily!

I honestly believe that education and learning will help in the future, things like home economics and cooking in school for our youngsters is imperative.
We have to get the powers that be, to understand, what can be done by a reduction of sugars that we consume and that the dependency on carbs to feed the world has to change.
A properly balanced lifestyle, where, good 'real' food is ate by those who just exist on convenient and take outs!
 
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