2.5-MONTH EFFECTS OF A HIGH-INTENSITY LOW-CARBOHYDRATE INTERVENTION ON GLYCEMIC AND LIPID PROFILE: A TYPE-2 DIABETES NEAR-TO-REMISSION CASE STUDY OF A 65-YEAR-OLD INDIAN WOMAN WITH RECENT BILATERAL KNEE REPLACEMENT SURGERY.
Main Article Content
Keywords
Older adults, Geriatrics, Low-carbohydrate, Type-2 diabetes, Eating behaviour, Eating habits, Age-friendly communication, Diabetes remission, Weight loss, Lipid profile, Metabolic health
Abstract
This case study presents the effects of approximately 2.5 months of low-carbohydrate dietary intervention in a 65-year-old woman who had chronic type-2 diabetes for approximately 4 years and had recently undergone bilateral knee replacement surgery. The intervention's primary aim was to tackle the markers of insulin resistance and type-2 diabetes. Results have demonstrated noticeable improvements in numerous important health indicators. The glycated haemoglobin (HbA1c) levels have decreased from 7.10% to 6%. Body weight has reduced from 78 kg to 71.5 kg, and Body Mass Index (BMI) has reduced from 30.46 to 27.92 kg/m2—these changes have occurred without employing calorie-deficit and exercises or increased physical activity, implying low-carbohydrate intervention’s potential in reducing weight. The lipid profile has improved—the Triglycerides (TG) to High-Density Lipoprotein (HDL) ratio, a well-established predictor of cardiovascular disease, has reduced from 4.23 to 2.65. Collectively, the results indicate low-carbohydrate intervention’s significance in managing and potentially reversing the markers of insulin resistance and type-2 diabetes.
Additionally, a positive change in eating behaviour and habits has been observed—likely because of age-friendly communication, involving family members in the consultations, encouraging positive dietary changes in the overall family members, providing various recipes, tailoring a personalised diet chart, providing guidelines to navigate through social and festive situations, and regularly repeated consultations. Although this is an approximately 2.5-month single-person case study and thus has its inherent limitations for generalisation, its results corroborate with the growing body of strong empirical evidence, suggesting the usefulness of low-carbohydrate intervention in type-2 diabetes and insulin resistance management. Furthermore, the results of this case study underline the importance of personalised dietary intervention and comprehensive support for adhering to it.
This case study adds to the current knowledge pertaining to dietary interventions by highlighting the conceivable benefits and evident relevance of a tailored low-carbohydrate dietary intervention in improving metabolic health markers and addressing insulin resistance in an older adult with chronic type-2 diabetes. In order to validate the results of this approximately 2.5-month single-person case study and to explore the broader benefits and applicability of low-carbohydrate interventions in older adults with chronic type-2 diabetes, further research with multiple participants (larger group) is needed with long-term intervention.
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5. Appleton, K. M. (2023). Barriers to and Facilitators of the Consumption of Animal-Based Protein-Rich Foods in Older Adults: Re-Analysis with a Focus on Sustainability. Nutrients, 15(2), 470. https://doi.org/10.3390/nu15020470
6. Best, R. L., & Appleton, K. M. (2013). The consumption of protein-rich foods in older adults: An exploratory focus group study. Journal of Nutrition Education and behavior, 45(6), 751-755. https://doi.org/10.1016/j.jneb.2013.03.008
7. Cucuzzella, M., Riley, K., & Isaacs, D. (2021). Adapting medication for type 2 diabetes to a low carbohydrate diet. Frontiers in nutrition. Volume 8. Article 688540. https://doi.org/10.3389/fnut.2021.688540
8. De La Monte, S. M., & Wands, J. R. (2008). Alzheimer's disease is type 3 diabetes—evidence reviewed. Journal of diabetes science and technology, 2(6), 1101-1113. https://doi.org/ 10.1177%2F193229680800200619
9. Diabetes UK. (n.d.). Metformin and diabetes. Retrieved from https://www.diabetes.org.uk/ guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/tablets-and-medication/metformin#:~:text=Some%20people%20are%20able%20to,range%20without%20needing%20any%20medication.
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11. Ebbeling, C. B., Swain, J. F., Feldman, H. A., Wong, W. W., Hachey, D. L., Garcia-Lago, E., & Ludwig, D. S. (2012). Effects of dietary composition on energy expenditure during weight-loss maintenance. Jama, 307(24), 2627-2634. doi:10.1001/jama.2012.6607
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13. Hallberg, S. J., McKenzie, A. L., Williams, P. T., Bhanpuri, N. H., Peters, A. L., Campbell, W. W., ... & Volek, J. S. (2018). Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study. Diabetes Therapy, 9(2), 583-612. https://doi.org/10.1007/s13300-018-0373-9
14. Hu, C., & Jia, W. (2018). Diabetes in China: epidemiology and genetic risk factors and their clinical utility in personalized medication. Diabetes, 67(1), 3-11. https://doi.org/10.2337/dbi17-0013
15. Iqbal, N., Vetter, M. L., Moore, R. H., Chittams, J. L., Dalton‐Bakes, C. V., Dowd, M., ... & Wadden, T. A. (2010). Effects of a low‐intensity intervention that prescribed a low‐carbohydrate vs. a low‐fat diet in obese, diabetic participants. Obesity, 18(9), 1733-1738. https://doi.org/10.1038/ oby.2009.460
16. Johnsson, K. M., Ptaszynska, A., Schmitz, B., Sugg, J., Parikh, S. J., & List, J. F. (2013). Urinary tract infections in patients with diabetes treated with dapagliflozin. Journal of Diabetes and its Complications, 27(5), 473-478. https://doi.org/10.1016/j.jdiacomp.2013.05.004
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18. Kelly, T., Unwin, D., & Finucane, F. (2020). Low-Carbohydrate diets in the management of obesity and type 2 diabetes: a review from clinicians using the approach in practice. International journal of environmental research and public health, 17(7), 2557. https://doi.org/10.3390/ijerph17072557
19. Kim-Dorner, S. J., Deuster, P. A., Zeno, S. A., Remaley, A. T., & Poth, M. (2009). Should triglycerides and the triglycerides to high-density lipoprotein cholesterol ratio be used as surrogates for insulin resistance?. Metabolism: Clinical and Experimental, 59(2), 299-304. https://doi.org/10.1016/j.metabol.2009.07.027
20. Knowler, W. C., Barrett-Connor, E., Fowler, S. E., Hamman, R. F., Lachin, J. M., Walker, E. A., Nathan, D. M., & Diabetes Prevention Program Research Group (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England journal of medicine, 346(6), 393–403. https://doi.org/10.1056/NEJMoa012512
21. Liu, F., Wu, M., Feng, Y. H., Zhong, H., Cui, T. L., Huang, Y. Q., ... & Fu, P. (2013). Influence of HbA1c on short-term blood pressure variability in type 2 diabetic patients with diabetic nephropathy. Journal of Zhejiang University Science B, 14(11), 1033-1040. https://doi.org/10.1631/jzus.B1300030
22. Luz, P. L. D., Favarato, D., Faria-Neto Junior, J. R., Lemos, P., & Chagas, A. C. P. (2008). High ratio of triglycerides to HDL-cholesterol predicts extensive coronary disease. Clinics, 63, 427-432. https://doi.org/10.1590%2FS180759322008000400003
23. Malhotra, A., Noakes, T., & Phinney, S. (2015). It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. British journal of sports medicine, 49(15), 967-968. http://dx.doi.org/10.1136/bjsports-2015-094911
24. Menke, A., Casagrande, S., Geiss, L., & Cowie, C. C. (2015). Prevalence of and trends in diabetes among adults in the United States, 1988-2012. Jama, 314(10), 1021-1029. https://doi.org/10.1001/jama.2015.10029
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27. Metabolic Health India. (2022c). Metabolic health conference – Day 3. Retrieved from https://www.youtube.com/live/y22HeshH_6g?feature=shared
28. Mohan, V., Bhavadharini, B., Mukhopadhyay, S., Nallaperumal, S., Tiwaskar, M., Anjana, R. M., & Unnikrishnan, R. (2021). Diabetes in pre-independence India: Rediscovering a forgotten era. Journal of the Association of Physicians of India, 69, 80-84. PMID: 34472814
29. Nasri, H., & Rafieian-Kopaei, M. (2014). Metformin: current knowledge. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences, 19(7), 658. PMCID: PMC4214027
30. National Institute on Aging. (2023). Talking with your older patients. Retrieved from https://www.nia.nih.gov/health/talking-your-older-patients
31. Ness-Abramof, R., & Apovian, C. M. (2005). Drug-induced weight gain. Timely topics in medicine. Cardiovascular diseases, 9, E31. https://pubmed.ncbi.nlm.nih.gov/16341287/
32. Nuttall, F. Q., & Gannon, M. C. (1991). Plasma glucose and insulin response to macronutrients in nondiabetic and NIDDM subjects. Diabetes care, 14(9), 824-838. https://doi.org/10.2337/ diacare.14.9.824
33. Pathare, A. V. (2021). Exercise Does Not Solve Obesity: The" Calorie-Burning Theory" Is Misleading And Incorrect. International Journal Dental and Medical Sciences Research, 3(5), 328-333.Retrieved from http://clok.uclan.ac.uk/39920/ 1/39920%20AbhinavIJDMSR Article Editorial.pdf
34. Pathare, A. V. (2023). Improving the support for older adults in India: A multi-faceted approach for a better future. International Journal of Paediatrics and Geriatrics, 6(2), 13-17. https://doi.org/10.33545/26643685.2023.v6.i2a.206
35. Pathare, A. V., & Chaudhary, A. B. (2022). Contemporary directions in fatty liver disease in light of low-carbohydrate approach: a review by public health India. European Journal of Molecular and Clinical Medicine, 9(2), 808–817. http://publichealthindia.com/wp-content/uploads/2022/04/Ejmcm-2263.1.pdf
36. Pavy F. W. (1890). On the Principles of the Treatment of Diabetes Mellitus. The Indian Medical Gazette. Nov;25(11):327-330. PMID: 29000506; PMCID: PMC5149308. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5149308/pdf/indmedgaz71145-0007.pdf
37. Playford, R. J., Pither, C., Gao, R., & Middleton, S. J. (2013). Use of the alpha-glucosidase inhibitor acarbose in patients with ‘Middleton syndrome’: Normal gastric anatomy but with accelerated gastric emptying causing postprandial reactive hypoglycemia and diarrhea. Canadian Journal of Gastroenterology, 27(7), 403-404. https://doi.org/10.1155/2013/791803
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Mar 22, 2024
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Abhinav Vitthalrao Pathare, & Anup Bhaskarrao Chaudhary. (2024). 2.5-MONTH EFFECTS OF A HIGH-INTENSITY LOW-CARBOHYDRATE INTERVENTION ON GLYCEMIC AND LIPID PROFILE: A TYPE-2 DIABETES NEAR-TO-REMISSION CASE STUDY OF A 65-YEAR-OLD INDIAN WOMAN WITH RECENT BILATERAL KNEE REPLACEMENT SURGERY. Journal of Population Therapeutics and Clinical Pharmacology, 31(3). https://doi.org/10.53555/jptcp.v31i3.5141
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Author Biographies
Abhinav Vitthalrao Pathare
Master of Science in Applied Public Health, The University of Central Lancashire (UCLan), England. Principal Investigator, Public Health India (PHI), Mumbai, India
Anup Bhaskarrao Chaudhary
Director & Chief Nutrition Advisor, Public Health India (PHI), Mumbai, India. Senior Lecturer in Nutrition Sciences, India.
How to Cite
Abhinav Vitthalrao Pathare, & Anup Bhaskarrao Chaudhary. (2024). 2.5-MONTH EFFECTS OF A HIGH-INTENSITY LOW-CARBOHYDRATE INTERVENTION ON GLYCEMIC AND LIPID PROFILE: A TYPE-2 DIABETES NEAR-TO-REMISSION CASE STUDY OF A 65-YEAR-OLD INDIAN WOMAN WITH RECENT BILATERAL KNEE REPLACEMENT SURGERY. Journal of Population Therapeutics and Clinical Pharmacology, 31(3). https://doi.org/10.53555/jptcp.v31i3.5141