Background: Many clinicians recommend low-salt diets for lowering blood pressure but there may be unintended consequences such as worsening insulin resistance.Aim: This paper aimed to find human clinical studies looking at low-salt diets on markers of glucose and insulin.Methods: 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.Results: 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.Conclusion: 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.Contribution: This review has revealed that low salt diets can induce insulin resistance.
Background: 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.Aim: To describe clinical cases that highlight the potential of ketogenic diets in the treatment of anorexia and the need for further research.Setting: Patient interviews were conducted via telemedicine.Methods: Medical interviews and chart reviews were conducted with three patients with severe anorexia. Written informed consent was provided by all participants.Results: Patients with anorexia, body mass index (BMI) nadirs of 10.7 kg/m2, 13.0 kg/m2 and 11.8kg/m2 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.Conclusion: These cases suggest a ketogenic diet may be useful for some patients with anorexia. Further research is needed.Contribution: 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.
Background: 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.Aim: 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.Methods: 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’.Results: Robust literature now exists on diabetes remission and international consensus panels are aligning on the strategies and the definition.Conclusion: 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.Contribution: This article highlights the importance of addressing DR and metabolic health to reduce not only the eye effects of T2D but the multisystem complications.
Background: 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. Aim: To determine the effects of brisk walking on fasting blood glucose and blood pressure of patients with T2DM living with hypertension in Ghana. Setting: The National Diabetes Management and Research centre at Korle-Bu Teaching Hospital. Methods: 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. Results: 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 p = 0.02) and blood pressure levels: (systolic blood pressure baseline: 141.12 mmHg (2.91) after intervention 120.75 mmHg (1.21) with p = 0.00); diastolic blood pressure (baseline: 80.78 mmHg (1.66), after intervention mmHg 69.38 (1.05) with p = 0.00) between baseline and post-intervention. Conclusion: Eight weeks of brisk walking reduced the levels of fasting blood glucose and blood pressure in patients with T2DM and hypertension. Contribution: 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.
