– About Low Carb Medicine –
As of 2018, The American Diabetes Association (ADA) along with the European Association for the Study of Diabetes (EASD) has approved a low carb diet as Medical Nutrition Therapy for the treatment of type 2 diabetes. It further states that a diet which is NOT low carb is ineffective for managing T2D.
The 2018 guidelines for the Canadian Diabetes Association includes a low carb diet as an acceptable dietary approach in the management of type 2 diabetes.
Low carb nutrition is an exciting new approach to type 2 diabetes management which can actually reverse the disease. A low carb diet has now been shown, in a trial with 350 patients, to reverse all important health parameters in type 2 diabetes. Here is a summary of the one year results:
- 94% of insulin users reduced or discontinued insulin
- 60% of type 2 diabetics achieved complete reversal
- average reduction of A1C by 1.3%
- 12% weight loss
- 24% decrease in triglycerides
- 18% increase in HDL
- 39% decrease in C-reactive protein
Hallberg SJ, McKenzie AL, et al, Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther. 2018 Apr;9(2):583-612
WHAT IS A LOW CARB DIET?
In a low carb approach, individuals restrict their daily carbohydrate intake below 100 grams. Clients are encouraged to eat a variety of healthy foods, including plenty of vegetables and healthy fats. There is no calorie restriction, although there is often a spontaneous decrease in calorie intake as hunger decreases and satiety increases with a shift in hormones (insulin, ghrelin, leptin) that occurs naturally as carbohydrates are decreased. The low carb diet instructed at Robinsong Health is NOT high protein (although there are plenty of poorly constructed low carb “plans” on the internet that are high protein.)
Clients with pain and inflammation often see significant improvement in the first couple of weeks. Low carb is currently the only treatment for fatty liver. Low carb is effective for type 2 diabetes reversal and weight loss. Please see the studies listed below.
The program starts with a 2 ½ hour workshop to learn the basics of low carb. They then have a 1 hour individual appointment followed by 6 half hour follow-up appointments. Most clients will need to decrease their medications- for diabetes and high blood pressure- over the course of the program. This can be done by the family physician or nurse practitioner, or if they would prefer it can be managed by the clinic pharmacist with updates sent to the primary care provider’s office.
Evidence to Support the Clinical Use of Low Carb Diets
Low carb diets decrease insulin resistance and fasting insulin levels.
Sato, J., Kanazawa, A., Makita, S., Hatae, C., Komiya, K. (2017). A randomized controlled trial of 130g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control. Clinical Nutrition, 36(4), 992-1000.
McKenzie, A. L., Hallberg, S. J., Creighton, B. C., Volk, B. M., Link, T. M., Abner, M. K., J. P., Volek, J. S., Phinney, S. D. (2017). A novel intervention including individualized nutritional recommendations reduces hemoglobin A1c level, medication use, and weight in type 2 diabetes. JMIR Diabetes, 2(1), e5
Calorie restricted diets lead to a decrease in resting metabolic rate and eventually weight gain. The Women’s Health Initiative study was the largest long term RCT dietary intervention ever. Nine years of low calorie, low fat diet did not improve health outcomes or weight loss.
Howard BV, Van Horn L, Hsia J, Manson JE, Stefanick ML, Wassertheil-Smoller S, (2006). Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Control Dietary Modification Trial. JAMA 8:295(6):655-66.
Low carb diets maintain metabolic rate. Patients are not hungry and they lose weight.
Gomez-Arbelaez, D., Crujeiras, A. B., Castro, A. I., Martinez-Olmos, M. A., Canton, A., Ordoñez-Mayan, L., Sajoux, I., Galban, C., (2018). Resting metabolic rate of obese patients under very low calorie ketogenic diet. Nutrition & Metabolism, 15(18), 2-10.
Adding fat to a Mediterranean diet reduces stroke, MI and CV death. MI decreased by 30%.
Estruch, R., Ros, E., Salas-Salvadó, J., Covas, M. I., Corella, D., Arós, F. (2013). Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine, 368(14), 1279-1290.
NON-ALCOHOLIC FATTY LIVER DISEASE
There is no drug treatment for NAFLD. Carbohydrate restriction is an effective treatment option.
Mardinoglu, A., Wu, H., Bjornson, E., Zhang, C., Hakkarainen, A., Räsänen, S. M., Lee, S., Mancina, R. M., Bergentall, M., Pietiläinen, K. H., (2018). An integrated understanding of the rapid metabolic benefits of a carbohydrate-restricted diet on hepatic steatosis in humans. Cell Metabolism.
Reversa Low Carb Clinic in Quebec:
Robinsong Low Carb Clinic is led by Erin Pitkethly, a pharmacist and nutritionist. Erin has additional training in low carb medicine with Dr. Bordua-Roy at the Clinique Reversa in Quebec. In addition, Erin is a member of Canadian Clinicians for Therapeutic Nutrition, a group of Canadian physicians and healthcare professionals who use evidence-based dietary intervention to improve, and when possible, reverse the symptoms of chronic, nutritionally-related diseases such as diabetes and obesity.
IDEAL PATIENTS FOR LOW CARB
ANYONE WHO HAS DIABETES, PRE-DIABETES, PCOS or is OVERWEIGHT and is INTERESTED and MOTIVATED.
When is a good time to mention low carb as an alternative?
- Symptom change (vision, weight gain)
- Dose changes
- Offer multiple times as with smoking cessation
- Unwin: offer to all- you may be surprised!
How the Robinsong Low Carb Clinic Works
Patients are managed by Erin Pitkethly, pharmacist (U of T 98). Erin has 20 years of experience in community pharmacy. She trained in low carb medicine with family physician Dr. Evelyne Bordua-Roy, a pioneer in low carb medicine in Canada.
- Clients taught low carb nutrition over 5 months.
- Pharmacist meets clients regularly; monitors BP, blood sugar, weight, waist circumference, side effects & is available for medication management 12 hours/day, 5 days a week.
- MD’s & NP’s are updated and given recommended medication adjustments.
- Exercise, sleep, stress management are addressed.
- Published results from similar clinic (VIRTA): 60% reversed DM2, 94% reduced or eliminated insulin, average A1C reduction 1.3%, average weight loss 30 pounds in 1 year.
- Physicians across Canada, including specialists in cardiology and nephrology, recommend low carb as a safe way to improve health.