Low carb programs emerge as viable T2D treatment


#1

Type 2 diabetes and pre-diabetes today threatens to swamp health care systems around the world. The American Diabetes Association publishes these statistics on its web page.

Overall Numbers, Diabetes and Prediabetes

  • Prevalence : In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes.

    • Approximately 1.25 million American children and adults have type 1 diabetes.
  • Undiagnosed : Of the 30.3 million adults with diabetes, 23.1 million were diagnosed, and 7.2 million were undiagnosed.

  • Prevalence in Seniors : The percentage of Americans age 65 and older remains high, at 25.2%, or 12.0 million seniors (diagnosed and undiagnosed).

  • New Cases : 1.5 million Americans are diagnosed with diabetes every year.

  • Prediabetes : In 2015, 84.1 million Americans age 18 and older had prediabetes.

  • Deaths : Diabetes remains the 7th leading cause of death in the United States in 2015, with 79,535 death certificates listing it as the underlying cause of death, and a total of 252,806 death certificates listing diabetes as an underlying or contributing cause of death.

This worrisome trend not only plagues the US but also countries the world over. Yet, the response from organizations and governments seems underwhelming. If this were an infectious disease, I think the mobilization and response would be much more active and robust. It almost appears that the groggy symptoms of hyperglycemia has impaired our collective motivation and sense of urgency.

I am a T1D but have successfully implemented a low-carb way of eating to restore metabolic sanity to my everyday health. Many critics of low-carb eating will disparage this way of eating as unsustainable. I have used low-carb eating to treat my T1D for seven years now!

I have become aware in the last several months of health care efforts to roll-out low-carb tactics to the burgeoning T2D population. Here are two programs that look promising to me. I have no financial or other interest in either of these programs.

I don’t like their use of the term, “reverse diabetes,” but their efforts looks like it could materially mitigate the T2D epidemic.

Here’s a similar effort from Dr. Eric Westman.

I like his use of the term, “remission,” instead of “reverse.”

I hope that these programs can take root and help people faced with a daunting diabetes diagnosis. One of the features of these programs is the ability to reduce or even stop diabetes medications for people with T2D. This de-presciption facet of the program excites me.

As I said, I am not a T2D, but I hope that programs like the two I’ve linked to will take hold in the T2D community and empower them to improve their health.

What do you think? Are programs like this part of the solution? Do you feel the same hope that I do about these tactics?


#2

For what it’s worth I agree with the premise that all types of diabetes seem to benefit from low carb to improve glycemic control.

The problem with low carb is its 100% dependent on self discipline. The majority of people won’t be able to do it.

It’s like dieting. If it was so easy everyone would be thin but people have a hard time overriding their bodies urge for carbs.


#3

I agree that success with this program will take some discipline. I don’t agree that most people will not be able to do it. Maybe most people will not even give it serious consideration since changing your way of eating is something that people inherently resist. But for those who try, I think success comes at a higher rate.

This program, however is different from most lifestyle changes, like a traditional calorie limited weight loss diet. Unlike almost all other diets, there is no calorie limit for ketogenic eating.

The only limit is on carb heavy foods like bread, rice, and pasta. Once you get past the initial stage, appetite naturally recedes. People can eat until they are satiated. And with low carb, high fat foods, people will usually stop eating when they are in a calorie deficit.

The comprehensive support system that these programs offer includes doctor management and advice. Doctors can help people push past the initial “keto flu” symptoms. Sodium supplementation and bone broth can really take the edge off that initial adjustment. It also includes peer support from other patients on the same path.

Another feature of this program that can stoke patient motivation is the de-prescription aspect. When people can stop taking meds and are freed from the economic burden that represents, it gives substantive feedback and reinforces continued participation.

This way of eating also leads to quick initial results. Weight loss is often felt in the first several days. And better yet, this weight loss includes little exercise of willpower, beyond getting past the keto flu. Weight loss, stopping meds, and much improved glucose numbers all serve to reinforce continued participation.


#4

You make great points, I think you’re right about everything but people remaining motivated enough to keep it up long term.

I would expect 95% of people or more to stop a low carb diet with in a few weeks.

They wouldn’t stop because it’s not working, they would stop because for the majority of people the desire for carb foods is very high. It’s also very limiting to not eat many carbs for social/work/family events.

I think doctors should encourage low carb but the reality is the vast majority won’t stick with it. (Opinion).


#5

I would agree with you about people attempting this on their own. I think the comprehensive nature of these formal programs help to sustain participation. Here’s one study that compared people in the “continuous care intervention” or CCI versus a control group labeled “usual care.” The sustained effect is impressive.

Eighty-three percent of participants remained enrolled in the CCI at 1 year.

What I’m seeing in this treatment model is that simultaneous doctor, health coach, and peer support bridges the gap where many people who try this tactic on their own often fail.

Separately, the de-prescripton success of this treatment model impresses me. Here’s the graph from the study that tells this story.

Over 90% of the continuous care intervention participants were able to reduce or eliminate their need for insulin.


#6

Most people won’t eat that diet. Not for any length of time. I hated the bernstein diet. I felt like I was starving and my bg was crashing all the the time. I still feel almost constantly hungry and bg goes all over but it’s better than that was. I literally was starving. I think insulin makes you hungry though as many type 1 have said they have the same symptoms. But lower carb is obviously better for all of us. And if anyone can put it into remission and stick with it that is great! I do gluten & grain free so my carbs come from fruit, veggies, and non starchy foods. Grains and starches are the worst for me. After losing 20 lbs 2 years ago and having so many digestive issues, that helped me get things under control a bit better.


#7

I’m type 2, and I’ve been on a LC diet for more than 20 years. I went to “try out” for a clinical study at Joslin, and when I said I was on a LC diet, the study doctor was horrified. “But that’s what they used 80 years ago.” Yes, they did, because it worked, and before insulin, it was the only thing they had.

What’s interesting to me is that it’s taken the establishment about 20 years to accept that this approach does work.

I agree it’s difficult in social situations, and newbies need a lot of support to figure out how to cope with them.


#8

I have been on low carb for 10 years, the last time I checked I was in nutritional Ketosis. No problems, enjoy the food and my a1c in the 5.s I can always find something to eat in restaurants, and at social events some times i just eat a salad.

I do diet and exercise only no meds! 30 carbs a day.T2

I just started out eating to my meter, and eventually eliminated most carbs.

I am sure if I did not eat this way and exercise I would be on insulin.
I much rather do low carb than medicine.


#9

When critics say that this way of eating is insustainable, I don’t get it. For some people that is true but many of us have been at it for years. What is really unsustainable is the extended periods of hyperglycemia on the standard American diet.


#10

Just wanted to make a point. I am not part of the group that eats only according to the book for Keto. I was asked not to come back to a Keto group because I carried glucose tablets, (not suppose to eat glucose during a run, your body will adapt. Since I don’t enjoy going low during a 10 K (like 50) I had no problem quitting the group.

So I generally follow a Keto program because I ended up there because my meter told me it worked. I consider my self Keto compliant if my Kentone level is within the nutritional Ketosis range.

Plus all Keto approved food does not work .for T2. My son in law baked a Keto Bread with almond flour. I ate a 2 by 2 inch piece My BG jumped 20 points. I can’t imagine making a full size sandwich out of it.

So I really try to say I’d do Low Carb WOE that keeps me in the nutritional Ketosis range.


#11

Hello,

Does any one have insight on how fasting insulin is affected with weight loss. My fasting insulin is really high 19.5 with 3.5 HOMA IR indicating severe insulin resistance with an A1C swinging between 6.2-6.7 with 1000mg of Metformin. I weight 157 pounds at 5"4. I started on HIIT and weight lifting, I see my muscles are toning slightly. Does anyone think this fasting insulin numbers can be lowered with exc and diet? I started Intermittent fasting today as I saw many ppl in remission with type 2? Also when I read about Type 2 DM, I understood that there is enough insulin being made but coz of muscle switch mechanism that has been disrupted, insulin resistance happens? So how is that fixed with Diet and Exercise? Sorry I am a new Type 2 with lot of Q. Please be patient with me


#12

My experience as a T2. Reducing carbs helps balance carb intake with what your body can process. Exercise also improves (reduces) insulin resistance.

I started at an A1c of 12.0 Now 5.7 without meds.
I have not done intermittent fasting. My age 73 10 years after dx


#13

Tom, Thanks for your input. If you don’t mind me asking how long were you prediabetic before a diagnosis of A1C with 12. And how long did it take for you to bring the A1C down to 5.7. I am quite confused with this whole scenario of prediabetes and diabetes? I am 37, with A1C fluctuating between 6-6.9 with Metformin 1000mg. I have very cold hands and feet, severe tightness of leg muscles, pain in my calf and feet, but no tingling/ numbness. I don’t know if this is PAD, but symptoms are not synonymous with peripheral artery disease?


#14

I was at the gym when I was writing the earlier post and didn’t realize that I posted it.

The conference I have been listening to by the doctors I mentioned are talking about why the low carb diet is harmful for many people and why the plant based vegan diet is so good for people.

I never felt that eating a lot of fat was good for me, but I certainly enjoyed the butter, nuts, bacon and nut butters. I paid for it dearly eventually. I realize that Dr. Bernstein is doing great on this diet at 82, but I wonder If many people are. My LDL rose to high rates, and I know that his stayed normal. I read books by Taubes and other people and ignored my high lipids. That was a huge mistake.


#15

Lola, re. the tightness of leg muscles, here is a YouTube video giving exercises for legs.
https://www.google.com/search?client=firefox-b-d&q=walkers+stretches#kpvalbx=1


#16

I was diagnosed in 2009, the term prediabetes was not used back then.
So I was just blindsided at diagnoses.
I went from 12.0 to less than 7.0 in three months and then to 6.0 at 6months.
It could a couple of years to consistently stay in the mid 5’s. I took metformin for the first year and then dropped it because a side effect (not digestion issues).
No meds since then The easy part was getting the numbers down from 12. To 6
Lowering below 6 went very slowly.
Current Age 73

You are the only one that is confused on the prediabetic name. As far as I am concerened it is a dosing term. I believe diet and exercise is first choice to control Prediabetis Maybe add metformin. Then as your numbers go up add more medice.

I have always done low carb and exercise. Low carb is to me is 30 carbs a day.


#17

Have you experience heart or kidney issues?


#18

Thank you for the info? What is the side effect you are talking about with Metformin? I thought Metformin is the drug of choice for Insulin resistance and Type 2 coz it is the safest as per the doc. I thankfully don’t have any digestive issues on it. But I am concerned if I am missing any imp info on a side effect? Does it have any neurological/ cardiovascular impact?


#19

Tom, after several years of eating low carb, I had kidney stones which needed surgery. That same year I also had emergency heart stents. I was told to get off the low carb diet by the cardiologist. Being stubborn and so convinced that it was so helpful for my diabetes, I refused to abandon the diet.

Eventually I also began to have migraines, and was gaining weight. After I starting eating low fat plant based food, my headaches disappeared, I lost the weight, my energy levels increased and my protein levels rose.


#20

Thanks