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Diet, Diabetes Status, and Personal Experiences of Individuals With Type 2 Diabetes Who Self-Selected and Followed a Low Carbohydrate High Fat Diet

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Diet, Diabetes Status, and Personal Experiences of Individuals With Type 2 Diabetes Who Self-Selected and Followed a Low Carbohydrate High Fat Diet

Christopher C Webster et al. Diabetes Metab Syndr Obes.

Abstract

Background: Low carbohydrate high fat (LCHF) diets are increasing in popularity amongst patients with type 2 diabetes (T2D), however it is unclear what constitutes a sustainable LCHF diet in a real-world setting.

Methods: This descriptive multi-method study characterized the diets, T2D status, and personal experiences of individuals with T2D who claimed to have followed an LCHF diet for at least 6 months. Participants completed a medications history, mixed-method dietary assessment, provided a blood sample, and were interviewed in-depth about their experiences with the diet (First-Assessment). Past medical records were obtained corresponding to T2D diagnosis and prior to starting their LCHF diets. Additionally, participants were followed up 15 months later to assess T2D remission (Follow-Up).

Results: Twenty-eight participants completed First-Assessment and 24 completed Follow-Up. Habitual carbohydrate intake was 20 to 50 g/d for 10 participants and 50 to 115 g/d for 17 participants. Commonly reported foods were full-fat dairy, non-starchy vegetables, coconut oil, eggs, nuts, olives and avocados, olive oil, and red meat and poultry with fat. Median (interquartile range) for HbA1c was 7.5 (6.5-9.5) % prior to starting their diets, 5.8 (5.4-6.2) % at First-Assessment and 5.9 (5.3-6.6) % at Follow-Up. Reported body weight and glucose-lowering medication requirements were considerably lower at both assessments than when starting the diet. At Follow-Up, 24 participants had been following their LCHF diets for 35 (26-53) months, the majority of which were in full or partial T2D remission. Participants perceived reduced hunger and cravings as one of the most important aspects of their diets. Of concern, many participants felt unsupported by their doctors.

Conclusion: This study described the foods and characteristics of an LCHF "lifestyle" that was sustainable and effective for certain T2D patients in a real-world setting.

Keywords: LCHF; carbohydrate restriction; diabetes remission; food addiction; ketogenic diet; nutritional therapy.

Conflict of interest statement

TN is the author of the books Lore of Running and Waterlogged and co-author of The Real Meal Revolution, Challenging Beliefs, Raising Superheroes (Superfoods for Superheroes), Lore of Nutrition, Real Food on Trial, and The Banting Pocket Guide. All royalties from the sale of books dealing with nutrition are donated to the The Noakes Foundation of which he is the Chairman and which funds research of insulin resistance, diabetes and nutrition (including this study) as directed by its Board of Directors. Money from the sale of other books is donated to the Tim and Marilyn Noakes Sports Science Research Trust which funds the salary of a senior researcher at the University of Cape Town, South Africa (research focuses on the study of skeletal muscle in African mammals and of the pathophysiology of type 2 diabetes in some such mammals). The other authors declare no potential conflicts of interest in this work.

Figures

Figure 1
Figure 1
Time with T2D and time following the LCHF diet at First-Assessment. Time since diabetes diagnosis and time on the LCHF diet is shown for each individual participant at First-Assessment. Participants are ordered from left to right based on time since T2D diagnosis. *Indicates the 7 participants who started the LCHF diet shortly after diagnosis; #Indicates the 2 participants who were following an LCHF diet prior to diagnosis. The remaining 19 participants had a period of conventional diabetes treatment prior to starting an LCHF diet.
Figure 2
Figure 2
The 25 most frequently reported foods according to the Food Frequency Questionnaire. Data shown is from the Food Frequency Questionnaire (FFQ) completed at First-Assessment (left) and Follow-Up (right). Figure shows the reported food portions per week. 1st-Ass, First-Assessment; Tbsp, tablespoon; *Biltong is cured, dried meat, usually from beef or game.
Figure 3
Figure 3
Change in HbA1c over time. HbA1c expressed as median, interquartile ranges, and outliers at Pre-LCHF, First-Assessment and Follow-Up for: (A) all participants with valid HbA1c records at these three timepoints (n = 22, p < 0.01); (B) the subset of participants who started LCHF shortly after diagnosis (Pre-LCHF is equivalent to Diagnosis) (n = 6, p < 0.01); and (C) the subset of participants who were receiving conventional T2D management prior to starting an LCHF diet (n = 16, p = 0.03). P values were determined using the Friedman test. *and **Indicates a significant difference to Pre-LCHF (p < 0.05 and <0.01 respectively); #Indicates that the p value for the difference between Pre-LCHF and Follow-Up changes from 0.08 to 0.02 if analyzed without the 14.1% outlier. Post hoc p values were determined using the unadjusted pairwise Wilcoxon post-hoc test.
Figure 4
Figure 4
Body weight at Start-LCHF, First-Assessment and Follow-Up. Body weight expressed as median, interquartile ranges, and outliers at Start-LCHF, First-Assessment and Follow-Up for: (A) all participants who completed Follow-Up (n = 24, p < 0.001); (B) the subset of participants who started LCHF shortly after diagnosis (n = 6, p = 0.03); and C) the subset of participants who were receiving conventional T2D management prior to starting an LCHF diet (n = 16, p < 0.001). P values were determined using the Friedman test. *, **, and ***Indicates a significant difference to Start-LCHF (p < 0.05, 0.01, and 0.001 respectively); Post hoc p values were determined using the unadjusted pairwise Wilcoxon post-hoc test.

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Grant support

This project was funded by the National Research Foundation of South Africa and The Noakes Foundation.
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