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Health Effects of Low-Carbohydrate Diets: Where Should New Research Go?

  • Issues in the Nutritional Treatment of Type 2 Diabetes and Obesity (E Mayer-Davis, Section Editor)
  • Published:
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Abstract

There has been considerable debate about the metabolic effects of restricting carbohydrate intake in weight and diabetes management. However, the American Diabetes Association has noted that weight and metabolic improvements can be achieved with low carbohydrate, low fat (implicitly higher carbohydrate), or a Mediterranean style diet (usually an intermediate level of carbohydrate). Our paper addresses variability in the definition for low or restricted carbohydrate, the effects of carbohydrate restriction on diabetes-related health outcomes, strategies for restricting carbohydrate intake, and potential genetic variability in response to dietary carbohydrate restriction. Issues for future research are also addressed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Brehm BJ, D'Alessio DA. Weight loss and metabolic benefits with diets of varying fat and carbohydrate content: separating the wheat from the chaff. Nature clinical practice Endocrinol Metab. 2008;4:140–6.

    Article  CAS  Google Scholar 

  2. Spence M, McKinley MC, Hunter SJ. Session 4: CVD, diabetes and cancer: diet, insulin resistance and diabetes: the right (pro)portions. The Proceedings of the Nutrition Society. 2010;69:61–9.

    Article  PubMed  CAS  Google Scholar 

  3. Dyson PA, Beatty S, Matthews DR. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabetic Med. 2007;24:1430–5.

    Article  PubMed  CAS  Google Scholar 

  4. Feinman RD, Volek JS. Carbohydrate restriction as the default treatment for type 2 diabetes and metabolic syndrome. Scand Cardiovasc J. 2008;42:256–63.

    Article  PubMed  CAS  Google Scholar 

  5. • Wheeler ML, Dunbar SA, Jaacks LM, Karmally W, Mayer-Davis EJ, Wylie-Rosett J, et al. Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature. Diabetes Care. 2012;35:434–45. This systematic review examines the effects of altering macronutrient distribution in diabetes management. The effects of carbohydrate restriction are addressed.

    Article  PubMed  CAS  Google Scholar 

  6. Franz MJ, Bantle JP, Beebe CA, Brunzell JD, Chiasson JL, Garg A, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 2002;25:148–98.

    Article  PubMed  Google Scholar 

  7. • American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2012;35 Suppl 1:S11–63. The Standards assess the evidence and provide guidelines regarding carbohydrate restriction in the management of diabetes.

    Google Scholar 

  8. Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, et al. American Diabetes Association; nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31 Suppl 1:S61–78.

    PubMed  CAS  Google Scholar 

  9. Kirk JK, Graves DE, Craven TE, Lipkin EW, Austin M, Margolis KL. Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. J Am Diet Assoc. 2008;108:91–100.

    Article  PubMed  CAS  Google Scholar 

  10. Delahanty LM, Nathan DM, Lachin JM, Hu FB, Cleary PA, Ziegler GK, et al. Association of diet with glycated hemoglobin during intensive treatment of type 1 diabetes in the Diabetes Control and Complications Trial. Am J Clin Nutr. 2009;89:518–24.

    Article  PubMed  CAS  Google Scholar 

  11. Vitolins MZ, Anderson AM, Delahanty L, Raynor H, Miller GD, Mobley C, et al. Action for Health in Diabetes (Look AHEAD) trial: baseline evaluation of selected nutrients and food group intake. J Am Diet Assoc. 2009;109:1367–75.

    Article  PubMed  Google Scholar 

  12. Oza-Frank R, Cheng YJ, Narayan KM, Gregg EW. Trends in nutrient intake among adults with diabetes in the United States: 1988–2004. J Am Diet Assoc. 2009;109:1173–8.

    Article  PubMed  CAS  Google Scholar 

  13. Konner M, Eaton SB. Paleolithic nutrition: twenty-five years later. Nutr Clin Pract. 2010;25:594–602.

    Article  PubMed  Google Scholar 

  14. Eaton SB, Konner MJ. Stone age nutrition: implications for today. ASDC. 1986;53:300–3.

    CAS  Google Scholar 

  15. Eaton SB, Konner M. Paleolithic nutrition. A consideration of its nature and current implications. N Engl J Med. 31 1985;312:283–9.

    Google Scholar 

  16. Eaton SB, Eaton 3rd SB. Paleolithic vs modern diets–selected pathophysiological implications. Eur J Nutr. 2000;39:67–70.

    Article  PubMed  CAS  Google Scholar 

  17. Eaton SB, Eaton 3rd SB, Konner MJ. Paleolithic nutrition revisited: a twelve-year retrospective on its nature and implications. Eur J Clin Nutr. 1997;51:207–16.

    Article  PubMed  CAS  Google Scholar 

  18. Wylie-Rosett J, Davis NJ. Low-carbohydrate diets: an update on current research. Curr Diabetes Rep. 2009;9:396–404.

    Article  CAS  Google Scholar 

  19. Castaneda-Gonzalez LM, Bacardi Gascon M, Jimenez Cruz A. Effects of low carbohydrate diets on weight and glycemic control among type 2 diabetes individuals: a systemic review of RCT greater than 12 weeks. Nutricion Hospitalaria. 2011;26:1270–6.

    PubMed  CAS  Google Scholar 

  20. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003;348:2074–81.

    Article  PubMed  CAS  Google Scholar 

  21. Nielsen JV, Joensson E. Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up. Nutr Metab. 2006;3:22.

    Article  Google Scholar 

  22. Daly ME, Paisey R, Paisey R, Millward BA, Eccles C, Williams K, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes–a randomized controlled trial. Diabetic Med. 2006;23:15–20.

    Article  PubMed  CAS  Google Scholar 

  23. Westman EC, Yancy Jr WS, Mavropoulos JC, Marquart M, McDuffie JR. The effect of a low-carbohydrate, ketogenic diet vs a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab. 2008;5:36.

    Article  Google Scholar 

  24. Davis NJ, Tomuta N, Schechter C, Isasi CR, Segal-Isaacson CJ, Stein D, et al. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet vs a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care. 2009;32:1147–52.

    Article  PubMed  CAS  Google Scholar 

  25. McLaughlin T, Carter S, Lamendola C, Abbasi F, Schaaf P, Basina M, et al. Clinical efficacy of two hypocaloric diets that vary in overweight patients with type 2 diabetes: comparison of moderate fat vs carbohydrate reductions. Diabetes Care. 2007;30:1877–9.

    Article  PubMed  CAS  Google Scholar 

  26. Guldbrand H, Dizdar B, Bunjaku B, Lindstrom T, Bachrach-Lindstrom M, Fredrikson M, et al. In type 2 diabetes, randomization to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia. 2012;55:2118–27.

    Article  PubMed  CAS  Google Scholar 

  27. Esposito K, Maiorino MI, Ciotola M, Di Palo C, Scognamiglio P, Gicchino M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med. 2009;151:306–14.

    PubMed  Google Scholar 

  28. Hussain TA, Mathew TC, Dashti AA, Asfar S, Al-Zaid N, Dashti HM. Effect of low-calorie vs low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition. 2012;28:1016–21.

    Article  PubMed  CAS  Google Scholar 

  29. Martin CK, Rosenbaum D, Han H, et al. Change in food cravings, food preferences, and appetite during a low-carbohydrate and low-fat diet. Obesity. 2011;19:1963–70.

    Article  PubMed  CAS  Google Scholar 

  30. Borradaile KE, Halpern SD, Wyatt HR, Klein S, Hill JO, Bailer B, et al. Relationship between treatment preference and weight loss in the context of a randomized controlled trial. Obesity. 2012;20:1218–22.

    Article  PubMed  Google Scholar 

  31. Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med. 2005;142:403–11.

    PubMed  CAS  Google Scholar 

  32. Yancy Jr WS, Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab. 2005;2:34.

    Article  Google Scholar 

  33. Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. The effects of low-carbohydrate vs conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140:778–85.

    PubMed  Google Scholar 

  34. Haimoto H, Sasakabe T, Wakai K, Umegaki H. Effects of a low-carbohydrate diet on glycemic control in outpatients with severe type 2 diabetes. Nutr Metab. 2009;6:21.

    Article  Google Scholar 

  35. Miyashita Y, Koide N, Ohtsuka M, Ozaki H, Itoh Y, Oyama T, et al. Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity. Diabetes Res Clin Pract. 2004;65:235–41.

    Article  PubMed  CAS  Google Scholar 

  36. Jonsson T, Granfeldt Y, Ahren B, Branell UC, Palsson G, Hansson A, et al. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009;8:35.

    Article  PubMed  Google Scholar 

  37. Wolever TM, Gibbs AL, Mehling C, Chiasson JL, Connelly PW, Josse RG, et al. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr. 2008;87:114–25.

    PubMed  CAS  Google Scholar 

  38. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Sato M, et al. Influence of fat and carbohydrate proportions on the metabolic profile in patients with type 2 diabetes: a meta-analysis. Diabetes Care. 2009;32:959–65.

    Article  PubMed  CAS  Google Scholar 

  39. Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003;78:734–41.

    PubMed  CAS  Google Scholar 

  40. Rodriguez-Villar C, Perez-Heras A, Mercade I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabetic Med. 2004;21:142–9.

    Article  PubMed  CAS  Google Scholar 

  41. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fatty acids and risk of coronary heart disease: modulation by replacement nutrients. Curr Atheroscler Rep. 2010;12:384–90.

    Article  PubMed  CAS  Google Scholar 

  42. Alminger M, Eklund-Jonsson C. Whole-grain cereal products based on a high-fibre barley or oat genotype lower post-prandial glucose and insulin responses in healthy humans. Eur J Nutr. 2008;47:294–300.

    Article  PubMed  CAS  Google Scholar 

  43. Accurso A, Bernstein RK, Dahlqvist A, Draznin B, Feinman RD, Fine EJ, et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab. 2008;5:9.

    Article  Google Scholar 

  44. Feinman RD, Volek JS. Low carbohydrate diets improve atherogenic dyslipidemia even in the absence of weight loss. Nutr Metab. 2006;3:24.

    Article  Google Scholar 

  45. Feinman RD. Fad diets in the treatment of diabetes. Curr Diabetes Rep. 2011;11:128–35.

    Article  CAS  Google Scholar 

  46. • Davis NJ, Crandall JP, Gajavelli S, Berman JW, Tomuta N, Wylie-Rosett J, et al. Differential effects of low-carbohydrate and low-fat diets on inflammation and endothelial function in diabetes. J Diabetes Complications. 2011;25:371–6. This paper reports the findings of a randomized trial that compared low fat and low carbohydrate diets focusing on endothelial function and inflammation.

    Article  PubMed  Google Scholar 

  47. Stevens A, Robinson DP, Turpin J, Groshong T, Tobias JD. Sudden cardiac death of an adolescent during dieting. South Med J. 2002;95:1047–9.

    PubMed  Google Scholar 

  48. Davis NJ, Cohen HW, Wylie-Rosett J, Stein D. Serum potassium changes with initiating low-carbohydrate compared with a low-fat weight loss diet in type 2 diabetes. South Med J. 2008;101:46–9.

    Article  PubMed  Google Scholar 

  49. Bozzetto L, Prinster A, Annuzzi G, et al. Liver fat is reduced by an isoenergetic MUFA diet in a controlled randomized study in type 2 diabetic patients. Diabetes Care. 2012;35:1429–35.

    Article  PubMed  CAS  Google Scholar 

  50. Spreadbury I. Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity. Diabetes Metab Syndr Obesity. 2012;5:175–89.

    Article  CAS  Google Scholar 

  51. Grabitske HA, Slavin JL. Gastrointestinal effects of low-digestible carbohydrates. Crit Rev Food Sci Nutr. 2009;49:327–60.

    Article  PubMed  CAS  Google Scholar 

  52. Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington, DC: The National Academies Press; 2005.

    Google Scholar 

  53. • Gemen R, de Vries JF, Slavin JL. Relationship between molecular structure of cereal dietary fiber and health effects: focus on glucose/insulin response and gut health. Nutr Rev. 2011;69:22–33. This paper addressed the role of fiber as a constituent of carbohydrate in relation to glucose, insulin, and gut response.

    Article  PubMed  Google Scholar 

  54. Zhou J, Martin RJ, Tulley RT, Raggio AM, McCutcheon KL, Shen L, et al. Dietary resistant starch upregulates total GLP-1 and PYY in a sustained day-long manner through fermentation in rodents. Am J Physiol. 2008;295:E1160–6.

    CAS  Google Scholar 

  55. Brand-Miller JC, Griffin HJ, Colagiuri S. The carnivore connection hypothesis: revisited. J Obes. 2012;2012:258624.

    PubMed  Google Scholar 

  56. Rossetti L, Rothman DL, DeFronzo RA, Shulman GI. Effect of dietary protein on in vivo insulin action and liver glycogen repletion. Am J Physiol. 1989;257(2 Pt 1):E212–9.

    PubMed  CAS  Google Scholar 

  57. Neel JV. Diabetes mellitus: a "thrifty" genotype rendered detrimental by "progress"? 1962. Bull WHO. 1999;77:694–703;discussion 692–3.

    Google Scholar 

  58. Neel JV. The "thrifty genotype" in 1998. Nutr Rev. 1999;57(5 Pt 2):S2–9.

    PubMed  CAS  Google Scholar 

  59. Liu J, Zhou L, Xiong K, Godlewski G, Mukhopadhyay B, Tam J, et al. Hepatic cannabinoid receptor-1 mediates diet-induced insulin resistance via inhibition of insulin signaling and clearance in mice. Gastroenterology. 2012;142:1218–28:e1211.

    Google Scholar 

  60. Florez JC. The new type 2 diabetes gene TCF7L2. Curr Opin Clinl Nutr Metab Care. 2007;10:391–6.

    Article  CAS  Google Scholar 

  61. Grau K, Cauchi S, Holst C, Astrup A, Martinez JA, Saris WH, et al. TCF7L2 rs7903146-macronutrient interaction in obese individuals' responses to a 10-wk randomized hypoenergetic diet. Am J Clin Nutr. 2010;91:472–9.

    Article  PubMed  CAS  Google Scholar 

  62. Cornelis MC, Qi L, Kraft P, Hu FB. TCF7L2, dietary carbohydrate, and risk of type 2 diabetes in US women. Am J Clin Nutr. 2009;89:1256–62.

    Article  PubMed  CAS  Google Scholar 

  63. Hindy G, Sonestedt E, Ericson U, Jing XJ, Zhou Y, Hansson O, et al. Role of TCF7L2 risk variant and dietary fibre intake on incident type 2 diabetes. Diabetologia. 2012;55:2646–54.

    Article  PubMed  CAS  Google Scholar 

  64. Feinman RD. Intention-to-treat. What is the question? Nutr Metab. 2009;6:1.

    Article  Google Scholar 

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Acknowledgments

This work was supported in part by 5R18DK075981, the Diabetes Research and Training Center P60 DK020541, and Clinical and Translational Science Award UL1 RR025750.

Disclosure

Conflicts of interest: J. Wylie-Rosett: provided research advice to the American Potato Research Council; has received grant support from NIDDK, Kraft-Provident, and the Robert C and Veronica Atkins Foundation; has received honoraria from the State of Montana, Nutrition Society Cardiovascular Nurses; has received book royalties from the American Diabetes Association; and has received travel/accommodations expenses covered or reimbursed from the State of Montana, Nutrition Society, Cardiovascular Nurses Association; K. Aebersold: none; B. Conlon: none; C.R. Isasi: none; N.W. Ostrovsky: none.

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  1. Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA

    Judith Wylie-Rosett, Karin Aebersold, Beth Conlon, Carmen R. Isasi & Natania W. Ostrovsky

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  1. Judith Wylie-Rosett
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  2. Karin Aebersold
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  3. Beth Conlon
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Correspondence to Judith Wylie-Rosett.

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Wylie-Rosett, J., Aebersold, K., Conlon, B. et al. Health Effects of Low-Carbohydrate Diets: Where Should New Research Go?. Curr Diab Rep 13, 271–278 (2013). https://doi.org/10.1007/s11892-012-0357-5

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