Low-carb nutrition education for metabolic health in veterans: A Veterans Affair clinical audit

Abstract

Background: United States (US) veterans face high rates of obesity and type 2 diabetes (T2D), with traditional interventions like VA MOVE! achieving limited success. Non-prescriptive low-carbohydrate (LC) nutrition education may offer a scalable alternative but remains under-evaluated.
Aim: To describe metabolic outcomes observed following the introduction of informal LC nutrition education among veterans with obesity, prediabetes or T2D in a rural Veterans Affair (VA) primary care clinic.
Setting: This clinical audit was conducted in a rural Veterans Affairs primary care clinic at the Martinsburg Veterans Administration Medical Center, where LC nutrition education was delivered during routine care visits without structured programming or additional clinical resources.
Methods: A retrospective audit at the Martinsburg Veterans Administration Medical Centre included 481 veterans with obesity, prediabetes or T2D who received informal LC education during a routine primary care visit. No structured protocol was used. Metabolic markers were measured at baseline and at the final visit, with an average of 10 months later. All eligible patients receiving education were included.
Results: Following introduction of the LC education approach, there was a statistically significant reduction in hemoglobin A1c (HbA1c) and weight, as well as discontinuation or reduction of insulin in 23 or 38 insulin-using veterans and of non-insulin glucose-lowering medications in 45 of 123 veterans. These reductions occurred in the context of an average 10-pound weight loss and a mean HbA1c reduction of 0.43% in those with prediabetes or T2D. Additionally, there was a statistically significant reduction in diastolic blood pressure (BP), triglycerides and the triglyceride-to-high-density lipoprotein (HDL) ratio, along with a 4.2-point increase in HDL cholesterol.
Discussion: Observed improvements in metabolic markers and medication use suggest that informal LC education may be a promising low-burden approach within primary care settings. Larger randomised trials are needed to assess scalability and long-term outcomes.
Conclusion: Informal low-carbohydrate nutrition education may represent a feasible and scalable approach to improving metabolic health and reducing medication burden among veterans. Further controlled studies are needed to confirm these findings and assess long-term outcomes, adherence, and generalisability.