VLCDs are Very Low Calorie Diets that can be used to 'treat' Diabetes, or more specifically, could be a novel aspect of both a medically or surgically managed weight loss treatment plan to target T2DM.
These ketogenic diets are typically less than 800 calories total, with a large percentage of that caloric total coming from protein at the expense of very limited carbohydrates.
We use these diets in our Bariatric Surgery program in 2 ways. Commonly, we use it as the means to achieving a 5-10% weight loss prior to surgery. This is through our 'Lean and Green' diet that is overseen by our Nursing and Registered Dietitian staff, or similarly through a Medifast program that we offer and manage for our patients.
We also utilize these types of diets in the post op setting, in a patient that may need a 'jump start' to losing some weight, or has experienced some weight recidivism. It probably goes without saying, but this limited duration (4-12 weeks average) dietary program is just a part of the behavior retraining that may be needed, along with exercise, support groups, and follow up visits to the practice for review also needed.
As the patient nears the end of the limited term dietary intervention with the VLCD (hopefully with some momentum-building results of pounds lost to show for it), we have a pre-scheduled dietitian visit to start to put in place a return to the proper way to eat, addressing both the quantity and the quality issues of the patient's proper post-op nutrition.
Often, patients may need a brief refresher on portion sizes, optimizing quality of their diet, avoiding empty snacks and/or emotional eating, and practical ways to combat hunger. Exercise is a key part of that 'new' lifestyle routine, and increased activity can go a long way toward aiding with increasing lean body mass, increasing resting/basal metabolic rate, improved sense of well-being, and creating that internal awareness, if you will, of self-control that comes from the discipline of getting out there and "just doing it"regularly enough to see results.
Another place where VLCDs have a role, and this was somewhat new to me, is in the non-surgical treatment of T2DM.
Makes sense.
I viewed a webcast this week about just such a topic. We are in the process of putting together a Medically Managed Weight Loss arm to our practice, and the information on this webcast was very intriguing to say the least.
In a multidisciplinary program, such as we have / are looking to put together for a non-surgical component to our surgical practice, VLCDs would be the replacement dietary portion of the same lifestyle interventions (exercise and behavior) that we review and reinforce in our pre-surgery or post-surgery patients that are in need of weight loss.
Let's face it, behavior is essential to weight gain, and therefore weight loss, but at a certain level - weight loss is weight loss.
The additional medical / metabolic benefits for T2DM specifically are specific to how the body handles the VLCD intervention, and how it can fairly rapidly trigger some metabolically beneficial benefits that become reinforced over time with subsequent weight loss.
By the way, in terms of weight loss, these VLCDs are reported to be at the 3-5# per week rate with some variability.
Specific to T2DM though, Studies show the improvement in glycemic control is quite rapid, and is above what would be expected from an accumulation of weight loss over time, or the calorie restriction alone. Very early physiologic benefit has been seen in areas of improved beta-cell function, reduced insulin resistance, decreased hepatic glucose production. In summary, in some ways similar to the near-immediate surgical effect on Diabetes that we see in our practice.
As I see this blog entry is starting to go a little longer than I thought, let's save some finishing aspects of this topic for the next entry.
In the part 2 of this entry, we'll cover some of the potential dangers of an unmonitored VLCD, some additional nutritional and medical safety aspects that should be addressed with the program, helpful guidelines for T2DM medical management along the way, and some additional information on the weight loss benefit that comes from the dietary program that starts with the VLCD, and how that helps to maintain the favorable glycemic control for the long haul.
Good stuff.
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| From Truehealthyproducts.com |
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