https://journalofmetabolichealth.org/index.php/jmh/issue/feedJournal of Metabolic Health2024-01-10T13:36:20+01:00AOSIS Publishingsubmissions@journalofmetabolichealth.orgOpen Journal Systems<a id="readmorebanner" href="/index.php/jmh/pages/view/journal-information" target="_self">Read more</a> <img style="padding-top: 2px;" src="/public/web_banner.svg" alt="" />https://journalofmetabolichealth.org/index.php/jmh/article/view/87Use of a very low carbohydrate diet for prediabetes and type 2 diabetes: An audit2024-01-10T13:36:20+01:00Mariela Glandtmglandt@gmail.comNir Y. Ailonnailon@gmail.comSlava Bergeryberger@gmail.comDavid Unwinunwin5@btinternet.com<p><strong>Background:</strong> Type 2 diabetes (T2D) is viewed as a progressive chronic condition, yet recent research has raised hopes for reversal of this trajectory through innovative approaches.</p><p><strong>Aim:</strong> This audit assessed the impact of a very low carbohydrate ketogenic diet (VLCKD) on glucose control, weight and medication usage in T2D and prediabetes patients. The Glandt Center for Diabetes Care, in Tel Aviv, Israel, from 2015 to 2022.</p><p><strong>Setting:</strong> The Glandt Center for Diabetes Care, in Tel Aviv, Israel, from 2015 to 2022.</p><p><strong>Methods:</strong> A cohort of 344 T2D or prediabetes patients following a VLCKD diet for 6 months at a specialised diabetes centre was analysed. Patient records were reviewed for glucose control, weight, blood pressure, lipid profile, liver function and medication usage, with paired t-tests used for analysis.</p><p><strong>Results:</strong> Patients (mean age: 62 years; T2D duration: 12.3 years) showed significant improvements. Among patients with diabetes (<em>N</em> = 244), median HbA1c dropped from 59 mmol/mol (7.6%) to 45 mmol/mol (6.3%), with 96.3% showing improvement. Prediabetes patients (<em>N</em> = 100) experienced a drop from 42 mmol/mol (6%) to 38.7 mmol/mol (5.7%), with 84% improving. Weight loss occurred in both groups (median changes: −6.5 kg and −5.7 kg). Blood pressure, triglycerides and liver enzymes also improved. Initially, 78 patients were on insulin, reduced to 16 patients at 6 months, with average dose of those remaining on insulin reduced by 72%.</p><p><strong>Conclusion:</strong> Very low carbohydrate ketogenic diet is effective in enhancing glucose control, weight loss and cardiovascular risk factors in T2D. Most patients achieved insulin independence, with others significantly reducing insulin dosage. The study underscores the potential of integrating a VLCKD with medication management in comprehensive T2D treatment.</p><p><strong>Contribution:</strong> The audit shows the application of a KD in patients with long-standing diabetes.</p>2024-01-04T06:00:00+01:00Copyright (c) 2024 Mariela Glandt, Nir Y. Ailon, Slava Berger, David Unwinhttps://journalofmetabolichealth.org/index.php/jmh/article/view/92Metabolic health: A new frontier2024-01-10T13:36:20+01:00Caryn Zinncaryn.zinn@aut.ac.nzNo abstract available.2023-12-27T06:05:00+01:00Copyright (c) 2023 Caryn Zinnhttps://journalofmetabolichealth.org/index.php/jmh/article/view/86The application of carbohydrate-reduction in general practice: A medical audit2024-01-09T06:57:29+01:00Marcus A. Hawkinsmarcus@botanydoctor.co.nzCaryn Zinncaryn.zinn@aut.ac.nzChristine Delonpost@christinedelon.co.uk<p><strong>Background:</strong> Carbohydrate-reduction has been used successfully in the management of conditions arising from insulin resistance.</p><p><strong>Aim:</strong> In this audit, the authors report on metabolic outcomes from 72 patients in primary care who have undergone counselling using a low-carbohydrate dietary approach.</p><p><strong>Setting:</strong> This audit took place in a family medical practice located in a relatively affluent suburb in East Auckland, New Zealand.</p><p><strong>Methods:</strong> Patients adopted a carbohydrate reduction diet with regular follow-up and monitoring of health parameters.</p><p><strong>Results:</strong> The mean duration of observation was 21.5 (± 10.4) months. On average, patients lost 11 (± 8.4) kg, with 17% attaining a healthy body mass index (BMI). Four out of five patients reversed prediabetes over 20.8 (± 13.4) months. Twenty-five per cent (28/113) of the practice population with type 2 diabetes (T2DM) participated, of which 64% reversed and 11% remitted T2DM over 20.7 (± 11.8) months. Two patients stopped insulin and 10 reduced or stopped other diabetes medications. Nearly 35% (25/72) of participants were initially hypertensive. Thirty-six per cent (9/25) normalised systolic blood pressure (SBP), 28% (7/25) normalised diastolic blood pressure (DBP), and 16% (4/25) normalised both SBP & DBP. Sixty-four per cent reduced or stopped some or all antihypertensive medication. There was a mean reduction in SBP of 10.3 (± 17.7) mmHg and DBP of 4.8 (± 12.3) mmHg over 23.8 (± 9.0) months. Lipid changes were generally favourable, with 52% normalising triglycerides, 61% increasing high density lipoprotein cholesterol (HDL-C) to greater than 1.0 mmol/L, and 39% reducing low density lipoprotein cholesterol (LDL-C).</p><p><strong>Discussion:</strong> This real-world audit aligns with published data on the benefits of carbohydrate reduction.</p><p><strong>Conclusion:</strong> Effective management of prediabetes using CR might represent the biggest ‘bang for buck’ with a potential reduction in weight and prevention of diseases related to IR.</p><p><strong>Contribution:</strong> A low-carbohydrate dietary approach in primary care may serve as a realistic option for improving multiple health outcomes.</p>2023-12-08T08:00:00+01:00Copyright (c) 2023 Marcus A. Hawkins, Caryn Zinn, Christine Delonhttps://journalofmetabolichealth.org/index.php/jmh/article/view/85Corrigendum: Look in or book in: The case for type 2 diabetes remission to prevent diabetic retinopathy2024-01-09T06:57:29+01:00John Crippsjacripps@gmail.comMark Cucuzzellacucuzzellam@hsc.wvu.eduNo abstract available.2023-11-30T09:10:00+01:00Copyright (c) 2023 John Cripps, Mark Cucuzzellahttps://journalofmetabolichealth.org/index.php/jmh/article/view/91Acknowledgement to reviewers2024-01-09T06:57:29+01:00Editoial Office10ts.srsupport@insulinresistance.orgNo abstract available.2023-11-24T16:20:00+01:00Copyright (c) 2023 Editoial Officehttps://journalofmetabolichealth.org/index.php/jmh/article/view/84Animal-based ketogenic diet puts severe anorexia nervosa into multi-year remission: A case series2024-01-09T06:57:29+01:00Nicholas G. Norwitznicholas_norwitz@hms.harvard.eduMichelle Hurnpikarunner@gmail.comFernando Espi ForcenFESPIFORCEN@mgh.harvard.edu<p><strong>Background:</strong> Anorexia nervosa is a devastating condition that increases risk of death over five-fold and is associated with a high rate of relapse. Considering the growing field of metabolic psychiatry, anorexia can be framed as a ‘metabolic-psychiatric’ condition that may benefit from treatment with metabolic health interventions with neuromodulatory properties. Ketogenic diets, very low carbohydrate high-fat diets, are one such neuromodulatory intervention with a long history of use in epilepsy and more recently in other systemic, neurological and mental health conditions.</p><p><strong>Aim:</strong> To describe clinical cases that highlight the potential of ketogenic diets in the treatment of anorexia and the need for further research.</p><p><strong>Setting:</strong> Patient interviews were conducted via telemedicine.</p><p><strong>Methods:</strong> Medical interviews and chart reviews were conducted with three patients with severe anorexia. Written informed consent was provided by all participants.</p><p><strong>Results:</strong> Patients with anorexia, body mass index (BMI) nadirs of 10.7 kg/m<sup>2</sup>, 13.0 kg/m<sup>2</sup> and 11.8kg/m<sup><a href="/index.php/jir/editor/proofGalleyFile/84/254#CIT0002_84">2</a></sup> and refractory to standard of care therapy, each achieved remission of between 1–5 years to date on a high-fat animal-based ketogenic diet. Patients exhibited not only improvements in weight, with weight gain of over 20 kg each, but also diminution of anxiety and overall enhanced mental well-being.</p><p><strong>Conclusion:</strong> These cases suggest a ketogenic diet may be useful for some patients with anorexia. Further research is needed.</p><p><strong>Contribution:</strong> This case series is the first to document treatment of anorexia with unimodal ketogenic diet intervention and raises provocative questions about the role of this neuromodulatory dietary treatment for patients with anorexia, as well as the neurometabolic nature of the disease itself.</p>2023-06-14T09:00:00+02:00Copyright (c) 2023 Nicholas G. Norwitz, Michelle Hurn, Fernando Espi Forcenhttps://journalofmetabolichealth.org/index.php/jmh/article/view/79Look in or book in: The case for type 2 diabetes remission to prevent diabetic retinopathy2024-01-09T06:57:29+01:00John Crippsjacripps@gmail.comMark Cucuzzellacucuzzellam@hsc.wvu.edu<p><strong>Background:</strong> Diabetic retinopathy (DR) remains the leading cause of legal blindness in 18- to 74-year-old Americans and in most developed nations. Screening for DR has increased minimally over four decades.</p><p><strong>Aim:</strong> Primary care physicians are critical to improve both visual and systemic outcomes in patients with diabetes. Diabetic retinopathy screening affords clinicians the opportunity to discuss type 2 diabetes (T2D) remission with patients. Primary care is well positioned to manage, and lower risks, of the systemic-associated diseases predicted by DR. The goal of this review was to assess the current literature on DR, new technology to enhance primary care-based screening, and the science and practical application of diabetes remission. A two-pronged strategy, bringing attention to ophthalmologists the potential of diabetes remission, and family physicians, the importance of retinopathy screening, may reduce the prevalence of blindness in patients with diabetes.</p><p><strong>Methods:</strong> Embase, PubMed, Google Scholar, AMED, and MEDLINE databases were searched using keywords ‘diabetic retinopathy; diabetic retinopathy screening, diabetes remission, diabetes reversal, and AI and diabetic retinopathy’.</p><p><strong>Results:</strong> Robust literature now exists on diabetes remission and international consensus panels are aligning on the strategies and the definition.</p><p><strong>Conclusion:</strong> Diabetic retinopathy remains the leading cause of legal blindness. Novel primary care friendly imaging would benefit nearly half of Americans from earlier detection and treatment of DR still not receiving such care. The most powerful way a primary care clinician could impact DR would be assisting in making the T2D go into remission. Prevention or slowing of progression of DR would greatly improve both visual and systemic outcomes patients with diabetes.</p><p><strong>Contribution:</strong> This article highlights the importance of addressing DR and metabolic health to reduce not only the eye effects of T2D but the multisystem complications.</p>2023-04-11T09:16:00+02:00Copyright (c) 2023 John Cripps, Mark Cucuzzellahttps://journalofmetabolichealth.org/index.php/jmh/article/view/78Sodium restriction and insulin resistance: A review of 23 clinical trials2024-01-09T06:57:29+01:00James J. DiNicolantoniojjdinicol@gmail.comJames H. O'Keefeokeefe@saint-lukes.org<p><strong>Background:</strong> Many clinicians recommend low-salt diets for lowering blood pressure but there may be unintended consequences such as worsening insulin resistance.</p><p><strong>Aim:</strong> This paper aimed to find human clinical studies looking at low-salt diets on markers of glucose and insulin.</p><p><strong>Methods:</strong> We reviewed PubMed using the search terms ‘sodium’, ‘insulin’ and ‘insulin resistance’ and found 23 human clinical studies testing low-salt diets showing negative harms on insulin or glucose.</p><p><strong>Results:</strong> Twenty-three human clinical trials have shown that low-salt diets lead to systemic or vascular insulin resistance, glucose intolerance, elevated fasting insulin and/or elevations in glucose and/or insulin levels after an oral glucose tolerance test.</p><p><strong>Conclusion:</strong> We discovered 23 human clinical studies showing that low-salt diets worsen markers of insulin and glucose. Caution is advised when recommending salt restriction for blood pressure control as this may lead to worsening insulin resistance.</p><p><strong>Contribution:</strong> This review has revealed that low salt diets can induce insulin resistance.</p>2023-03-14T09:28:00+01:00Copyright (c) 2023 James J. DiNicolantonio, James H. O’Keefehttps://journalofmetabolichealth.org/index.php/jmh/article/view/77Effects of brisk walking on fasting blood glucose and blood pressure in diabetic patients2024-01-09T06:57:29+01:00Bridgette Opokubbridgeop@gmail.comCaroline R. de Beer-Brandonrubine.brandon@up.ac.zaJonathan Quarteyneeayree@googlemail.comNombeko Mshunqanenombeko.mshunqane@up.ac.za<p><strong>Background:</strong> Aerobic exercises have been administered as an adjunct treatment for health conditions; however, the effects of brisk walking on Type 2 diabetes mellitus (T2DM) patients living with hypertension in Ghana are yet to be explored.</p><p><strong>Aim:</strong> To determine the effects of brisk walking on fasting blood glucose and blood pressure of patients with T2DM living with hypertension in Ghana.</p><p><strong>Setting:</strong> The National Diabetes Management and Research centre at Korle-Bu Teaching Hospital.</p><p><strong>Methods:</strong> Males and females above 18 years with T2DM and hypertension were included. Fasting blood glucose, anthropometric measurements and distance walked were measured at baseline and after 8 weeks of intervention. The intervention consisted of brisk walking three times a week for 8 weeks.</p><p><strong>Results:</strong> Sixty participants completed the intervention. There was a statistically significant reduction of fasting blood glucose (baseline: 8.79 mmol/L (3.55), after intervention: 7.62 mmol/L (2.73) with <em>p</em> = 0.02) and blood pressure levels: (systolic blood pressure baseline: 141.12 mmHg (2.91) after intervention 120.75 mmHg (1.21) with <em>p</em> = 0.00); diastolic blood pressure (baseline: 80.78 mmHg (1.66), after intervention mmHg 69.38 (1.05) with <em>p</em> = 0.00) between baseline and post-intervention.</p><p><strong>Conclusion:</strong> Eight weeks of brisk walking reduced the levels of fasting blood glucose and blood pressure in patients with T2DM and hypertension.</p><p><strong>Contribution:</strong> This study will enlighten healthcare workers about the integration of brisk walking as a possible adjunct to control blood glucose and blood pressure levels in patients with T2DM and hypertension.</p>2023-02-23T11:30:00+01:00Copyright (c) 2023 Bridgette Opoku, Caroline R. de Beer-Brandon, Jonathan Quartey, Nombeko Mshunqanehttps://journalofmetabolichealth.org/index.php/jmh/article/view/80Table of Contents Vol 5, No 1 (2022)2023-04-03T13:34:36+02:00Editorial Officepublishing@aosis.co.zaNo abstract available.2022-12-31T06:00:00+01:00Copyright (c) 2022 Editorial Office