A low-carb ketogenic diet in patients with type 2 diabetes was so effective that diabetes medications were reduced or discontinued in most patients, according to U.S. researchers. The 2005 report recommends that similar dieters be under close medical supervision or capable of adjusting their own medication, because the diet lowers blood sugar dramatically.
Twenty-eight overweight people with type 2 diabetes were placed on the study diet and followed for 16 weeks. Seven people dropped out, so the analysis involved 21, of which 20 were men—the study was done at a Veterans Administration clinic. Thirteen were caucasian, eight were black. Average age was 56; average body mass index was 42. The seven dropouts were unable to come to the scheduled meetings or couldn’t follow the diet. No dropout complained of adverse effects of the diet.
Participants were instructed on the Atkins Induction Phase diet, which daily includes:
- under 20 g carbohydrate
- one cup of low-carb vegetables
- two cups of salad greens
- four ounces of hard cheese
- unlimited meat, poultry, fish, eggs, shellfish
- a multivitamin
At the outset, diabetes medication dosages were reduced in this general fashion: insulin was halved, sulfonyureas were halved or discontinued. If the participant were taking a diuretic (fluid pill), low doses were discontinued; high doses were halved.
Study subjects returned every two weeks for diet counseling and medication adjustment (based on twice daily glucose readings and episodes of hypoglycemia). Food cravings and/or good progress on weight goals triggered a 5-gram (per day) weekly increase in carbohydrate allowance. In other words, if a participant’s weight loss goal was 20 pounds and he’d already lost 10, he could increase his daily carbs during the next week from 20 to 25 g. Carbs could be increased weekly by five gram increments as long as weight loss progressed. [This is typical Atkins.] Food records were analyzed periodically.
- hemoglobin A1c decreased from an average baseline of 7.5% down to 6.3% (a 1.2% absolute decrease and 16% relative drop)
- the absolute hemoglobin A1c decrease was at least 1.0% in half of the participants
- diabetic drugs were reduced in 10 patients, discontinued in seven, and unchanged in four
- average body weight decreased by 6.6%, from 131 kg (288 lb) to 122 kg (268 lb)
- triglycerides decreased 42%, while cholesterols (total, HDL, and LDL) didn’t change significantly
- no change in blood pressures
- average fasting glucose decreased by 17% (by week 16)
- uric acid decreased by 10%
- no serious adverse effects occurred
- one hypoglycemic event involved EMS but was treated without transport
- only 27 of 151 urine ketone measurements were greater than trace
The degree of improvement in hemoglobin A1c—our primary gauge of diabetes control—is equivalent to that seen with many diabetic medications. I see many overweight diabetics on two or three drugs and a standard “diabetic diet,” and they’re still poorly controlled. This diet could replace the expense and potential adverse effects of an additional drug.
In August this year I blogged about a study comparing the Atkins diet with a traditional low-fat diet in overweight diabetic black women in the U.S. As measured at three months, the Atkins diet proved superior for weight loss and glucose control.
This study at hand is small, but certainly points to the effectiveness of an Atkins-style very low-carb ketogenic diet in overweight men with type 2 diabetes.
Yancy, William, et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes [in men]. Nutrition and Metabolism, 2:34 (2005). doi: 10.1186/1743-7075-2-34
5 responses to “Low-Carb Ketogenic Diet for Overweight Diabetic Men: A Pilot Study”
Is this decrease in uric acid due to decreased fructose consumption? Or do things like metformin and TZDs reduce uric acid, too?
[For non-Isaacs, note that uric acid is a breakdown product of protein metabolism. Gout is caused by uric acid crystalization inside joints – very painful. Low-carb diets are usually higher than average in protein intake, not uncommonly 28-30% of total energy. Average protein consumption is 15-20% of total energy.]
I’m not aware of thiazoladinediones or metformin affecting uric acid levels. I made note of the lowered uric acid level in this study because low carb diets are associated with elevated uric acid and gout attacks, in the literature anyway.
I’m not sure of the uric acid-fructose connection.
An interesting study in rats looking at a potential causal relationship of uric acid and insulin resistance.
Of course, any animal experiment carries all sorts of caveats as to the relation to human disease. I’m not sure of the mechanism (potential cotransport, compensatory antioxidant?) but it does seem to correlate in humans. Causality is another thing. I have a hard time believing that allopurinol is going to affect A1c levels.
My husband is not diabetic but his BMI is 37. He suffers from COPD and sleep apnea, and while his weight seems to be contributing to his physical discomfort, it is not enough to get him to eat healthy. Any suggestions to change his attitude?
That’s a tall order, Beverly!
Just tell him, “Dr. Parker says you need to get your BMI down to 30 or less. Doctors orders!”