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  #1   ^
Old Tue, Nov-03-20, 16:12
Demi's Avatar
Demi Demi is offline
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Default Insights from general practice service evaluation supporting a lower carb diet

Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years

David Unwin, Ali Ahsan Khalid, Jen Unwin, Dominic Crocombe, Christine Delon, Kathy Martyn, Rajna Golubic and Sumantra Ray

https://nutrition.bmj.com/content/e...nph-2020-000072


Quote:
Abstract

Background
In a single general practice (GP) surgery in England, there was an eightfold increase in the prevalence of type 2 diabetes (T2D) in three decades with 57 cases and 472 cases recorded in 1987 and 2018, respectively. This mirrors the growing burden of T2D on the health of populations round the world along with healthcare funding and provision more broadly. Emerging evidence suggests beneficial effects of carbohydrate-restricted diets on glycaemic control in T2D, but its impact in a ‘real-world’ primary care setting has not been fully evaluated.

Methods Advice on a lower carbohydrate diet was offered routinely to patients with newly diagnosed and pre-existing T2D or prediabetes between 2013 and 2019, in the Norwood GP practice with 9800 patients. Conventional ‘one-to-one’ GP consultations were used, supplemented by group consultations, to help patients better understand the glycaemic consequences of their dietary choices with a particular focus on sugar, carbohydrates and foods with a higher Glycaemic Index. Those interested were computer coded for ongoing audit to compare ‘baseline’ with ‘latest follow-up’ for relevant parameters.

Results By 2019, 128 (27%) of the practice population with T2D and 71 people with prediabetes had opted to follow a lower carbohydrate diet for a mean duration of 23 months. For patients with T2D, the median (IQR) weight dropped from of 99.7 (86.2, 109.3) kg to 91.4 (79, 101.1) kg, p<0.001, while the median (IQR) HbA1c dropped from 65.5 (55, 82) mmol/mol to 48 (43, 55) mmol/mol, p<0.001. For patients with prediabetes, the median (IQR) HbA1c dropped from 44 (43, 45) mmol/mol to 39 (38, 41) mmol/mol, p<0.001. Drug-free T2D remission occurred in 46% of participants. In patients with prediabetes, 93% attained a normal HbA1c. Since 2015, there has been a relative reduction in practice prescribing of drugs for diabetes leading to a T2D prescribing budget £50 885 per year less than average for the area.

Conclusions This approach to lower carbohydrate dietary advice for patients with T2D and prediabetes was incorporated successfully into routine primary care over 6 years. There were statistically significant improvements in both groups for weight, HbA1c, lipid profiles and blood pressure as well as significant drug budget savings. These results suggest a need for more empirical research on the effects of lower carbohydrate diet and long-term glycaemic control while recording collateral impacts to other metabolic health outcomes.

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http://dx.doi.org/10.1136/bmjnph-2020-000072

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  #2   ^
Old Tue, Nov-03-20, 16:54
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JEY100 JEY100 is offline
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The DietDoctor analysis of this study: https://www.dietdoctor.com/study-sh...and-saves-money

Also Dr Unwin was recently interviewed on the newish Dr Tony Hampton podcast. Amazing amount of dedication from a small town GP to get anything published in The BMJ.

https://doctortonyhampton.libsyn.co...-dr-david-unwin


Daily Mail headline emphasizes the Older Diabetic outcome.
https://www.dailymail.co.uk/health/...dest-treat.html

Last edited by JEY100 : Wed, Nov-04-20 at 07:08.
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  #3   ^
Old Wed, Nov-04-20, 08:44
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Dodger Dodger is offline
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Quote:
Those who lost less weight seemed to do as well as those with greater weight loss in terms of improving their diabetes.

I have always suspected that weight loss was just a side effect of low-carbing. The main effect is to improve health, whether or not weight was lost.
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  #4   ^
Old Wed, Nov-04-20, 17:26
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Kristine Kristine is offline
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Quote:
Originally Posted by Dodger
I have always suspected that weight loss was just a side effect of low-carbing. The main effect is to improve health, whether or not weight was lost.
Agreed. Corollary - obesity is just one of some possible side effects of poor metabolic health, and fixing the metabolic health can help lead to weight normalization.
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  #5   ^
Old Thu, Nov-05-20, 03:35
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JEY100 JEY100 is offline
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Plan: P:E/DDF
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Dr Unwin also mentioned in the interview that PHCUK.org helped him get this study posted as Open Access.
So worth it because in the study which is a .pdf anyone can copy is the Diet he uses in his Norwood practice. It is written in a narrative style...How he would explain low carb ten minute visit.
No forbidding list of Eat this, Not that.

https://www.repository.cam.ac.uk/bi...e=2&isAllowed=y
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  #6   ^
Old Thu, Nov-05-20, 03:40
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Demi Demi is offline
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Going low carb is the ‘gateway to good health’

https://diabetestimes.co.uk/going-l...to-good-health/
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  #7   ^
Old Thu, Nov-05-20, 03:50
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Demi Demi is offline
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Deprescribe the world! New study shows low-carb diets would save BILLIONS currently wasted on drugs. But will Big Pharma allow it?

https://www.rt.com/op-ed/505282-low-carb-diet-covid/

Quote:
By Malcolm Kendrick, doctor and author who works as a GP in the National Health Service in England. His blog can be read here and his book, 'Doctoring Data – How to Sort Out Medical Advice from Medical Nonsense,' is available here.

The work of a British family doctor demonstrates that stopping eating carbohydrates helps with blood pressure, diabetes and weight loss - helping save lives during Covid-19. But the medical industry doesn’t want you to know this.

If you want to avoid dying of Covid-19, one of the most important things you can do, if you are overweight, is to shed the pounds

A recent study by an international team of researchers using data from 399,000 patients found that people with obesity who contracted coronavirus were 113 percent more likely than people of healthy weight to end up in hospital, 74 percent more likely to be admitted to intensive care, and 48 percent more likely to die.

Why? Well, the ‘why’ centres around the damaging effect of raised blood glucose on endothelial cells and… it gets complicated.

The most important thing is not to understand the complex metabolic and physiological pathways involved, but simply to help people to lose weight, and this is where Dr. David Unwin comes in.

For years, this family doctor from Southport, in northwest England, has believed, as I do, that the main driver of weight gain, eventually leading on to type 2 diabetes, is a high-carbohydrate diet. That means consuming too much pasta, potatoes, rice, bread, processed sugar, and so on, and not enough red meat, olive oil, butter, eggs, and the like.

This, of course, is exactly the opposite of what we have been told for decades by the ‘experts’ who demonise fat and promote carbohydrates. We have the ‘eat-well’ plate, and the ‘food pyramid’, and hundreds of thousands of dieticians around the world, all promoting carbohydrates as the ‘healthy’ option.

Dutifully following this advice, the entire population of the Western world has become fatter, and fatter… and fatter. And more and more unhealthy. By the way, this is not a coincidence; it is cause and effect.

But getting back to Dr. Unwin – years ago, he despaired of ever getting any of his patients to lose weight. It was so disheartening, he furtively studied his pension plan and dreamed of retirement. Then, one day, a patient came in to his surgery who had lost a lot of weight and kept it off.

At first, this woman was reluctant to say how she had done it, as she feared the inevitable criticism. In the end, however, she confessed to Dr. Unwin that she had achieved it by eating a low-carbohydrate diet. In Dr. Unwin’s own words:

“I was interested to find out how the patient had improved her diabetic control. She confessed she had ignored my advice and learnt a much better way to look after herself from the internet. I suppressed my wounded pride and looked at the low-carb forum on diabetes.co.uk. There were thousands of type 2 diabetics on there ignoring their doctors – and getting great results ([but] now that is just not allowed).”

The GP did not criticise his patient; instead, he was intrigued. Could this possibly be true? It went against everything he had been told about healthy eating, weight loss, and type 2 diabetes – fat has twice the calories per gram as carbohydrates… and suchlike. Eating fat, he’d been programmed to believe, makes you fat, and then you develop diabetes and heart disease.

Dr. Unwin did more research, then made the decision to work with his patients, mainly those with diabetes, to see if a low-carbohydrate diet could be beneficial. Lo and behold, it was – very beneficial. In fact, it was like a miracle cure.

In 2014, he published a paper on his results on a small number of patients. It stated:

“It was observed that a low-carbohydrate diet achieved substantial weight loss in all patients and brought about normalisation of blood glucose control in 16 out of 18 patients. At the same time, plasma lipid profiles improved, and BP [blood pressure] fell, allowing discontinuation of antihypertensive therapy in some individuals…

“Conclusions: Based on our work so far, we can understand the reasons for the internet enthusiasm for a low-carbohydrate diet: the majority of patients lose weight rapidly and fairly easily [and,] predictably, the HbA1c levels are not far behind. Cholesterol levels, liver enzymes, and BP levels all improved. This approach is simple to implement and much appreciated by people with diabetes.”

Now, he has published results of a much larger study, of nearly 200 patients over a six-year period, which has just been published in the British Medical Journal’s Nutrition, Prevention & Health.

Its main findings make an impressive case for the low-carb diet and how it can lead to people being much healthier and getting off lifelong medication:
  • 46 percent drug-free Type 2 diabetes remission.
  • Significant improvements in weight, blood pressure, and lipid profiles.
  • 93 percent remission of prediabetes.
  • Four individuals came off insulin altogether.
  • Total weight loss for the 199 participants was 1.6 metric ton.
  • £50,885 annual savings in the practice’s diabetes-drug budget.
  • If every GP practice adopted the practice, the NHS could save c. £277 million (c.$350 million) a year

This paper will be attacked, of course, as there are massive financial interests involved here. The savings that the NHS could achieve would be dwarfed if the US, with its much higher drugs costs, adopted the policies: we could be looking at around $2 billion a year. Around the world, who knows, but it would be vast sums of money.

So, you can imagine the joy that this paper will be met with in pharmaceutical company boardrooms around the world. The words ‘lead’ and ‘balloon’, spring to mind. Equally, the massive low-fat high-carb food manufacturers will be throwing their hands up in horror – “My bonus, my bonus! Nooooo!’ You can take all your low-carb yoghurts and…

As for the rest of us, I can assure you that Dr. Unwin has only ever been interested in one thing: working out how to help people lose weight and control their diabetes. He has achieved this for his patients and is showing the rest of the world how to do the same.

Will his research now be taken up by the authorities around the world? Will we move away from promoting a high-carbohydrate diet? You have to be joking. There is far too much money to be lost by the companies who exert tight control over the world of medical research, and whose lobbyists swarm around politicians in rich countries.

Which is a damn shame, because more than ever in this endless Covid-19 pandemic, obesity represents a health crisis. This paper, and the tireless work by Dr Unwin, clearly tells us what we need to do – now, urgently. If Boris Johnson is serious about his plan for the nation to get slimmer and fitter, he himself should go on a low-carb diet and extol its virtues.

Dr Unwin’s approach won’t work instantly, and it won’t work for everyone – nothing ever does. However, it represents hope. It could save hundreds and thousands of lives. Perhaps more than any vaccine. His research should be shouted from the rooftops.

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  #8   ^
Old Thu, Nov-05-20, 07:37
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GRB5111 GRB5111 is offline
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Thank you, Dr. Kendrick, for a very clearly written piece shining a light on the need to correct the nutritional myths causing the massive increase of T2D and the many cohort diseases of Insulin Resistance.
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  #9   ^
Old Thu, Nov-05-20, 09:56
JEY100's Avatar
JEY100 JEY100 is offline
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If anyone hesitates to share an RT Article (Russia Today), not wanting to do a Dr Scott Atlas , this article was also posted on Dr Kendrick's website.

https://drmalcolmkendrick.org/2020/...ing-of-covid19/
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