The MetabolicHealth Program Outcomes

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To quote the words of  Sean McKelvey , founder of the Institute for Personalized Therapeutic Nurition, "The baseline expectation for a new diagnosis of type 2 diabetes should be remission."

In the Fall of 2018, I conducted a quality improvement study of the MetabolicHealth Program for patients with prediabetes or type 2 diabetes. The following results are not peer reviewed and hypothesis generating only but suggest that a low carbohydrate dietary pattern can be safely and effectively prescribed from a doctor's office.

Setting: My family practice in Chatham, Ontario

Time frame: July 2015 to June 2018 

Inclusion criteria: Patients must have received a low carb consultation and at least 2 follow-up appointments in a 12-month period

Population: Age < 80 years, from my family practice or referred, baseline HbA1c > 6%

From my practice:

• Patients with HBA1c > 6% in time frame: 74
• Number encouraged to adopt the present LCHF prescription: 39
• Number who met inclusion criteria: 20
• LCHF was not recommended to 35 patients because the patient expressed no desire for lifestyle change or it was felt an alternate strategy would be more beneficial

Referred:

• Number who had consultation appointment: 68
• Number who met inclusion criteria: 50

Prescription: see How to Precribe Low Carb for details

Group Demographics:

• Only 70 of 142 patients with HBA1c > 6% met the inclusion criteria (that is, had a consultation and at least 2 follow-up appointments completed within 12 months)
• Average age 61 years (range 36-79)
• 44 females
• 41 with baseline HbA1c > 7%

The following are average baseline values and changes at 6 months for the 70 patients meeting inclusion criteria: 

Blood pressure: 126/72, SBP down 2, DBP up 0.1

Creatinine: 81, up 2

Albumin:Creatinine Ratio:  2, up 0.1

• None of the negative ACRs at baseline became positive

Uric acid: 357, up 17

ALT: 29, down 5

Non-HDL-C: 3.11, up 0.14

HDL-C: 1.12,  up 0.17

TG: 2.24, down 0.38

Weight: 108 kg,  down 11 kg

% Body Weight: down 10 %

Waist: 120 cm, down 11 cm

HbA1c: 7.6 %, down 0.9 %

Energy: 5.3, up 2.2

• Patients were asked before each appointment: “On a scale of 1 to 10, 1 being awful and 10 being tremendous, how has your energybeen, most of the time, since your last appointment?”

Cost of Anti-diabetes Medications per day: $4.68, down $2.06

Weight loss was maintained at 6 months of follow-up and patients report improved energy.

The MetabolicHealth Program uses a  patient self-study approach. It is not easy to precribe but it is possible in the busy office environment and with 10% body weight loss at 6 months, it is rewarding.