An orthopaedic surgeon has found a low-carbohydrate, low-sugar diet is helping his patients defer surgery - and divert them off the path to type 2 diabetes.
Sydney knee specialist Dr Doron Sher had relatively young patients experiencing issues and knew they could avoid a knee replacement if they lost weight, because that would reduce the load on the joint.
However, he found these patients were returning to him having not lost the weight, despite their best efforts.
"So what we were looking for was something to understand why the dietary advice wasn't working and that's when we came across the whole concept of insular resistance and inflammation," Dr Sher said.
Dr Sher, working with exercise physician Dr Paul Mason, had these patients take on a low-carbohydrate, low-sugar diet that avoided processed foods.
"We finally understood why people weren't losing weight and then we could help them lose weight," Dr Sher said.
"And once they've lost weight, they then get rid of a lot of the inflammation in their body, then they don't have the knee pain and they can defer their surgery for months, years."
Many of these people would eventually need knee replacement surgery due to having already developed arthritis, he said, but having lost the weight that eventual surgery was much less risky.
They were less likely to experience anaesthetic complications, less likely to get infections, and less likely to have the artificial components put into their knee fail.
"So from every perspective, if they can lose weight and delay their surgery, they're going to be better off in the long run," Dr Sher said.
These patients are also often on track to developing type 2 diabetes, but following the diet recommended by Dr Sher's colleagues can prevent their insulin resistance getting worse and thereby halt their development of the disease.
"This diet obviously has more far-reaching benefits than just weight loss and the impact it has on their knees and other joints," Dr Sher said.
"It's like an overall health diet."
Type 2 diabetes occurs when the body becomes resilient to the effects of insulin - the hormone that converts glucose into energy - and eventually loses the ability to produce enough insulin.
While genetic risk factors play a role in the disease, Diabetes Australia says it is also often associated with lifestyle.
The risk of developing the disease is heightened for people who are overweight, have high blood pressure, do not do enough physical activity, have a poor diet, or carry extra weight around their waist (an 'apple' body shape).
Type 2 diabetes, which accounts for about 85 per cent of all diabetes and is on the rise, can lead to heart attacks, blindness, kidney failure, and a host of other physical and mental health complications.
Dr Sher has followed the low-carb, low-sugar dietary approach with his patients for about five years now, having practised as a surgeon for two decades.
He said he could think of at least 15 to 20 patients just off the top of his head who had lost "significant" amounts of weight following this way of eating.
While it was not a magic bullet in solving their health problems, he said it was a "very useful" tool.
Dr Sher is careful to point out that he is not a dietitian or sports medicine doctor (he refers his patients to experts in that area when they need to lose weight) but he can outline the basic principles of a diet that helps individuals lose weight and avoid developing conditions like type 2 diabetes.
These include avoiding sugar and carbohydrates, and being aware of "hidden" sugars in processed foods.
"The more the patient can get back to a more simple diet where they are actually cooking their own food, which is mainly a protein-based diet - so fish, meat, chicken, seafood," Dr Sher said.
"All of these sorts of things where that is the bulk of their diet, along with green leafy vegetables.
"Avoiding starchy foods, like avoiding potatoes and rice, certainly avoiding bread... every slice of bread has about three teaspoons of sugar in it."