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The Atkins Nutritional Approach is an Effective Tool for Treating Metabolic Syndrome X A GP’s perspective. Dr Sarah Brewer. Metabolic Syndrome X. Metabolic syndrome X is associated with: Insulin resistance High insulin levels Glucose intolerance Overweight, especially around the waist - PowerPoint PPT Presentation


  • The Atkins Nutritional Approach is an Effective Tool for Treating Metabolic Syndrome X

    A GPs perspectiveDr Sarah Brewer

  • Metabolic Syndrome XMetabolic syndrome X is associated with:Insulin resistanceHigh insulin levelsGlucose intoleranceOverweight, especially around the waistHigh blood pressureHigh levels of harmful very low density lipoprotein cholesterol (small dense particles)Low levels of beneficial HDL-cholesterolHigh triglyceride levelsIncreased blood clotting factors

  • Metabolic Syndrome XThe European Group for the Study of Insulin Resistance defines Metabolic syndrome as:

    Insulin levels in the highest 25% of the population range

    PLUS two of the following:

    fasting glucose levels 6.1 mmol/l but 7.0 mmol/l high blood pressure 140/90 mmHgplasma triglycerides 2 mmol/l or HDL 1mmol/lCentral obesity: waist measurement greater than 94cm in men or 80cm in women

  • Metabolic Syndrome XAll these clinical factors are important, independent risk factors for heart disease and stroke, and often lead to Type 2 diabetes if left untreated

    Recent evidence suggests these traits together interact to produce more damage to artery walls than expected from their additive effects alone

    As many as one in five people are believed to have metabolic syndrome in the UK

    Metabolic syndrome has been described as a cardiovascular time-bomb

  • Metabolic Syndrome XThere is excellent evidence that improving single risk factors such as high blood pressure, raised glucose levels or abnormal cholesterol levels can reduce the risk of heart attack and stroke Research is now investigating whether aggressive diet and lifestyle changes at an early stage in the development of metabolic syndrome might prevent the development of these major risk factors altogether All the clinical signs associated with metabolic syndrome X can be reduced or even reversed by following a low-carb diet

  • Results of a High-Carb DietThe underlying cause of metabolic syndrome is insulin resistance in which body cells lose their sensitivity to insulin hormone; this may be linked with obesity Foods that raise blood sugar levels stimulate the production of insulin to help push excess glucose into adipose cells for storage as body fat Cells become increasingly insensitive to the effects of insulin when levels are persistently raised, so more and more insulin is produced to help maintain normal blood sugar levels People with metabolic syndrome are basically over-dosing on glucose and insulin

  • Result of Carbohydrate Intake

  • The Obesity Epidemic in the UK

    Insulin is a storage hormone that actively promotes overweight and obesity

    More than half the adult population of England (two thirds of men and half of women) are overweight and 20% of these are obese .1,000 people in England reach the stage of obesity every day

    In 2001, 8.5% of 6 year olds and 15% of 15 year olds were classed as obese due to a combination of over eating and lack of physical activity.

    Sources: National Audit Office Tackling Obesity in England, February 2001TOAST (The Obesity Awareness & Solutions Trust), March 2000

  • Benefits of Weight LossLosing 10kg in weight (22lb) has been shown to: blood pressure by 10/20 mmHg fasting blood glucose levels by 50% triglycerides by 30% total cholesterol levels by 10% harmful LDL-cholesterol by 15% good HDL-cholesterol by at least 8%

    For someone who is obese, losing 10kg can reduce their overall risk of premature death by 20% and their risk of diabetes-related death by as much as 30%

  • Evaluation of the Atkins Nutritional Approach28 people with Type 2 diabetes who could not achieve good glucose control 9 were previously treated with diet alone, 19 were on oral hypoglycaemic drugs (although these were discontinued at the start of the trial). All followed a low-carb diet supplying 25% of daily energy in the form of carbohydrate for 8 weeksAfter 8 weeks, they switched to a diet providing the same amount of energy, but with 55% carbohydrate

    Gutierrez M et al.. Journal of the American College of Nutrition 1998. 17(6): 595-600

  • Evaluation of the Atkins Nutritional Approach

    After the first 8 weeks (low-carb) there were significant improvements in blood glucose control and haemoglobin A1c levels When they switched back to the so-called healthy 55% carbohydrate diet, their glucose control worsened again and their haemoglobin A1c level rose significantly over the following 12 weeks Conclusion: a low-carb, low calorie diet had beneficial effects in people with Type 2 diabetes, and may reduce their need to move on to insulin treatment

  • Evaluation of the Atkins Nutritional ApproachA controlled trial funded by the American Heart Association randomised 53 obese females to 6 months of an ad libitum very low carbohydrate diet or a calorie restricted, low fat (30%) diet Both groups reduced calorie consumption by comparable amounts at 3 and 6 months Total intake of saturated fat was not excessiveAt 3 months the low-carb group consumed 20.7% saturated fat 20.6% monounsaturated fat and 9% polyunsaturated fatAt 6 months the low-carb group consumed 17.4% saturated fat 15.8% monounsaturated fat and 8.2% polyunsaturated fatThe percentage of saturated fat is consistent with other studies following free-living individuals using the Atkins Nutritional Approach

  • Evaluation of the Atkins Nutritional ApproachMean levels of blood pressure, lipids, fasting glucose and insulin improved in both groups Even through the low carb dieters ate more calories per day by 6 months, compared with those on the low fat diet (1302 Vs 1247) they lost significantly more weight and body fat The low-carb group lost more weight (8.5kg vs 3.9kg) and more body fat (4.8kg vs 2kg) than the low fat group with no adverse effect on cardiovascular risk factors A very low carbohydrate diet is more effective than a low fat diet for weight loss and, over 6 months, is not associated with deleterious effects on cardiovascular risk factors in women

  • A Calorie is Not a Calorie?This trial, and others, suggest that a low carbohydrate diet provides a metabolic advantageFor the greater weight loss in the low carbohydrate diet to result from decreased calorie consumption alone, the group would have had to consume 300 fewer calories per day over the first 3 months compared with the low fat diet groupAlthough the inaccuracy of dietary records for obese subjects is well documented, it seems unlikely that a systematic discrepancy of this magnitude occurred between groups of subjects who were comparably overweight. Quotes: Brehm et al, J Clin Endocrinol Metab 2003, 88(4):1617-1623

  • Evaluation of the Atkins Nutritional ApproachThe researchers concluded that: For the greater weight loss in the low carbohydrate diet to result from decreased calorie consumption alone, the group would have had to consume 300 fewer calories per day over the first 3 months compared with the low fat diet group

    Consider calorie reductionConsider metabolic advantage

  • Evaluation of the Atkins Nutritional Approach

    One year, controlled trial involving 63 obese men and women Average BMI 34kg/M2Randomised to either a low-carb (high protein, high fat) diet, or a conventional low calorie, low fat diet Those on the low-carb diet had a statistically significant greater weight loss for the first 6 months (7% body weight versus 3.2% body weight), and maintained greater weight loss at 12 months (even though carb intake had been increased greatly) although not statistically significant Foster GD et al, New Eng J Med 2001; 348;21:2082-2090.

  • Evaluation of the Atkins Nutritional Approach

    There was little difference in the LDL-cholesterol between the two groupsBoth diets significantly decreased diastolic blood pressure and the insulin response to a known intake of glucose Those on the low-carb diet had greater improvements in serum triglycerides and HDL-cholesterol than those on the conventional dietThese beneficial changes were as good as can be obtained with some medications

  • Evaluation of the Atkins Nutritional Approach

    The researchers concluded:

    The low-carbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease

    the changes are greater than those expected from a moderate weight loss alone

  • Evaluation of the Atkins Nutritional Approach132 severely obese subjects randomly assigned to a low-carb diet or a calorie and fat restricted diet 6/12 Mean BMI 43 kg/M2 39% had diabetes, 43% metabolic syndrome Of the 79 subjects that completed the study (low fat dieters were twice as likely to drop out), those following a low-carb diet lost more weight than those on the low fat diet (5.8kg vs 1.9kg) irrespective of their use or non-use of drugs to lower blood glucose or cholesterol levels

    Samaha FF et al N Engl J Med 2003; 348:21, 2074-81.

  • Evaluation of the Atkins Nutritional ApproachNine out of 64 people starting the low carbohydrate diet eventually lost at least 10% of their body weight compared with only 2 out of the 68 people who started on the low fat diet Triglyceride levels by over 20% for those on the low-carbohydrate diet versus only a 4% for those on the low fat diet Insulin sensitivity was measured in the people with diabetes and was found to have improved more in those following the low-carb diet

  • Evaluation of the Atkins Nutritional ApproachThe researchers concluded that:

    . being assigned to the low-carbohydrate diet was an independent predictor for improvements in triglyceride levels and insulin sensitivity

  • Evaluation of the Atkins Nutritio


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