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Thursday, 23 June 2016

UK doctor saves government £45K by using low carb diet to treat type 2 diabetes

Dr David Unwin, a general practitioner (GP) in England has recently been named ‘Innovator of the Year’ at the national NHS Leadership Recognition Awards 2016.

Dr Unwin, who practices at the Norwood Surgery in Southport, spent three years working on a project combining the benefits of a low carb diet with psychological support to help patients with diabetes. As well as having much healthier patients, the practice now saves around £45,000 a year on diabetes drugs.

Imagine the impact on health systems if every GP instituted the same approach to our type 2 diabetics. Not only saving huge amounts of money, but also seriously impacting people’s health.

I wrote previously about Dr Unwin and the specific diet he prescribes for his patients here:

A UK doctor puts 18 patients with type 2 diabetes on a low carb diet with amazing results

Since I last wrote about Dr Unwin in 2014 he has had a further case study published in the British Medical Journal, about a patient who wanted to reduce his medication for type 2 diabetes, heart disease and high blood pressure:

A patient request for some “de-prescribing”

A 52 year old man with a history of type 2 diabetes for 14 years and hypertension for nine years presented to his general practitioner. He was a non-smoker with an alcohol intake of eight units a week. He had been experiencing bloating, abdominal pains, and erratic motions for more than a year. Because he drove about 12 000 miles a year for his job he found the loose motions “a real worry.” He wondered whether any of his problems might be caused by his drugs and asked if he could cut down on any if they weren’t all needed. He admitted to being afraid that his diabetic control might deteriorate and that he might need insulin, like some of his relatives who also had diabetes.

He was taking aspirin 75 mg once daily, metformin 500 mg three times daily, perindopril 4 mg daily, and simvastatin 40 mg at night.

On examination his weight was 108.8 kg (steady at this for 10 years), body mass index was 34.4, waist circumference was 113 cm, and his blood pressure was 130/80 mm Hg (steady at this level for some years). His abdominal examination was normal, except that he had central obesity.

Glycated haemoglobin (HbA1c) was 52 mmol/mol (reference range 0-41), bilirubin was 7 µmol/L (0-20), alanine aminotransferase (ALT) was 53 U/L (5-37), and γ-glutamyl transferase (GGT) was 59 U/L (0-50). In addition, his estimated glomerular filtration rate was 100 mL/min/1.73m2 (90-120), total cholesterol was 3.7 mmol/L (desirable ≤4.0), high density lipoprotein-cholesterol was 1.3 mmol/L (>1.0), and triglycerides were 1.3 mmol/L (<1.7).

ALT and GGT were both raised, this is a sign of a fatty liver; those with type 2 diabetes have increased amounts of fat in their liver cells, called non-alcoholic fatty liver disease (NAFLD).

The case study goes on to discuss what condition this patient has, what is most likely causing his abdominal discomfort, and why his GGT is high.

The next section is the most pertinent:

How could his request to cut down on drugs be handled?

Dr Unwin compiled this table that compared the use of diet and exercise pharmaceutical drugs and their side effects. He used data from this website to calculate risk of drugs vs non drug treatment. The Absolute CVD Risk/Benefit Calculator

“Using this adapted QRISK2-2014 calculator, a person like our patient with type 2 diabetes of age 52 years, weight 108.8 kg, height 178 cm, systolic blood pressure 155 mm Hg, total cholesterol 5.0 mmol/L, high density lipoprotein 1.0 mmol/L, no family history of note or history of smoking, chronic kidney disease, atrial fibrillation, or rheumatoid arthritis would have an untreated 10 year risk of heart attacks or strokes of about 15% at baseline.

As shown in the table, physical activity is as effective as low to moderate intensity statins at reducing our patient’s risk of cardiovascular disease and outperforms aspirin. The Mediterranean diet is nearly as effective as metformin. In addition, the major lifestyle interventions mentioned (physical activity and Mediterranean diet) have a low risk of harm compared with the drugs listed and reduce the risk of comorbidities such as osteoarthritis, some cancers, and gallstones.”

The patient was put on a low carbohydrate diet – this is described in detail in my previous post

How did the patient respond?

Here is a table I put together with his results after 8 months

The patient steadily lost a total of 16 kg over seven months and successfully stopped all four prescribed drugs, thereby achieving his goal of being medication-free. This was accomplished using a low carbohydrate diet—in his words: “more a lifestyle than a diet.” The weight loss enabled him to take more exercise, join a gym, and take up yoga. He has come off sugar altogether and cut out bread (he previously consumed a lot of this), potatoes, pasta, cereals, and rice. This has led to greater consumption of green vegetables, but also eggs, full fat Greek yoghurt, and cheese.

The weight loss has been maintained for a year, so he weighs less now than at any time in his adult life. The goal of coming off all drugs was achieved in a stepwise manner as he lost weight—first metformin, then perindopril, followed by simvastatin and aspirin.

His weight loss has been matched by improvements in other parameters: HbA1cdown from 52 mmol/mol to 43 mmol/mol (6.9% to 6.2%), blood pressure from 130/80 mm Hg to 117/70 mm Hg, GGT from 59 U/L to 19 U/L, and alanine aminotransferase from 53 U/L to 20 U/L. Of particular note is that—despite eating more eggs and lots of full fat Greek yoghurt, and stopping statins—his cholesterol:high density lipoprotein ratio has improved slightly from 2.8 to 2.7, and serum triglycerides have improved from 1.3 mmol/L to 1.1 mmol/L.

His bowel problems and abdominal pains ceased within days of stopping metformin, his energy returned, and he now needs an hour and a half less sleep a day.

In general he reports feeling “just much younger again.”

I’m looking forward to the day when low carbohydrate whole food diets are standard for treating type 2 diabetes.

I suggest you also read the comments section – numerous people reporting on their own success for both type 1 and type 2 diabetes plus a host of other health issues.


DeniseinVA said...

Thank you for this very interesting article.

Sandra Cox said...

Very interesting post. I'm going to pass on the info to a family member.

Linda said...

Showing how money can be saved is a good way to get the government's attention!

Galina L. said...

No anonymous comments on the post - I hope your opponents rush to discard low fat cereals and "healthy" cookies. There is nothing negative to say.