Sydney Low Carb Specialists – 2023 Central West Outreach Clinic

Dr. Deepa Mahananda

04/08/2023

Sydney Low Carb Specialists (SLCS), in Castle Hill is a sub-specialty clinic that is directed by Dr Deepa Mahananda and Dr Alex Petrushevski. It incorporates their special interest areas of using evidence based nutritional approaches, including carbohydrate restriction & ketogenic therapies, as a therapeutic option or intervention. We are fortunate to work alongside Accredited Practicing Dietitian Kate Oetsch, Health Coach Kathryn Mayne, Dr Amala Jayasuriya and Exercise Physio Christopher Kondos as well as a highly dedicated administrative team.

We will be bringing our services to Outreach clinics in Bathurst, Orange and Dubbo from September 1st to September 8th. We work in a complementary way with a patients’ existing GP, much like a specialist functions in any other area of medicine. We have extensive clinical experience in the field of therapeutic carbohydrate restriction, having assisted over 1300 patients to date since our clinic opened in 2019.  Our consultations involve identification of the root causes/s of disease through a comprehensive history & examination, providing further patient education and formulation of personalised management plans. Where appropriate we order investigations to identify metabolic syndrome, nutritional deficiencies and assess cardiovascular risk with use of apolipoprotein B , lipoprotein A, lipid subfraction analyses and CT coronary calcium scores. Of utmost importance is our understanding of how to deprescribe medications such as antihypertensives and oral hypoglycaemic agents. We assist patients to successfully traverse some of the real and perceived challenges of low carb eating patterns – ‘keto flu’ also known as sodium natriuresis, maintenance of muscle mass and how to maintain this pattern of eating long term. These consultations seek to translate the changing scientific information with regards to how to reverse metabolic syndrome.

Our dietitian is vital to engage our patients in implementing dietary variations that are present in the full spectrum of low carb diets including elimination diets that accommodate dietary preferences and can fit within a patients’ lifestyle and budget.  Health Coaching is recommended for those that are trying to create new habits to make a sustainable lifestyle change and require strategies and support to combat emotional eating.

A ketogenic diet is defined as low in carbohydrate, moderate protein and higher healthy fats in a ratio that achieves production of ketones (nutritional ketosis). This is not the same as the condition of diabetic ketoacidosis which is a medical emergency. Even today health practitioners incorrectly label keto as dangerous citing the possibility of DKA – this is a rare complication outside of the setting of Type 1 diabetics, often precipitated in the context of severe illness.

The burgeoning evidence for low carbohydrate diets means that our clinic is at the forefront of translating this science into clinical practice. Very low carb diets, also known as ketogenic diets, were originally formulated in the 1920s for paediatric patients with refractory epilepsy. Today, modified versions are now used for a wide variety of conditions including but not limited to weight management[1], Type 2 diabetes reversal/remission[2], metabolic syndrome[3],  metabolic associated fatty liver disease[4], polycystic ovarian syndrome[5] and various mental health conditions[6]. Ketogenic diets are an old therapeutic strategy with new applications due to renewed scientific research interest in the past 2 decades.

References

[1] Choi YJ, Jeon SM, Shin S. Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Nutrients. 2020 Jul 6;12(7):2005. doi: 10.3390/nu12072005. PMID: 32640608; PMCID: PMC7400909.

2 Athinarayanan SJ, Adams RN, Hallberg SJ, McKenzie AL, Bhanpuri NH, Campbell WW, Volek JS, Phinney SD, McCarter JP. Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial. Front Endocrinol (Lausanne). 2019 Jun 5;10:348. doi: 10.3389/fendo.2019.00348. PMID: 31231311; PMCID: PMC6561315.

3 Hyde PN, Sapper TN, Crabtree CD, LaFountain RA, Bowling ML, Buga A, Fell B, McSwiney FT, Dickerson RM, Miller VJ, Scandling D, Simonetti OP, Phinney SD, Kraemer WJ, King SA, Krauss RM, Volek JS. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight. 2019 Jun 20;4(12):e128308. doi: 10.1172/jci.insight.128308. PMID: 31217353; PMCID: PMC6629108.

4 Cunha GM, Guzman G, Correa De Mello LL, Trein B, Spina L, Bussade I, Marques Prata J, Sajoux I, Countinho W. Efficacy of a 2-Month Very Low-Calorie Ketogenic Diet (VLCKD) Compared to a Standard Low-Calorie Diet in Reducing Visceral and Liver Fat Accumulation in Patients With Obesity. Front Endocrinol (Lausanne). 2020 Sep 14;11:607. doi: 10.3389/fendo.2020.00607. PMID: 33042004; PMCID: PMC7521128.

5 Shang Y, Zhou H, He R, Lu W. Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021 Nov 1;12:735954. doi: 10.3389/fendo.2021.735954. PMID: 34790167; PMCID: PMC8591222.

6 Norwitz NG, Dalai SS, Palmer CM. Ketogenic diet as a metabolic treatment for mental illness. Curr Opin Endocrinol Diabetes Obes. 2020 Oct;27(5):269-274. doi: 10.1097/MED.0000000000000564. PMID: 32773571.

[1] Choi YJ, Jeon SM, Shin S. Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Nutrients. 2020 Jul 6;12(7):2005. doi: 10.3390/nu12072005. PMID: 32640608; PMCID: PMC7400909.

[2] Athinarayanan SJ, Adams RN, Hallberg SJ, McKenzie AL, Bhanpuri NH, Campbell WW, Volek JS, Phinney SD, McCarter JP. Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial. Front Endocrinol (Lausanne). 2019 Jun 5;10:348. doi: 10.3389/fendo.2019.00348. PMID: 31231311; PMCID: PMC6561315.

[3] Hyde PN, Sapper TN, Crabtree CD, LaFountain RA, Bowling ML, Buga A, Fell B, McSwiney FT, Dickerson RM, Miller VJ, Scandling D, Simonetti OP, Phinney SD, Kraemer WJ, King SA, Krauss RM, Volek JS. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight. 2019 Jun 20;4(12):e128308. doi: 10.1172/jci.insight.128308. PMID: 31217353; PMCID: PMC6629108.

[4] Cunha GM, Guzman G, Correa De Mello LL, Trein B, Spina L, Bussade I, Marques Prata J, Sajoux I, Countinho W. Efficacy of a 2-Month Very Low-Calorie Ketogenic Diet (VLCKD) Compared to a Standard Low-Calorie Diet in Reducing Visceral and Liver Fat Accumulation in Patients With Obesity. Front Endocrinol (Lausanne). 2020 Sep 14;11:607. doi: 10.3389/fendo.2020.00607. PMID: 33042004; PMCID: PMC7521128.

[5] Shang Y, Zhou H, He R, Lu W. Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021 Nov 1;12:735954. doi: 10.3389/fendo.2021.735954. PMID: 34790167; PMCID: PMC8591222.

[6] Norwitz NG, Dalai SS, Palmer CM. Ketogenic diet as a metabolic treatment for mental illness. Curr Opin Endocrinol Diabetes Obes. 2020 Oct;27(5):269-274. doi: 10.1097/MED.0000000000000564. PMID: 32773571.