Dr. David Unwin, Fellow of the Royal College of General Practitioners (FRCGP) together with fellow researchers recently completed a study showing low carb diets significantly reduce fatty liver, weight and blood sugar. Trialing a low carb approach over a year, they found rapid improvements in liver function among other positive effects.
“My interest in abnormal liver, and particularly GGT blood results began when I noticed that in our family practice of 9,000 patients well over a 1,000 had an abnormal GGT result,” said Dr. Unwin. “I could predict which patients would have lost weight -before they came into my consulting room from the improvement in GGT blood results alone- so began to wonder about raised GGT levels, Diabetes and non-alcoholic fatty liver disease (NAFLD): Was dietary carbohydrate a link?”
Before we get to the summary, let’s breakdown some of the statistics.
- Approximately 30 million children and adults have diabetes in the United States. Out of that number, nearly 95% have type 2 diabetes according to the American Diabetes Association.1
- The National Conference of State Legislatures (NCSL) reports obesity affects more than one-third of adults and 17% of youth in the United States. This equates to 78 million adults and 12 million children suffering from the obesity epidemic. As adopters of the Paleo diet well know, obesity increases risk for heart disease, type 2 diabetes, and cancer among other debilitating health conditions, like non-alcoholic fatty liver disease (NAFLD).2
- The American Liver Foundation reports (NAFLD) affects up to 25% of Americans, where risk is directly correlated to being overweight or obese, having diabetes, high cholesterol or high triglycerides.3
As the cost of health care continues to skyrocket, Dr. Unwin has decreased his prescribing budget £15,000-£30,000 a year by prescribing a low carb diet to patients who in two years’ time decreased average blood sugar by 10% and is now below the national average in the UK4 and US.
Well, thankfully the Paleo diet is devoid of breads, pastas, grains, pseudo grains, and processed sugars. When we focus upon lean meats, fish, poultry, veggies, and fruits, nuts, and seeds in moderation, a Paleo prescription is the best, cost effective investment you can make for your health.
Summary* presented ahead of publication in Diabetes in Practice September 15, 2015.
Unwin DJ1, Cuthertson DJ2, Feinman R3, Sprung VS2 (2015) A pilot study to explore the role of a low-carbohydrate intervention to improve GGT levels and HbA1c. Diabesity in Practice 4 [in press]
1Norwood Surgery, Norwood Ave, Southport. 2Department of Obesity and Endocrinology, Institute of Ageing & Chronic Disease, University of Liverpool, UK. 3Professor of biochemistry and medical researcher at State University of New York Health Science Center at Brooklyn, USA.
Working title: Raised GGT levels, Diabetes and NAFLD: Is dietary carbohydrate a link? Primary care pilot of a low carbohydrate diet
Abnormal liver function tests are often attributed to excessive alcohol consumption and/or medication without further investigation. However they may be secondary to non-alcoholic fatty liver disease (NAFLD). NAFLD is now prevalent in 20-30% of adults in the Western World. Considering the increased cardiovascular and metabolic risk of NAFLD, identification and effective risk factor management of these patients is critical.
Background Excess dietary glucose leads progressively to hepatocyte triglyceride accumulation (non-alcoholic fatty liver disease-NAFLD), insulin resistance and T2DM. Considering the increased cardiovascular risks of NAFLD and T2DM, effective risk-factor management of these patients is critical. Weight loss can improve abnormal liver biochemistry, the histological progression of NAFLD, and diabetic control. However, the most effective diet remains controversial.
Aim We implemented a low-carbohydrate (CHO) diet in a primary health setting, assessing the effect on serum GGT, HbA1c levels (as proxies for suspected NAFLD and diabetic control), and weight.
Design 69 patients with a mean GGT of 77 iu/L (NR 0-50) and an average BMI of 34.4Kg/m2 were recruited opportunistically and advised on reducing total glucose intake (including starch), while increasing intake of natural fats, vegetables and protein.
Method Baseline blood samples were assessed for GGT levels, lipid profile, and HbA1c. Anthropometrics were assessed and repeated at monthly intervals. The patients were provided monthly support by their general practitioner or practice nurse, either individually or as a group.
Results After an average of 13 months on a low-CHO diet there was a 46% mean reduction in GGT of 29.9 iu/L (95% CI= -43.7, -16.2; P<0.001), accompanied by average reductions in weight [-8.8Kg (95% CI= -10.0, -7.5; P<0.001)],and HbA1c [10.0mmol/mol (95% CI= -13.9, -6.2; P<0.001)].
Conclusions We provide evidence that low-carbohydrate, dietary management of patients with T2DM and/or suspected NAFLD in primary care is feasible and improves abnormal liver biochemistry and other cardio-metabolic risk factors. This raises the question as to whether dietary carbohydrate plays a role in the etiology of diabetes and NAFLD, as well as obesity. Over the study period and given a choice not a single patient opted to start antidiabetic medication, losing weight instead. This helps explain why our practice is the only one in the Southport and Formby CCG to have static diabetes drug costs for three years running.
*Note: The summary displayed above is not the official abstract from Diabetes in Practice.
David Unwin is the senior partner and GP trainer at the Norwood Surgery, Southport, a seaside resort in the North West of England. He is an expert clinical adviser in diabetes for the Royal College of General Practitioners, and has a special interest in the Solution Focused psychological approach to the consultation. David lives on a farm with his wife, son and their sheep, turkeys, hens -and a very large pig!