New study from Steve Freedland below.
"The objective of this study was to test a low-carbohydrate diet (LCD) plus walking to reduce androgen deprivation therapy (ADT)-induced metabolic disturbances."
"LCD (≤20g carbohydrate/day) plus walking (≥30 min for ≥5 days/week)"
"At 6 months, LCD/walking reduced insulin resistance by 4% vs. 36% increase in control ... At 3 months, vs. control, LCD/walking arm significantly lost weight (7.8kg ...), improved insulin resistance (↑36% ...), hemoglobin A1c (↓3.3% ...), high-density lipoprotein (HDL) (↑13% ...), and triglyceride (↓37% ...). At 6 months, weight loss (10.6kg ...) and HDL (↑27% ...) remained significant. LCD/walking preserved total body bone mineral count .., reduced fat mass .., lean mass .., and percent body fat ..."
Disappointing to see such a small reduction in insulin resistance (4%), but given the inexorable effect of ADT on most men, it seems like a big achievement when compared to the 36% increase in the control arm.
-Patrick
ncbi.nlm.nih.gov/pubmed/306...
Prostate Cancer Prostatic Dis. 2019 Jan 21. doi: 10.1038/s41391-019-0126-5. [Epub ahead of print]
A lifestyle intervention of weight loss via a low-carbohydrate diet plus walking to reduce metabolic disturbances caused by androgen deprivation therapy among prostate cancer patients: carbohydrate and prostate study 1 (CAPS1) randomized controlled trial.
Freedland SJ1,2, Howard L3, Allen J4, Smith J5, Stout J6, Aronson W7,8, Inman BA6, Armstrong AJ9, George D6, Westman E10, Lin PH5.
Author information
1
Center for Integrated Research on Cancer and Lifestyle, Samuel Oschin Comprehensive Cancer Institute and Department of Surgery, Division of Urology Cedars-Sinai Medical Center, Section of Urology, Los Angeles, CA, USA. Stephen.freedland@cshs.org.
2
Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, USA. Stephen.freedland@cshs.org.
3
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.
4
Translational Population Health Research, Duke Clinical and Translational Science Institute, Kannapolis, NC, USA.
5
Department of Medicine, Nephrology Division, Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC, USA.
6
Division of Urology, Duke University Medical Center, Durham, NC, USA.
7
Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
8
Department of Urology, UCLA School of Medicine, Los Angeles, CA, USA.
9
Department of Medicine, Division of Urology, Duke University Medical Center, Durham, NC, USA.
10
Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Abstract
PURPOSE:
The objective of this study was to test a low-carbohydrate diet (LCD) plus walking to reduce androgen deprivation therapy (ADT)-induced metabolic disturbances.
MATERIALS AND METHODS:
This randomized multi-center trial of prostate cancer (PCa) patients initiating ADT was designed to compare an LCD (≤20g carbohydrate/day) plus walking (≥30 min for ≥5 days/week) intervention vs. control advised to maintain usual diet and exercise patterns. Primary outcome was change in insulin resistance by homeostatic model assessment at 6 months. To detect 20% reduction in insulin resistance, 100 men were required. The study was stopped early after randomizing 42 men due to slow accrual. Secondary outcomes included weight, body composition, lipids, and prostate-specific antigen (PSA). Changes from baseline were compared between arms using rank-sum tests.
RESULTS:
At 6 months, LCD/walking reduced insulin resistance by 4% vs. 36% increase in control (p = 0.13). At 3 months, vs. control, LCD/walking arm significantly lost weight (7.8kg; p<0.001), improved insulin resistance (↑36%; p = 0.015), hemoglobin A1c (↓3.3%; p = 0.01), high-density lipoprotein (HDL) (↑13%; p = 0.004), and triglyceride (↓37%; p = 0.036). At 6 months, weight loss (10.6kg; p<0.001) and HDL (↑27%; p = 0.003) remained significant. LCD/walking preserved total body bone mineral count (p = 0.025), reduced fat mass (p = 0.002), lean mass (p = 0.036), and percent body fat (p = 0.004). There were no differences in PSA. Limitations include the effect of LCD, weight loss vs. walking instruction are indistinguishable, and small sample size.
CONCLUSIONS:
In an underpowered study, LCD/walking did not improve insulin sensitivity at 6 months. Given most secondary outcomes were improved at 3 months with some remaining improved at 6 months and a secondary analysis showed that LCD/walking reduced insulin resistance over the study, supporting future larger studies of LCD/walking intervention to reduce ADT-induced disturbances.
PMID: 30664736 DOI: 10.1038/s41391-019-0126-5
