Just Read: Hope for 20th Century Medicine – Pilot study of a low-carbohydrate modified Diabetes Prevention Program (DPP)

This pilot study is good news for “mainstream” (20th Century) medicine utilizing the current Diabetes Prevention Program (DPP), to prevent diabetes, which is currently a covererd service “…by a growing number of health plans, including Medicare.”

The study team has significant credentials in this space, in my opinion

Currently, a low-fat diet approach

Although the DPP is the prevailing public health strategy for T2DM, rates of programme uptake and engagement are very low and only 35% of real-world DPP participants achieve goal weight loss of at least 5%.Hafez Griauzde D, Saslow L, Patterson K, Ansari T, Liestenfeltz B, Tisack A, et al. Mixed methods pilot study of a low-carbohydrate diabetes prevention programme among adults with pre-diabetes in the USA. BMJ Open [Internet]. 2020 Jan 21;10(1):e033397.

Adding a low-carbohydrate diet approach

This study was a pilot to see whether an additional approach, using a low-carbohydrate diet, could be used instead of a low-fat one to achieve the same or better weight loss goals, with the ultimate goal of preventing diabetes. It was conducted over a year in 21 individuals, and sought to mirror the currently recommended DPP program.

Allowable foods included meats, fish, poultry, eggs, cheese, seeds, nuts, leafy greens, non- starchy vegetables and some fruits (eg, berries). Participants were also taught to use low- carbohydrate substitutes when cooking or baking (eg, almond flour in Participants were also taught to use low- carbohydrate substitutes when cooking or baking (eg, almond flour in place of wheat flour).Hafez Griauzde D, Saslow L, Patterson K, Ansari T, Liestenfeltz B, Tisack A, et al. Mixed methods pilot study of a low-carbohydrate diabetes prevention programme among adults with pre-diabetes in the USA. BMJ Open [Internet]. 2020 Jan 21;10(1):e033397.

I appreciated the rigor of the training of the coaches, including the testing done to ensure they understant what a low-carbohydrate diet is, as well as requirement that the coaches adopt the diet themselves. It’s worth taking a look yourself, this test is not easy.

Results

At 12 months, the per cent body weight loss among all LC- DPP participants was greater than weight loss among histor- ical NDPP controls (5.2% vs 4.2%) and a similar number of LC- DPP participants achieved at least 5% body weight loss (38% vs 35%).Hafez Griauzde D, Saslow L, Patterson K, Ansari T, Liestenfeltz B, Tisack A, et al. Mixed methods pilot study of a low-carbohydrate diabetes prevention programme among adults with pre-diabetes in the USA. BMJ Open [Internet]. 2020 Jan 21;10(1):e033397.

A full randomized-controlled trial will be needed to assess whether this approach is better than a low-fat approach.

The qualitative analysis is also helpful here and shows that under current conditions, a low-carbohydrate diet is not easy to adopt for everyone. It’s important to hear these stories and think about low-carbohydrate as an additional option.

Fear of Fat

One thing that caught my eye around “current conditions” is our societal obsession with demonizing fat intake, and the way it might affect a person’s ability to engage in an intervention like this:

The majority of interviewees expressed fear regarding the diet’s fat content, reflecting the widely held belief that dietary fat and cholesterol increase cardiovascular disease risk. While observational data demonstrating this association emerged in the 1950s, the causative role of dietary saturated fat and cholesterol in heart disease is not well established. Furthermore, the Women’s Health Initiative, the largest RCT to evaluate health outcomes of low- fat diet adherence, showed no reduction in cardiovascular disease risk among intervention versus control group participants.Hafez Griauzde D, Saslow L, Patterson K, Ansari T, Liestenfeltz B, Tisack A, et al. Mixed methods pilot study of a low-carbohydrate diabetes prevention programme among adults with pre-diabetes in the USA. BMJ Open [Internet]. 2020 Jan 21;10(1):e033397.

For the purposes of knowing what’s right, it’s as important as ever that the medical profession embrace data over dogma (yes, #DataOverDogma) so that investigations like this can proceed in a way that deliver accurate results.

Hope for the future

If an RCT is completed and shows a favorable impact of this diet compared to the low-fat diet, it might be possible for doctors and patients to have another option to prevent diabetes, in a way that’s respected (and reimbursed) as current methods are. More options that work for more people is always good news in health.

Reference

Hafez Griauzde D, Saslow L, Patterson K, Ansari T, Liestenfeltz B, Tisack A, et al. Mixed methods pilot study of a low-carbohydrate diabetes prevention programme among adults with pre-diabetes in the USA. BMJ Open [Internet]. 2020 Jan 21;10(1):e033397.