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» ACCREDITED PHARMACIST SPECIAL INTEREST GROUP
Trish Russell is a Canberra-based accredited
pharmacist and co-ordinator of the PSA APSIG group.
Medicines, diets, and
diabetes – a short overview
BY TRISH RUSSELL
What do we know about some of the new fad diets? Should we recommend
them? Are any of these suitable for people with diabetes? How might
medicines be affected by some of these diets? What about statins and the
risk of diabetes?
Modern fad diets and medicines
The 5:2 diet1
One of the modern diets, the 5:2 diet,
recommends very low food intake
(fasting) on two days a week. Calorie
consumption is restricted to 25% of
normal energy needs on these two
days, and returns to normal eating for
the rest of the week. The average limit
for women would be 500 calories and
for men 600 calories. Due to the risk of
hypos on low calorie days, the promoters
of this diet warn that people with type
1 or type 2 diabetes using insulin or oral
hypoglycaemic agents or with other
chronic medical conditions must talk to
their doctor before starting this plan.
Some medicines have increased
adverse effects if taken when fasting.
Increased gastrointestinal side effects
would occur with many drugs including
doxycycline, lithium, paroxetine,
sodium valproate and venlafaxine.
Some medicines have altered
absorption if taken when fasting.
These include griseofulvin, HIV drugs,
labetalol and rivaroxaban.
The Paleo diet
Another modern diet, the Paleo diet,
promotes eating mostly meat, fish
vegetables, nuts, animal fats and coconut
oil. Foods from agriculture such as grains,
legumes, dairy foods and processed
foods are avoided. This diet may pose
problems for people with reduced renal
function (who need a lower protein
intake) and/or diabetes, (especially type
1), where a more controlled carbohydrate
intake may be needed.2
In addition the low carbohydrate in the
Paleo diet may adversely affect the level
of gut microbes, which we know are
important for the prevention of bowel
disease. Some of the fats included in
the Paleo diet (e.g. in avocados, nuts
and eggs) are supported by Australian
Dietary Guidelines. However fats such
as butter and coconut oil are not
supported. The Dieticians Association
of Australia (DAA) cautions that there is
only short-term trial research into the
Paleo diet. They point out that no-one
who lived in the Palaeolithic era actually
consumed coconut oil as they had no
means of extracting and refining it. The
DAA remind us that weight problems
usually result from sedentary lifestyles
and excess kilojoules, rather than the
distribution of foods across food groups.
‘I quit sugar’ diet
‘I quit sugar’ is another celebrity based
diet. The author is a journalist and
entrepreneur. ‘I quit sugar’ involves an
eight week program to wean off snacks,
initially eliminating fruit, and shifting
to a three-meals-a -day style of eating
based on vegetables, proteins, full-fat
dairy and whole grains.
This may sound
perfect for your patients with diabetes,
but Diabetes Australia recommends an
individual meal plan designed by an
accredited dietician for everyone with
diabetes. The World Health Organization
recommends reducing free sugar intake
to less than 10% of total kilojoule intake.
Statins and diabetes
In 2013 a Canadian retrospective analysis
of the risk of diabetes among patients
treated with statins suggested there
was between 10% and 22% increased
risk of new onset diabetes.
the same trial showed a 54% lower risk
of myocardial infarction and a 48% lower
risk of stroke with statin use compared
with placebo. Treatment with the higher
potency statins (atorvastatin, rosuvastatin
and simvastatin) might be associated
with an increased risk and might be dose
dependent. Cederberg, et al. followed 8,749
Finnish non-diabetics for 5.9 years and they
released their results in January 2015: those
on statins had a 46% increased relative risk
of developing type 2 diabetes.5 Both insulin
sensitivity and insulin secretion were
reduced in those people taking the statin.
These reductions were dose dependent for
simvastatin and atorvastatin.
These sorts of results have led people
to question the use of statins.
The cardiovascular risk of the patient with
diabetes needs to be assessed before a
statin is started. Statins prevent heart
disease in patients at high risk and in
those with established cardiovascular
disease. Statins reduce blood levels of
LDL cholesterol and promote health of
the lining of blood vessels. The use of a
statin for primary prevention (before any
cardiovascular events have occurred) in
low risk people is not recommended in
Australian Guidelines for the Management
of Absolute Cardiovascular Disease Risk.
Given the evidence and depending on
absolute CVD risk, it seems that starting
the patient on a less potent statin or a
lower dose of a potent statin would be a
When conducting medication reviews
for people with diabetes, where weight
loss may be desirable, be cautious in your
approach and adhere to recommendations
suggested by Diabetes Australia and the
Dieticians Association of Australia.
1. The 5-2 Diet at: http://the5-2dietbook.com/
2. The Dieticians Association of Australia. At: http://daa.asn.au/
3. The ‘I quit sugar’ program at: https://iquitsugar.com
4. Carter A, Gomes T, Camacho X et al. Risk of incident diabetes
among patients treated with statins: population based study.
BMJ 2013;346:f2610 At: http://www.bmj.com/content/346/
5. Cederber H, Stancakova A, Yaluri N et al. Diabetologia (jan
2015) 58:1109–17 At: http://link.springer.com/article/10.1007/
6. Shah R, Goldfine A. Statins and risk of new-onset diabetes.
Circulation. 2012;126:e282–e284 At: http://circ.ahajournals.
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