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Low-Carb Diet in a Pill – A Good Idea?

forxigaeng

Here’s the most interesting drug in a long time: Forxiga (dapaglipflozin – a SGLT2 inhibitor).

The interesting thing is that it’s a low-carb diet in a pill.

Forxiga is sold as a diabetes drug but comes with a side effect that will no doubt interest many: Weight loss. 

NOTE

I have no financial interests in Forxiga or any other part of the pharmaceutical industry. This post was written only because the drug is interesting.

Forxiga

Forxiga is a new drug for type 2 diabetics that lowers blood sugar, lowers weight and lowers blood pressure.

How does it work? Forxiga blocks the reabsorption of glucose in the kidneys. This leads to the excretion of glucose – up to 70 g per day may leak out into the urine for people with diabetes (less for people with normal blood sugar).

So the result may be the same as if you had eaten 70 g less carbohydrate that day. This results in lower levels of the hormone insulin. And the effect – lower blood sugar, blood pressure and weight – is exactly what you see in studies on low-carb diets.

The decrease in long-term blood sugar (HbA1c) is significant. But, this is not the exciting part – many diabetes drugs lower the blood sugar this much. The exciting thing is that most other diabetes drugs (especially insulin) have weight gain as a side effect. Forxiga does the opposite.

Weight

Here’s the result on weight in two studies that tested Forxiga on type 2 diabetics.

In the first study all patients received the basic medication Metformin. They were then randomly divided into two groups where one group was given a placebo addition (grey line) while the other group received Forxiga (red line):

f-placebo

Forxiga produced an average weight loss of 6.5 lbs (3 kg), as compared to placebo.

It’s even more exciting is to compare Forxiga with other diabetes drugs that cause weight gain. One such common group is called sulfonylureas, which act through increasing the release of the fat storing hormone insulin. Elevated levels of insulin will lower blood sugar – at the price of, among other things, weight gain.

In this second study too, all participants took the basic drug Metformin. They were then randomly assigned to two groups. One group received the sulfonylurea drug Glipizide which releases insulin (grey line). The other group received Forxiga (red line):

f-glip

In this comparison Forxiga on average reduced weight by 12 lbs (5 kg)!

Side Effects

Unfortunately Forxiga is not free from side effects. In particular, the risk of urinary tract infections and vaginal yeast infections increases – the result of all the sugar (food for bacteria and fungi) that leak into the urine. Furthermore, you can get an increased urine production and an increase in thirst.

Preliminary results from studies also show uncertain indications of a slightly increased risk of cancer – more extensive studies are underway to clarify whether this increased risk is real.

Conclusions

Despite the side effects, this is an exciting addition to the treatment of type 2 diabetes.

Many may indeed want to use it to lose weight, even without having diabetes. However, the drug isn’t approved for this use (yet). Moreover, the effect on weight for people with normal blood sugar will likely be smaller – less sugar will leak into the urine. Thus, Forxiga is presently not a diet drug.

Then, who with type 2 diabetes may benefit from Forxiga? Here’s the treatment ladder that I use, provided there is no obvious lack of insulin (so called LADA, causing otherwise unexplained weight loss).

  1. A low-carbohydrate diet, being as strict as you can. This is often enough to normalize blood sugar without medication.
  2. If necessary Metformin
  3. If necessary a GLP-1 analogue (Victoza, Byetta or Bydureon)

Forxiga should be a good alternative as step four.

The sad part is that many will be using Forxiga instead of a low-carb diet. But, then you’ll only reach part of the effect – a maximum of 70 g glucose leakage daily will of course not be enough if you’re eating 300 g carbs per day. In addition you will be suffering side effects unnecessarily. Finally, there’s something sick and environmentally unfriendly in eating carbs unnecessarily just to pee them out.

Forxiga may however, be a good complement to other treatments, when they are not sufficient.

The most exciting? Forxiga is low-carb in a pill. And it improves both weight and blood sugar – just like the low-carb diet.

What do you think about it?

PS: Farxiga in the US

Forxiga is sold under the brand name Farxiga in the US.

More

Previously on drugs

How to Lose Weight: Lose Weight by Reviewing Your Medications

Previously on diabetes

How to Cure Type 2 Diabetes

More on Forxiga

Low Carb Made Easy How to Lose Weight Low-Carb Recipes Low-Carb Success Stories

52 Comments

Top Comment

  1. WerteX
    Personally I think this is just big pharmas way imitating the benefits of a low carb diet with side effects. I wouldn't take a pill that may cause urinary infections or yeast. As a male I don't think all that leaking sugar going through your prostate is not good, not to mention women having yeast infections one after another. More and more diabetics are finding the good health benefits of low carb diet, probably most of all the weight loss. I have lost almost 40 kilos (over 80lbs) the past four years on a low carb diet. I got rid of rash, bad hair, smelly sweat and bad breath. I would not go back to eat even that 70g of carbs, even if I were using this drug to compensate, because I don't think it won't keep all the other health problems away.
    Read more →

All Comments

  1. bookwyrmb
    If one is a type 2 diabetic, but only marginally so, why would one have to take the other meds first or in addition to the Forxiga? I have trouble going below 60-75 grams carb. My hair gets thin, I crave carbs unceasingly, and I experience all the symptoms of adrenal fatigue. Would Forxiga not be a good idea for me without the other meds? I do not need anything so powerful as all those combined.
  2. Natalie
    Hi, what do you think would happen if you already ate a low carb diet (<20g per day) and took this drug? Sounds interesting!
  3. WerteX
    Personally I think this is just big pharmas way imitating the benefits of a low carb diet with side effects. I wouldn't take a pill that may cause urinary infections or yeast. As a male I don't think all that leaking sugar going through your prostate is not good, not to mention women having yeast infections one after another. More and more diabetics are finding the good health benefits of low carb diet, probably most of all the weight loss. I have lost almost 40 kilos (over 80lbs) the past four years on a low carb diet. I got rid of rash, bad hair, smelly sweat and bad breath. I would not go back to eat even that 70g of carbs, even if I were using this drug to compensate, because I don't think it won't keep all the other health problems away.
  4. Howard Lee Harkness
    Looks to me like it mimics all of the bad effects of IDDM. Sugar in the urine, excessive thirst, increased risk of bladder infection... Probably others.

    If you are eating <70g carb/day, then how much will this help?

    I don't believe anyone has a Forxiga deficiency. Just like there is no such thing as a statin deficiency. Or an amlodipine besylate deficiency.

    Maybe it's a help for somebody who won't follow LCHF, but I think it just perpetuates the pill-pushing mentality.

    Personally, it pisses me off every time my VA doc tries to push a pill. Ok, I have high blood pressure, but that's not the real problem. The real problem is that my VA doc not only has NO CLUE why my BP is high, she also doesn't care. Which means I'm on my own to track down the cause.

    Another question: How does Forxiga affect all-cause mortality? One of the issues I have with my current amlodipine besylate perscription is that the clinic evidence shows NO improvement in all-cause mortality, which makes me wonder why I'm taking it... (actually, I quit taking it because of the side-effects).

  5. robert
    Sounds interesting! Can't wait for the Forxiga-cupcakes to arrive.

    I wonder if they're also working on something similar for alcohol.

    <sigh>

  6. Dan
    Andreas, have you explored the use of the natural substance Berberine instead of Metformin? It has been shown in some studies to do the same job with NONE of the pharmaceutical side effects. I know I found it very helpful in lowering blood sugar and its effects.
  7. Susan Kundert
    Although I suppose there are individuals for whom such a pill would be desirable, I agree with Howard (above). Why push MORE pills? Why not instead try to eat and live healthfully, so that you prevent the disease in the first place ?
  8. Daytona
    I don't understand why so many commenters are misreading the article... He clearly states that the first thing for everyone to try is a STRICT DIET. On this list, this medication is the 4th down to try.

    If diet isn't enough (and it's NOT for many advanced diabetics), I see no issue with looking into additional measures that can be applied on top of diet modifications. This pill specifically is interesting because it doesn't raise insulin, making it a possible alternative to insulin for those already insulin resistant.

  9. laza
    Maybe this might help the people who want to be on LCHF diet but don't have enough willpower? They could still be eating, let's say, 100gr carbs/day, and thus drop it down to effectively 30gr, and so stay in ketosis?

    Or maybe it might help people to slowly adjust to the strict LCHF diet. I'm now strict for a good while, and what helped me a lot (and still do) are zero-carb sucralose sweetened drinks. Nothing to be too proud about, but they did help me get here. There's a lot sinning to do before one can become a saint.

  10. jake
    the interesting thing about this is that it essentially works by mimicking some of the effects of T2 diabetes - impaired glucose metabolism, and excretion of glucose in urine. weird!
  11. FrankG
    Maybe (maybe) there is a place for this new drug but comparing it to an LCHF diet? I don't think so. Last thing I think a Diabetic should be doing, is chemically screwing around with their kidneys.
  12. TJ the Grouch
    Superficially, this sounds quite attractive. The problem with an elevated glucose content in urine is that it eventually will lead to chronic urinary tract infections, both bacterial as well as fungal (Candida albicans). Some of these could be passed on to sexual partners. I don't think that this drug will escape the law of unintended consequences.
  13. sten
    Not the first product with this effect "Zuxxarin" or mulberries have been sold as wonder drugs for weightloss and we bought but stopped once we understood the mechanism with urine excretion of
    sugar.
    Just the tought to consume food in excess (the wrong food !) and then compensate by consuming something that could cost a good fraction of the food to waste it should be revolting to all of us except in rare once off situations.
    If LCHF isn't enough combine with intermittent fasting and/or short bursts of high intensity exercise. It works for me.
  14. Robin Nixon
    Very interesting, particularly since there seems to be a number of low carbers eating this way for health reasons, and who cannot (but would like to) lose weight. Perhaps this drug might help in some of these cases.
  15. Evelyn aka CarbSane
    Would it be possible to get the names of and/or links to these studies? Thanks!
  16. Jeff C
    I have to disagree with the enthusiasm shown for this drug. This sentence is key:

    "The sad part is that many will be using Forxiga instead of a low-carb diet."

    Not only will many do it, this is exactly how those pillars of virtue at pharma will market it. Even if it is not approved for this purpose, they will use illegal off-label promotion to increase sales. They have done this many times in the past, most of the huge pharma fines paid in recent years were for exactly this behavior. It has not stopped them, it's considered just another cost of doing business.

    Hailing a drug that allows one to eat large amounts of glucose-producing food so one can later pee it out seems about as wise as promoting laxatives with meals.

  17. Jennifer - Yummylowcarb
    I get annoyed every time I read about new medicines that promises this and that. What surprises me is that most people have a strong opinion about LCHF and our amount of fat intake, but they are more than happy to stuff themselves with chemicals in the form of 'medicine' that no one knows what the long-term effects are...

    PS. Follow my instagram for LCHF recipes and inspiration - @yummylowcarb

  18. Martin Levac
    Brilliant. Once it becomes standard treatment, patients will start to get the idea that it's pretty stupid to eat the carbs only to pee it later. Might as well not eat the carbs to begin with. It's gonna be easy to make the connection between dietary glucose and blood glucose.
  19. FrankG
    "It's gonna be easy to make the connection between dietary glucose and blood glucose."

    You'd think eh?!?

    Shame it has not proved to be so obvious for august bodies like the American Diabetes Association! :-P

  20. Welldun
    While I agree that this may be a good thing for some people, to me, the small amount of weight loss involved isn't enough to take yet another pill.

    I survived ovarian cancer, since then I just really despise the predatory, deceptive practices of big pharma. I would imagine the researchers who came up with this had the best of intentions, let's watch the marketing...

  21. Galina L.
    I wish more people in general population, not only diabetics and nuts who read diet blogs (like me), start measuring their blood sugar more often, it may give them important clues. Such drag could bring more attention to the importance of blood sugar numbers.
    Reply: #22
  22. Zepp
    And they should measure there C-petid on a regular basis.. its almost better then glukos levels!

    Almoste nobody knows way they should measure C-peptides.. and what it says.. it says hyperinsulinemia.. and it takes about 10-30 years of bad food to develope diabetes/metabolic syndrome.

  23. Richard
    Would anyone really take this drug for TWO YEARS knowing that the most they could expect to lose is only 3.7Kg ? Not me, that's for sure!
    Reply: #30
  24. Eric Anderson
    I agree that 1) strict HFLC 2) along with medical advice look at Intermittent fasting 3) also with doctor look at Metformin 4) Then consider newer drugs

    A lower Hemoglobin A1c (90 day average glucose levels) is associated with so many health benifits and the more above 5 the worse health like heart disease, cancer, diabetes stroke outcomes and in general mortality and morbidity.

    Only 25% of USA has a A1c of 5 or less. My experiance and reading other stric followers is 4.2 to 4.6 A1c levels are reasonable achievments on HFLC

    The opposite is the diabetic smoker and heavy drinker with BMI over 32. Not a pretty site!

    Look at HgB A1c and over all mortality as well as morbid conditions. Even strict vegetarians have higher A1c levels than HFLC.

    May we all live long and prosper! Eric

  25. Elizabeth barron
    This drug has changed my life! I have gone from being extremely ill for years back to the lively, vivacious person i was before i became diabetic. It is very easy to slate new meds but unless you have experienced this particular drug yourself you have no idea of its life changing effects.
  26. Margo Kipps
    Side effects of Metformin are mentioned but not discussed.????[ I take 800mg a day, 320 Diovan and 100 Atenolol for HBP, and for whatever reason, Avorostatin. MY ears ring constantly, but especially when I feel my blood pressure on the rise. I have been grain free and almost completely sugar free fro quite a while, I don't bake all the non-grain sweets or breads. I have not lost more than 10 pounds in all this time. I guess the website page that got me into this discussion says I maybe eat too many nuts, dairy. I did drink, now cut way back on that; nothing moves the scale.]
  27. Sue Hamilton
    I have been on this drug for three weeks. At first it lowered my blood sugars brilliantly. I am also on insulin. I keep waking at 4am feeling very hungry and start having a hypo. I have reduced the amount of insulin but no effect. I will not be taking it anymore. I would prefer higher readings and getting sleep. It's all about quality of life.
  28. Iknow
    F A R X I G A - it is FARXIGA not Forxiga.
    Replies: #35, #39, #50
  29. Khalida Manzoor
    I've just been prescribed Forxiga because I have type 2 diabetes and my blood sugars are still high despite taking losartan, which is metformin and sitagiliptin combined. I am really freaked out about this new medication because my kidneys and liver are ok (although I have fatty liver) and scared about the increased risk of cancer. I was told either take that or go on insulin. I want to keep them ok. Worried about effects on kidneys.
    Wondering what Diet doctor thinks and also how Elizabeth Barron is feeling now as it will be two years since she went on it.
    I am supposed to start tomorrow but I don't want to as I'm very nervous about it.
  30. Dan
    No wise man, no! You have to remember that although the weight only drops a little this is in contrast to the inevitable slow weight gain which is what all other diabetes drugs do.

    Considering, popular opinion is that you'll be on diabetes drugs for LIFE not just a two year trial, Over the fifty years (for the young T2 patient) this could make a big difference!

    That said, of course diet is better... Urinary infection anyone?

  31. junebug
    Has anyone ever experienced knee joint pain? Shortly after taking this new Forxiga, my knees both started to hurt so badly that I have great difficulty walking up and down stairs.
    Feedback, please!
    Reply: #40
  32. PaulB
    Forxiga in Europe. Farxiga in U.S.
  33. Barbara
    My knee pain has diminished considerably since doing low carb HF. I want to be OFF of all meds. Recently dropped the insulin and only on metformin. That's what makes me happy. All of these drugs have side effects. We are all guinea pigs for Big Pharma.
    Reply: #34
  34. Great news Barbara!
  35. George
    Here is a critique of the study from someone who actually read the whole thing and refuses to buy the spin/statistical manipulation presented by the manufacturer:

    http://diabetesupdate.blogspot.com/2015/09/cutting-through-jardiance-...

    Reply: #37
  36. Jimmy
    I've been on the drug as a supplement to my Metformin about 8 months. I haven't experienced any side effect with the exception of two times when I ran out and didn't fill for a few days. Both times I experienced severe swelling of my ankles and very tight chest and difficulty breathing. My finger hovered over 911 for a few till the symptoms subsided.
  37. Marge
    this is jardiance of Boehringer not Forxiga/Farxiga
  38. Kamsue101
    I have been eating low carb for years. My blood sugars came down and I lost 30 lbs quickly. Staying with the diet, with a few lapses now and again, I have kept my weight down for several years and gradually lost a few more pounds. However, my blood sugars remain border-line diabetic. My doctor recommended I try Farxiga. After 2.5 months I have lost an additional 15 lbs. I have continued my low carb diet the whole time, staying around 100 carbs per day. I have not had any uti's or yeast infections. I will see my doctor in a few weeks to get blood work and see how my blood sugars are doing. I feel like I can finally reach a healthy bmi after years of believing it wasn't possible.
  39. Sarah
    In Canada it is FORXIGA and in USA it is FARXIGA
  40. Meena Kapoor
    Yes! I feel like my knees are on fire. Never had this problem before.

    Has anyone ever experienced knee joint pain? Shortly after taking this new Forxiga, my knees both started to hurt so badly that I have great difficulty walking up and down stairs.
    Feedback, please!

  41. paula roberts
    I'm a diabetic t2 I've tried everything to lose weight and I keep putting it on .so I went to see my diabetes top doctor a few days a go and he had offered me this tablet a while a go and I said no coz my partner þawas on the 10 my and she's on 5mg now but she went though hell on the 10th. So now she's on 5mg and she's OK so my partner said to me we not all the same try it and see how I feel .cos my doctor said all he can do for me is insollin and I said no ill try this tablet and see how I go .well it's my 4th tablet to moz and I'm OK up to now yes weeing a bit more but I'm not hungry that's the funny thing I have to make my self eat some thing .aww it's all OK up to now .
  42. sue
    What a patronising end comment about it being "sick and environmentally unfriendly to pee out ....glucose". Diabetics are human beings too, and the odd bit of occasional chocolate makes life just that little bit nicer. Have just started 5mg forxiga, and the weight is starting to fall off after years of unsuccessful dieting.
  43. 1 comment removed
  44. tara
    I was prescribed Invokana for my diabetes. It works really well for me - but with terrible side effect - yeast infection, UTI, constant itching and burning, etc. I now take it with the Lady Soma Candida Cleanse because it takes those symptoms away. My endocrinologist confirmed that the Lady Soma Candida Cleanse is safe to use.
  45. Paul
    been on it 22 weeks lost 10.5 kilos without even changing diet find it amazing and no side affects
  46. Kish Fox
    "Sick and environmentally unfriendly" is a bit harsh when you consider that carbohydrates are just macromolecules... not some organism whose life is being sacrificed to sate the demon of greed's lust for human affection O.o
  47. Tim
    A1c dropped an average of a quarter percent in the study...basically useless.

    http://diabetesupdate.blogspot.ca/2015/09/cutting-through-jardiance-s...

    Another quote..."Basically if you have serious heart disease and take this drug, your chance of having a heart attack or heart failure goes down, while your chance of having a fatal or nonfatal stroke goes up."

  48. Elena
    Hello,

    My name is Elena and I have been doing LCHF diet for a month now. I feel amazing!!!

    I have lost 2% body fat and I feel stronger physically and mentally. My asthma is gone as well!!!
    The first 2 weeks were very rough, training wise (I am a runner and I practice intense bootcamp) but after the 2nd week I feel stronger and faster than ever.

    I have a question and I hope I can get an answer as I can't find anything on the internet on this regard. The bread I bake following your recipes here is amazing but I still miss the crunchiness and the texture of "a common loaf of bread made with wheat".
    My question is: can we use yeast to bake bread and cakes? By yeast I mean: https://en.wikipedia.org/wiki/Yeast

    I would very much appreciate an answer to my question!!!

    Thanks for your website and for changing my life!!!

    Regards,

    Elena

  49. Peter
    I was on Metformin and Forxiga before but my Diabetes got more worse with the government recommended food intake. Always struggled with weight and it only went down with high exercises and less food (skipped dinner). In June 2016 I started the lchf from dietdoctor.com and until today I lost 10kg and got my blood sugar to normal level (with some high days to 8.3), with reduction from 3 Metformin (2 Janumet+1Glucophage) and 1 Forxiga to only 1 Glucophage. My goal is to get away from all the medicine with only lchf food and exercises, or movement. I won't go back to the carb loaded diets which are still promoted by governments. Special in Singapore they just start a campaign to "beat Diabetes" and still promoting the high carb food pyramid.
    Thanks dietdoctor.com for this professional website and advice.
    Best Regards
    Peter
  50. John Dwyer
    It depends where you are in the world. I'll guess you are in the USA. Where I am it is called Forxiga. Both are correct. The actual name of the drug is dapagliflozin. Forxiga/Farxiga are market friendly names.
  51. mohammad
    will this drug leads to ketoacidosis ?
  52. Mimo Aum
    I would choose low carbing over Farxiga! I recall the symptoms of yeast infections and sleepless nights getting up to pee when 1st diagnosed with Diabetes Type 2 ....15 years back !! I was appalled that big pharma should even call this a breakthrough drug for Type 2 diabetes!!!!! To top it all .......just like all the newer therapies not enough long term safety and efficacy studies in my opinion. The looming side effects .....increased risk of cancer......increased burden on kidneys are a high price to pay for temporary reduction in blood glucose numbers and momentary sense gratification of the taste buds. I am Type 2 who went off insulin by adopting LCHF. I work in the Big Pharma business unfortunately but look to food and herbs as "medicine".
  53. Chris
    I am a type one and not sure why my endo started me on this drug. After about six months I had most of the side effects and I although I lost weight, my most recent BMI showed some to most of the loss was muscle, not fat. Also, being fully keto adapted I thought it was strange I was getting glucose readings in my urine? How with carbs at less than 20g/day and all from above ground low sugar vegies? I finally looked the drug up and to my surprise it is not meant for type one's. So I stopped two weeks ago and still have some of the side effects. I would suggest as many others have here that if you are a type two there are many diet options which will help and may even reverse your type two. And yes before people comment about it is my own fault for not looking up the drug first, you are right and I should have. If I would have seen it was not for type one's I would not have taken it, but made the mistake of outright trusting my endo, thinking he knew best. Last, my A1c went from 7.1 to 7.9 during the six months taking this. Not sure why anyone would take this drug other than if they own stock in the company that makes it.

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