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

59 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.
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All comments

  1. mohammad
    will this drug leads to ketoacidosis ?
  2. 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".
  3. 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.
  4. Sarah
    Type 1's can use this drug - I am type 1 and on this drug as well as just been prescribed Victoza but my question is can I take both of these at the same time?
  5. SteveM
    I see that Farxiga is currently priced at ~$450/mo US or $5,400 a year. The Pharma company is obviously wringing its hands in anticipatory delight for each and every new life-time Farxiga customer.

    Patients trying the LCHF diet should send a copy of their Farxiga script to their insurance company offering not to have it filled if the insurance company gives them a premium rebate (say 300 bucks a month) for meeting health improvement targets consistent with Farxiga expectations.

    Win - Win...

  6. Gillian
    Hi all I am type2 - diagnosed in 2003. I recently went onto Forxiga (am already on Metformin and Onglyzia) as my doctor said the results seemed promising. She has been talking about insulin for awhile, and my A1c had been climbing steadily. I have been doing intermittent fasting for some time now, and just the thought of urinary tract or yeast infections kept me sticking to low carb! I did lose 5 kg during the first three months, but there was a huge positive difference in my blood pressure. so far it is looking good and of course the ultimate aim is to lose more weight and then hopefully reduce the amount of medication I have to take.
    One question - has anyone noticed that this medication seems to increase neuropathy? They might not be related, but that is one side effect i have noticed. .
  7. happywith results so far
    I've been using this drug since February and think it is the best diabetes drug ever. I've lost 18 lbs since starting . Only side effects in the first few months for me was thurst and peeing more but these have subsided.
  8. FatChick
    I take Forxiga (as it's called in Australia) and have lost about 5kg, but struggle with recurring thrush (women's yeast infection), 1 week in every 2. I have solved this, so I'll share my tips: (1) Drink lots of water. (2) Take the Forxiga at night, so the glucose extraction happens overnight and you pee most of it out in the morning instead of at every bathroom break [for the same reason, eat any sugary treats only in the evening :-) ] (3) Instead of waiting until you get thrush then treating it for 6 days straight, just use the thrush medication once every 3 days as a preventative. I'm about to transition to once every 4 days, for a few weeks, and if that works, once every 5 days, etc.
  9. Kelly
    Hi FatChick how much does it cost in Australia?
  10. Toni
    I'm a bit concerned that this site (which I thought was dedicated to the health and well-being of it's readers/subscribers/members), would advocate a drug that has had a strong link to bladder cancer, kidney damage, and renal failure. This drug was voted the worst drug in 2014 due to all the health risks associated with it. On top of that, yeast infections run rampant in patients taking this drug. Shame on you Diet Doctor for suggesting this poison. I've lost respect.
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