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"Instead of counseling people like we used to about food... we're just putting them on insulin." - Sarah Hallberg, DO

Posted by Daniel Patrick on

One particular message continues to make its rounds from the World Congress on Insulin Resistance, Diabetes, and Cardiovascular Disease. The message is from Sarah Hallberg's low-carb diet presentation for reversing type 2 diabetes.

"Carbohydrate restriction is a viable patient choice for type 2 diabetes reversal."

  • Nutritional ketosis supports diabetes reversal
  • Low-carb nutritional patters have extensive clinical evidence for improvement of type 2 diabetes
  • Keto diet is not a fad, it's the old way of treating people before insulin
  • Possible 'misuse' of insulin in type 2 diabetes- where nutritional counseling 'the way we used to about food' 
  • American Diabetes Association and others updated their guidelines to include low-carb eating patters for type 2 diabetes
  • Differences between low-carb, very-low-carb, and well-formulated Ketogenic diets
    • "Dr. Hallberg, who is also medical director for Virta Health, defined a very-low-carbohydrate or ketogenic diet as less than 50 g of carbohydrates per day, or fewer than 10% of calories consumed. A low-carbohydrate diet is 51-130 g of carbohydrates per day, or 25% or fewer calories consumed, whereas anything above 25% calories consumed is a not a low-carbohydrate diet. A well-formulated ketogenic diet, she continued, consists of 5%-10% carbohydrates (or less than 50 g), 15%-20% protein, and 70%-80% fat. The carbohydrates include 5-10 g per day of protein-based food, 10-15 g of vegetables, 5-10 g of nuts/seeds, 5-10 g of fruits, and 5-10 g of miscellaneous nutrients. “When we’re talking about a total carbohydrate intake per day of under 50 g, you can get a lot of vegetables and nuts in,” she said. “I like to tell my patients they’re not eating GPS: no grains, no potatoes, and no sugar.”
  • Research highlights from Dr. Hallberg's presentation 
    • Evidence varies widely for Mediterranean, plant-based, DASH, but Dr. Hallberg's team suggests low-carb eating patterns for diabetes have stronger evidence comparatively
    • Patients can expect fast results - https://annals.org/aim/article-abstract/718265/effect-low-carbohydrate-diet-appetite-blood-glucose-levels-insulin-resistance
    • Patients experienced significant decreases in body weight, LDL, triglycerides, and urea while HDL increased -https://link.springer.com/article/10.1007%2Fs11010-007-9448-z
    • Compared to low-fat and Mediterranean diets, Low-carb diet showed better weight loss, though less drop in fasting glucose, and best changes toHbA1c  - https://www.nejm.org/doi/full/10.1056/NEJMoa0708681
    • Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes. The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633336/
    • Preliminary research from Dr. Hallberg's 5-year study shows a retention rate of 83% after 1 year and 74% at 2 years. At the end of 2 years, the mean HbA1c reduction was 0.9, the mean reduction for the Homeostatic Model Assessment of Insulin Resistance was 32%, and 55% of completers experienced reversal of their diabetes. Overall, 91% of insulin users reduced or eliminated their use of insulin, and the average weight loss was 10% of baseline weight. - https://clinicaltrials.gov/ct2/show/NCT02519309

Here it is distilled, “This is huge from a cost-savings and a patient-satisfaction standpoint. We were improving A1c levels in patients who have had diabetes for an average of over 8 years while we were getting [them] off medication, including insulin. Low carb is now the standard of care.”

Cost-effective, evidence-based, diverse treatment.

References:

https://www.mdedge.com/endocrinology/article/215242/diabetes/carbohydrate-restriction-viable-choice-reversal-type-2

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