In the first of a two-part series examining the growing trend for using weight-loss drugs to tackle diabetes Type 2, Sarah Stacey reports on the serious potential risks for patients – and a safe, long-term alternative…
The slew of hopeful – or perhaps hype-full – headlines about the new weight-loss drugs – marketed as Ozempic for diabetes (the original indication) and Wegovy for obesity – took another turn recently, when the first population-level analysis of patients highlighted increased risks of serious gastro-intestinal side effects.
The research found that over 4,000 US adults taking semaglutide or liraglutide (both glucagon-like peptide-1 (GLP-1) agonists) for weight loss, had higher incidence of stomach paralysis (gastroparesis), pancreatitis, and bowel obstruction.
Researchers at the University of British Columbia said that, although the events are rare, it could still lead to hundreds of thousands of people worldwide experiencing such problems, especially as the drugs may be ordered online. Warning labels should be updated to include gastroparesis, they say.
Dr David Unwin, a supporter of the Beyond Pills Campaign and long-time researcher into dietary shifts for diabetes, has prescribed the drug a number of times but worries about it for various reasons.
‘My first concern is that we are “medicalising” obesity with a risk that people instead of looking at the true cause of their weight problem, which is almost certainly poor diet, could come to feel it’s okay to eat whatever they like as long as they get their weekly injection.’
He has also been concerned about the potential side effects reported in clinical trials by manufacturers Novo Nordisk and now in this epidemiological review. ‘My biggest concern though is what happens when you stop the drug? A double-blind randomised, controlled trial studied the effect of switching people from semaglutide to placebo after 20 weeks.
Those who continued to take semaglutide continued to lose weight. They had an average (mean) body weight loss from week 20 to week 68 of 7.9%. Those who were switched to a placebo regained 6.9% body weight on average. This suggests that to keep the weight off you need to inject the drug for life.’
Dr Unwin’s NHS practice near Liverpool has been offering a low carb approach for over ten years, with audited and published results.
He explains: ‘For those patients advised to follow a low carb diet, the average weight loss was 10kg over an average of 33 months and this without a single serious side effect, saving £68,000 per year from our diabetes drug budget into the bargain and improving all cardiovascular risk markers as well as renal function.’
Here, one of Dr Unwin’s patients reports on his own successful experience of following a low carb diet for nearly three years.
Business analysis manager Daniel Hayes, 42, says he feels ‘a bit of a fraud’. That’s nothing to do with his work for a finance company; it’s because his medical records list him as ‘diabetic’ since 2020. ‘In practical
terms, I was only diabetic for two months because following a low carb diet, suggested by my doctor, meant that my blood sugar levels fell so significantly I went into remission and have stayed that way ever since.’
Daniel’s story started 15 years ago when a routine check-up revealed he had high blood pressure. He was prescribed antihypertensives. He says: ‘The dose increased over the years to keep my blood pressure under control; it ended up pretty heavy’.
As part of monitoring for repeat prescriptions, Daniel had six-monthly check-ups at Norwood Surgery, his primary care practice in Southport, Merseyside.
‘About three years ago, I was told my blood sugar levels were high but to wait for the next check-up as the spike could be a one-off.’
The second reading showed the father-of-two’s blood sugar levels were ‘sky high’. He explains: ‘They’d rocketed in six months to nearly double. The doctor told me I had diabetes.’
At that point, many patients in Daniel’s position would have automatically been prescribed drugs but the Norwood Surgery, led by Dr Unwin, had been pioneering an alternative option – the low carb diet – for ten years. ‘I was told I could either take medication, which would likely be insulin, or try “turning off the sugar tap” for a couple of months and see if it made a difference.’
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The prospect of taking drugs, particularly insulin, shocked Daniel: ‘I felt it was a last resort; I wanted to see what I could do myself first.’ He learnt that sugar wasn’t the only problem but also starchy carbs like potato, rice, bread and pasta, which turn to sugar in the body. Because everyone reacts differently to foods, ‘the most useful thing was being given a continuous glucose monitor,’ he says.
The device, which he wore on his arm for a month, alerted Daniel to which foods caused a blood sugar spike, in his case, bread, rice and potatoes.
Cutting out those starchy carbs for three months caused his blood sugar levels to fall so dramatically that Daniel’s diabetes was virtually reversed at that point. Today, after consistently following a low carb diet (with the very occasional lapse, he admits), he has technically been in remission from diabetes for two and a half years.
‘I know it would come back if I went back to eating the way I did before and most of the time it’s fine. Having bacon, eggs and sausages for breakfast makes up for missing out on the Mars bars – and cauliflower rice with curry and chili is a great substitute.’
Although most puds are out, he enjoys his own ice cream made using frozen berries mixed with cream or thick yogurt.
There were unexpected and very positive consequences of following a low carb diet: Daniel’s weight dropped two stone to 12 stone seven pounds, his waist size shrank from a ‘snug’ 36 inches to 32, with a BMI of 23.8, which all meant he had to buy a new wardrobe. But there was another bonus: Daniel’s blood pressure began to fall and today he no longer needs to take pills for that.
Dr Unwin has published various studies: read, his latest here: What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate
diet with weight loss
Daniel is very appreciative of the ongoing support from the practice. ‘Dr Unwin doesn’t let patients go; he keeps in touch every six months or so. He even produces a graph to show how you’ve improved. There’s a
monthly support group at the practice too.’ It was from another patient that Daniel learnt he could access his medical records via the NHS app.
‘As a data analyst, it really helps me to chart my progress. It helped so much wearing the glucose monitor over that first month. Nowadays, with NHS app I can see the results of my blood tests, for instance, within a couple of days. Seeing the data is very motivating.’
Would Daniel have wanted to try semaglutide? ‘I don’t like the sound of that,’ he says. ‘Unless you change your habits, you’re not really solving the problem.’
Look out for the second article in this series, in which Sarah Stacey reports on other options and programmes available for patients with diabetes…