The case for low carbohydrate diets in diabetes management

Division of Endocrinology, Diabetes and Hypertension, SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY 11203, USA.
Nutrition & Metabolism (Impact Factor: 3.36). 07/2005; 2(1):16. DOI: 10.1186/1743-7075-2-16
Source: PubMed

ABSTRACT A low fat, high carbohydrate diet in combination with regular exercise is the traditional recommendation for treating diabetes. Compliance with these lifestyle modifications is less than satisfactory, however, and a high carbohydrate diet raises postprandial plasma glucose and insulin secretion, thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and diabetes. Moreover, the current epidemic of diabetes and obesity has been, over the past three decades, accompanied by a significant decrease in fat consumption and an increase in carbohydrate consumption. This apparent failure of the traditional diet, from a public health point of view, indicates that alternative dietary approaches are needed. Because carbohydrate is the major secretagogue of insulin, some form of carbohydrate restriction is a prima facie candidate for dietary control of diabetes. Evidence from various randomized controlled trials in recent years has convinced us that such diets are safe and effective, at least in short-term. These data show low carbohydrate diets to be comparable or better than traditional low fat high carbohydrate diets for weight reduction, improvement in the dyslipidemia of diabetes and metabolic syndrome as well as control of blood pressure, postprandial glycemia and insulin secretion. Furthermore, the ability of low carbohydrate diets to reduce triglycerides and to increase HDL is of particular importance. Resistance to such strategies has been due, in part, to equating it with the popular Atkins diet. However, there are many variations and room for individual physician planning. Some form of low carbohydrate diet, in combination with exercise, is a viable option for patients with diabetes. However, the extreme reduction of carbohydrate of popular diets (<30 g/day) cannot be recommended for a diabetic population at this time without further study. On the other hand, the dire objections continually raised in the literature appear to have very little scientific basis. Whereas it is traditional to say that more work needs to be done, the same is true of the assumed standard low fat diets which have an ambiguous record at best. We see current trends in the national dietary recommendations as a positive sign and an appropriate move in the right direction.

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    • "The metabolic disturbances associated with obesity can therefore place older adults at increased risk of diabetes, and the subsequent glucose dysregulation and insulin resistance associated with diabetes may adversely affect appetite regulation and lead to excessive food intake. Thus, the adverse metabolic effects of obesity may ultimately dysregulate appetite and further predispose obese older adults to develop diabetes (Anora and McFarlane, 2005). Since increased levels of inflammation have been shown to be detrimental to muscle (Anker et al., 1999), a negative cycle can occur whereby the pathophysiological effects of obesity and diabetes may interact in such a manner to dramatically increase risk of sarcopenia in this subpopulation of obese older adults with diabetes (Dominquez and Barbagallo, 2007). "
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    ABSTRACT: Obesity and diabetes are known risk factors for the development of physical disability among older adults. With the number of seniors with these conditions rising worldwide, the prevention and treatment of physical disability in these persons has become a major public health challenge. Sarcopenia, the progressive loss of muscle mass and strength, has been identified as a common pathway associated with the initial onset and progression of physical disability among older adults. A growing body of evidence suggests that metabolic dysregulation associated with obesity and diabetes accelerates the progression of sarcopenia, and subsequently functional decline in older adults. The focus of this brief review is on the contributions of obesity and diabetes in accelerating sarcopenia and functional decline among older adults. We also briefly discuss the underexplored interaction between obesity and diabetes that may further accelerate sarcopenia and place obese older adults with diabetes at particularly high risk of disability. Finally, we review findings from studies that have specifically tested the efficacy of lifestyle-based interventions in maintaining the functional status of older persons with obesity and/or diabetes.
    Experimental gerontology 07/2013; 48(9). DOI:10.1016/j.exger.2013.06.007 · 3.53 Impact Factor
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    • "Before the advent of exogenous insulin, dietary modification was the main therapy for diabetes. However, the diet recommendations during that time were completely different from the current low-fat, high-carbohydrate dietary recommendations for patients with diabetes [14] [15]. For example, Dr. Elliot Joslin's Diabetic Diet in 1923 consisted of meats, poultry, fish, clear soups, gelatin, eggs, butter, olive oil, coffee, and tea, providing approximately 5% of energy from carbohydrates, 20% from protein, and 75% from fat [16]. "
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    ABSTRACT: Effective diabetic management requires reasonable weight control. Previous studies from our laboratory have shown the beneficial effects of a low-carbohydrate ketogenic diet (LCKD) in patients with type 2 diabetes after its long term administration. Furthermore, it favorably alters the cardiac risk factors even in hyperlipidemic obese subjects. These studies have indicated that, in addition to decreasing body weight and improving glycemia, LCKD can be effective in decreasing antidiabetic medication dosage. Similar to the LCKD, the conventional low-calorie, high nutritional value diet is also used for weight loss. The purpose of this study was to understand the beneficial effects of LCKD compared with the low-calorie diet (LCD) in improving glycemia.
    Nutrition 06/2012; 28(10):1016-21. DOI:10.1016/j.nut.2012.01.016 · 3.05 Impact Factor
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    • "For example, 20 percent of people with diabetes with public coverage and 23 percent of those without insurance spend more than et al., 2004). They point out that rising rates of obesity in the U.S. are coincident with the steady increase in the share of calories from carbohydrates (Arora and McFarlane, 2005). "
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    ABSTRACT: We investigate the impact of changes in the relative price of low- and high-carbohydrate foods on medical expenditures for diabetes care using Nielsen Homescan price data merged to the 2000--2005 Medical Expenditure Panel Survey. We find that an increase in low-(high-)carbohydrate food price increases (decreases) both the likelihood of a diabetes diagnosis and the level of medical expenditures among those with diabetes. We also find small impacts of food prices on body mass index that differ by gender. Policy simulations suggest that subsidizing the low-carbohydrate food purchases of people with diabetes could result in significant reductions in health care costs. Copyright 2010, Oxford University Press.
    American Journal of Agricultural Economics 12/2010; 92(5):1271-1282. DOI:10.1093/ajae/aaq064 · 1.36 Impact Factor
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