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Helping Diabetics Reduce Medications & Improve Quality of Life

A healthier weight, particularly for diabetics, often translates to a lower risk of complications, improved blood sugar control and reduced medications. However, the process of weight loss often involves frequent changes in physical activity, diet and medications which add to the complexity and challenges for diabetics. The option of a physician-supervised very-low-calorie-diet can help diabetics more quickly experience the benefits of weight loss with fewer changes and adjustments.

What is a very-low-calorie-diet (VLCD), and how does it fit into the spectrum of choices for weight loss? A VLCD is defined as 800 calories/day or less, and is typically provided using specially-formulated meal replacement products which utilize a high-biologic-value protein source and a level of vitamin/mineral supplementation specific to VLCD management. Some VLCD meal replacements are also low-carbohydrate, promoting a mild level of ketosis which is associated with decreased hunger. (These products are not the same as over-the-counter nutrition drinks typically sold to replace one or two meals per day.) Patients considering a VLCD have already tried “eat less, exercise more” and may be reluctant to take the short and long-term risks of a lap-band or gastric bypass surgery. VLCDs are also an option after bariatric surgery as a strategy for weight regain.

The NIH—National Institutes of Health, and the NHLBI— National Heart Lung and Blood Institute in The Practical Guide for obesity treatment identifies qualifying patient criteria as a BMI of 30 or a BMI of 27 with obesity-related diagnoses such as Type 2 diabetes, high cholesterol or hypertension. The NIH/NHLBI and the American Society of Bariatric Physicians advise that patients should be assessed and monitored by a specialized practitioner specifically trained in the clinical use of a VLCD. Further, the Obesity Action Coalition advises that physician-supervised programs should offer services such as nutrition education, pharmacotherapy, physical activity and behavioral therapy with a healthcare team which includes nurses, registered dietitians and behavioral counselors. The American Dietetic Association’s Evidence Analysis Library assigned a Grade I for the evidence on VLCDs, concluding that “adherence to a very low calorie diet… results in significant weight loss.” Potential side effects of VLCDs include fatigue, nausea, constipation, and diarrhea.

What about food-based diets similar to the 500-calorie diet recommended with HCG? Food-based VLCDs in the 1970s were found to be associated with electrolyte abnormalities resulting in heart rhythm disorders and death. Apart from the fact that the FDA considers the use of HCG for weight loss to be fraudulent, there are risks and side effects with a food-based, unsupervised VLCD.

VLCDs are not an appropriate strategy for everyone, and a physician experienced in clinical VLCD management would conduct a thorough medical screening, including labs and a baseline EKG at the initial appointment. Medical monitoring should continue on a weekly basis, including the adjustment of medications, periodic labs and monthly physician exams. Diabetics, in particular, will experience quick reduction of medications and improvement in blood glucose levels within the first four weeks of a VLCD. Therefore, frequent monitoring is essential for patient safety.

Last, it should be noted that a VLCD is an INITIAL phase which offers patients quick weight loss results with medical benefits, translating to increased motivation and commitment. A high-quality VLCD program will include education, skill-building and support from a multidisciplinary team throughout the initial, transitional, and long-term maintenance phases, offering the patient/client the best possible chance for success.