New study supports restricting carbohydrates
IN 2013, my colleagues and I published The Real Meal Revolution (RMR). The central theme of the book is that people with insulin resistance (IR) – the underlying biological abnormality in Type 2 diabetes mellitus (T2DM) – enjoy substantial health benefits when they restrict their dietary carbohydrate intakes to 0-150 grams a day, depending on the severity of their IR.
While the book and the eating plan it promotes became an overnight success with the South African public, just as rapidly influential medical colleagues and dietitians across the country dismissed it as a dangerous diet fad that causes harm.
The unrivalled success of the book and the challenge to dietary convention that it poses soon became a unifying provocation for the subsequent four-year, multimillion-rand investigation into my professional conduct by the Health Professions Council of South Africa.
On February 7, the medical journal Diabetes Therapy published a peer-reviewed scientific paper reporting the findings from the first year of a two-year study of the use of remote care (telemedicine) for the management of T2DM undertaken by the Virta Health company in San Francisco.
The key focus of the study was to ensure that patients with T2DM develop a state of continual mild ketosis by eating a severely carbohydrate-restricted diet (<30 g/day).
This is the same diet prescription promoted for the management of IR and T2DM in the RMR and all my other nutrition books. In fact the RMR was used as a patient resource for dietary information in the Virta Health trial.
The study initially enrolled 262 people with T2DM for the intervention trial; at the end of the first year, 218 remained in the study, giving a retention rate of 83%.
A further 87 T2DM patients who continued to receive conventional care (insulin and/or other antidiabetic medications; non-ketogenic high carbohydrate diet) were also followed for one year.
The result: 94% of T2DM patients on the intervention trial had either reduced or ceased their insulin use at the end of year one. The use of other anti-diabetic medications, excluding metformin, fell from 57 to 30% and no patient was still using a sulfonylurea drug at the end of the trial.
In contrast, medication use increased by 9% in the group receiving conventional care.
Despite reduced use of antidiabetic medications, 61% of subjects on the intervention trial “reversed” their diabetic markers, especially glycated haemoglobin (HbA1c) values, to below those considered diagnostic of T2DM. As a result, these patients are technically “in T2DM remission”.
This does not mean that they are, or ever will be, “cured” of T2DM, since reintroduction of a higher carbohydrate diet to people with severe IR/T2DM will rapidly reverse these gains. However, it might logically be expected that people “in T2DM remission” will be much less likely to develop T2DM complications in the future, provided they continue to restrict their carbohydrate intake to <30g/day.
Other benefits included an average 12% (14kg) weight loss, decreases in systolic and diastolic blood pressures and in all blood markers of IR and inflammation.
In contrast, most of these markers deteriorated in the usual care group.
The authors conclude that a North American with T2DM who stops using insulin will save $10 000 (R118 8000) a year for the rest of his or her life.
The importance of this study is many fold. First, it disproves the depressing medical opinion that T2DM is a chronic progressive disease with a dismal future. Instead it shows that T2DM can be effectively managed with a quite simple dietary change.
Second, it shows that, in essence, T2DM is a condition of choice. Patients can choose to eat <30 g/ day of carbohydrate and so minimise their risk for developing any of the disease’s myriad complications. Or they can continue to eat an unrestricted carbohydrate diet, in which case it is probable that they will develop the complications of T2DM regardless of how much medication they use.
Third, it confirms that the cause of the current T2DM/obesity pandemic is clear. It was the adoption of the high carbohydrate diet mandated by governmental agencies and vigorously promoted by medical and dietetics organisations around the world since 1977.
Every month another 15 000 South Africans develop T2DM. The Virta Health study proves that this is unnecessary. This tragic epidemic can be stopped.
People with IR need to understand that eating a diet in which carbohydrate intake is unrestricted will likely lead to T2DM and all its tragic complications.
This is as we described it in RMR in 2013.