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Metabolic Reset Programme: Evidence Base

The Combe Grove Metabolic Reset Programme is based around the Five Roots of Metabolic Health: Nutrition, Movement, Sleep, Mindset and Environment. At each stage of the programme development, our experienced team has considered the latest science to develop these five roots and produce evidence-based recommendations to help our guests achieve positive lifestyle change with potential to prevent the onset of diabetes and potentially reverse prediabetes.

A list of peer-reviewed journal articles underpinning the Metabolic Reset Programme can be found below:

Nutrition:

Evidence for outlining why we support a low-carb diet  

Brown, A., McArdle, P., Taplin, J., Unwin, D., Unwin, J., Deakin, T., … & Mellor., D. (2020). Dietary strategies for remission of type 2 diabetes: A narrative.

Summary:

  • Narrative review supporting use of a low carb diet to achieve remission from Type 2 diabetes.

 

Feinman, R. D., Pogozelski, W. K., Astrup, A., Bernstein, R. K., Fine, E. J., Westman, E. C., … & Worm, (2015). Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition, 31, 1-13.

Summary:

  • A review paper highlighting that a restricted-carb diet is an effective means of managing high blood sugar and Type 2 diabetes.
  • Review also defines a ‘low-carb’ diet as 130g of carbohydrate per day or less. This is what we are working to at Combe Grove. There has previously been no consensus on the definition of ‘low-carb’.

 

Hussain, T. A., Mathew, T. C., Dashti, A. A., Asfar, S., Al-Zaid, N., & Dashti, H. M. (2012). Effect of low calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition, 28, 1016

1021.

Summary:

  • Evidence that a low-carbohydrate diet is effective in promoting weight loss and reducing blood sugar over 24 weeks.

 

Centers for Disease Control and Prevention. (2004). Trends in intake of energy and macronutrients United States: 1971 to 2000, JAMA, 291, 1193-1194.

Summary:

  • Study followed 5000 Americans from 1974 to 2000.
  • Evidence that the increase in Type 2 diabetes is linked to an increase in carbohydrates in the Western diet, and not an increase in fat. Suggest that reducing carbs in our diet may therefore help to tackle rising diabetes cases.

 

Westman, E. C., Yancy, W. S., Mavropoulos, J. C., Marquart, M., & McDuffie, J. R. (2008). The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & metabolism, 5, 1-9.

Summary:

  • Evidence that a low-carb diet is an effective tool for achieving weight loss and a reduction in HbA1c (a measure of the average sugar content of the blood over 12 weeks). More effective than a low calorie diet.

 

Evidence outlining why we recommend a protein source at each meal

 

Krieger, J. W., Sitren, H. S., Daniels, M. J., & Langkamp-Henken, B. (2006). Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression. The American journal of clinical nutrition, 83(2), 260-274.

Summary:

  • Evidence that a high protein diet helps to prevent loss of lean tissue (muscle mass) when following a low carb diet. Sustaining adequate muscle mass is important for protecting against Type 2 diabetes, especially as we get older.

 

Phillips, S. M., Paddon-Jones, D., & Layman, D. K. (2020). Optimizing adult protein intake during catabolic health conditions. Advances in Nutrition, 11, 1058-1069.

Summary:

  • Review outlining the benefits of higher protein diets for optimising health during aging, inactivity, bed rest, or metabolic dysfunction such as type 2 diabetes.

 

Areta, J. L., Burke, L. M., Ross, M. L., Camera, D. M., West, D. W., Broad, E. M., … & Coffey, V. G. (2013). Timing and distribution of protein ingestion during prolonged recovery from resistance exercise alters myofibrillar protein synthesis. The Journal of Physiology, 591, 2319-2331.

Summary:

  • Evidence that protein ingestion is most effective at stimulating muscle protein synthesis when a moderate amount of protein is consumed at every meal.

 

Evidence outlining why we support the inclusion of natural fats in our diet and do not support a low-fat diet:

 

Howard, B. V., Van Horn, L., Hsia, J., Manson, J. E., Stefanick, M. L., Wassertheil-Smoller, S., and Kotchen, J. M. (2006). Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA, 295, 655-666.

Summary:

  • Study of 48,000 post-menopausal women
  • Evidence that a low-fat diet does not reduce risk of coronary heart disease, cardiovascular disease, which are risk factors for Type 2 diabetes.

 

Deakin, T., & Garden, L. (2015). Saturated fat doesn’t increase coronary heart disease in people with diabetes. Practical Diabetes, 32, 254-260.

Summary:

  • Review of studies consider the relationship between saturated fat in the diet (such as that found in animal products such as meat and dairy) and risk of coronary heart disease. Concluded that saturated fat in the diet does not increase risk of CHD.

 

Siri-Tarino, P. W., Sun, Q., Hu, F. B., & Krauss, R. M. (2010). Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. The American journal of clinical nutrition, 91(3), 535-546.

Summary:

  • During 5–23 y of follow-up of 350,000 subjects, 11,000 developed CHD or stroke. Intake of saturated fat was not associated with an increased risk of CHD, stroke, or CVD.

 

Evidence outlining why we recommend intake of non-starchy vegetables (broccoli, cauliflower, asparagus etc) as the largest component of any given meal

 

Martin, K. E. (2017). Glycaemic response to varying the proportions of starchy foods and non-starchy vegetables within a meal: A randomised controlled trial (Doctoral dissertation, University of Otago).

Summary:

  • Evidence that meals with larger proportions of starchy carbs (pasta / rice) and smaller portions of non-starchy vegetables cause the greatest increase in blood sugar levels. Meals that contain smaller proportions of starchy carbs and larger proprtions of non-starchy vegetables have the lowest impact on blood sugar.

 

Moore, L. L., Singer, M. R., Bradlee, M. L., & Daniels, S. R. (2016). Adolescent dietary intakes predict cardiometabolic risk clustering. European Journal of Nutrition, 55, 461-468.

Summary:

  • Evidence that eating plenty of non-starchy veg earlier in life may have a protective effect against risk factors for Type 2 diabetes and cardiovascular disease

 

Evidence underpinning our commitment to drinking plenty of water and minimising sugar-sweetened beverages and artificially sweetened beverages

 

Armstrong, L. E., Barquera, S., Duhamel, J. F., Hardinsyah, R., Haslam, D., & Lafontan, M. (2012).Recommendations for healthier hydration: addressing the public health issues of obesity and type 2 diabetes. Clinical Obesity, 2, 115-124.

Summary:

  • Consensus statement from experts in medicine, nutrition, physiology and public health on healthy hydration practises to tackle obesity and Type 2 diabetes.

 

Evidence underpinning our commitment to time-restricted eating

 

Wilkinson, M. J., Manoogian, E. N., Zadourian, A., Lo, H., Fakhouri, S., Shoghi, A., … & Taub, P. R. (2020). Ten-hour time-restricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome. Cell Metabolism, 31, 92-104.

Summary:

  • Evidence that TRE (10-hr eating window) reduces risk factors for Type 2 diabetes including waist circumference, percent body fat, and visceral fat, blood pressure, HbA1c (a measure of blood sugar)

 

Cienfuegos, S., McStay, M., Gabel, K., & Varady, K. A. (2022). Time restricted eating for the prevention of type 2 diabetes. The Journal of Physiology, 600, 1253-1264.

Summary:

  • Review outlining the evidence for the effectiveness of TRE on body weight and markers of glycaemic control (both risk factors for Type 2 diabetes)

Sutton, E. F., Beyl, R., Early, K. S., Cefalu, W. T., Ravussin, E., & Peterson, C. M. (2018). Early time restricted feeding improves insulin sensitivity, blood pressure, and oxidative stress even without weight loss in men with prediabetes. Cell Metabolism, 27, 1212-1221.

Summary:

  • Evidence that TRE can reduce risk factors for Type 2 diabetes (insulin resistance, high blood pressure, oxidative stress) in individuals with prediabetes.