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: 3.26). 07/2005; 2(1):16. DOI: 10.1186/1743-7075-2-16
Source: PubMed


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 · 3.49 Impact Factor
    • "These approaches include diets containing 50–60% calories from carbohydrates and administration of low-glycemic load (GL) diet (100 g) (glucose equivalents per day) without elevating fat intake.[5] Conventional high carbohydrate intake recommended in diabetes, results in suboptimal glycemic control and lipoprotein profile, gradually increasing insulin and/or oral hypoglycemic medication requirement and eventually weight gain.[6] "
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    ABSTRACT: One dietary strategy aimed at improving both diabetes control and control of cardiovascular risk factors is the use of low glycemic index diets. These diets have been reported to be beneficial in controlling diabetes, and also increase high density lipoprotein cholesterol (HDL-C), lower serum triglyceride, and reduce glycated protein. Therefore, we aimed to investigate the effect of a low glycemic index-low glycemic load (GL = 67-77) diet on lipids and blood glucose of poorly controlled diabetic patients. In an intervention study, 100 poorly controlled diabetic patients (age 52.8 ± 4.5 years) who were taking insulin or on oral medication underwent administration of low GL diet (GL = 67-77; energy = 1800-2200 kcal, total fat = 36%, fat derived from olive oil and nuts 15%, carbohydrate = 41%, protein = 22%) for 10 weeks. Patients were recommended to follow their regular lifestyle. Total cholesterol, low density lipoprotein (LDL), HDL, triglyceride, glycated hemoglobin (HbA1c), weight, and body mass index (BMI) were measured before and 10 weeks after the intervention. Before intervention, initial blood cholesterol and triglyceride concentrations were 205.9 ± 21.6 and 181.5 ± 22.2, respectively, and were reduced to 182.6 ± 18.2 and 161.6 ± 16.7, respectively, after 10 weeks intervention (P < 0.001). LDL reduced and HDL increased significantly. The HbA1c percentage reduced by 12% (from 8.85 ± 0.22% to 7.81 ± 0.27%) (P < 0.001), and also their weight significantly reduced from 74.0 ± 5 kg to 70.7 ± 4.6 kg (P < 0.001). This study demonstrated that low GL diet having lower carbohydrate amount and higher fat content is an appropriate strategy in blood lipid and glucose response control of poorly controlled diabetic patients.
    11/2012; 16(6):991-5. DOI:10.4103/2230-8210.103010
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    • "Better weight loss with low-carbohydrate diets may be explained by higher satiating properties of dietary protein in comparison to other macronutrients, an effect that has been shown both in short- [52–56] and long-term [57, 58] studies. Further factors involved may include a reduced variety of allowed foods, and an aversion against dietary fat content in the absence of relevant amounts of carbohydrates [59], whereas the often proposed ketosis is less likely to play a key role in this context [60, 61]. Lowering the percent protein of the diet from 15% to 10% results in higher total energy intake, predominantly from savoury-flavoured foods available between meals [62], reiterating that a higher dietary protein intake may help to reduce energy intake. "
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    ABSTRACT: Insulin resistance has been proposed as the strongest single predictor for the development of Type 2 Diabetes (T2DM). Chronic oversupply of energy from food, together with inadequate physical activity, have been recognized as the most relevant factors leading to overweight, abdominal adiposity, insulin resistance, and finally T2DM. Conversely, energy reduced diets almost invariably to facilitate weight loss and reduce abdominal fat mass and insulin resistance. However, sustained weight loss is generally difficult to achieve, and distinct metabolic characteristics in patients with T2DM further compromise success. Therefore, investigating the effects of modulating the macronutrient composition of isoenergetic diets is an interesting concept that may lead to additional important insights. Metabolic effects of various different dietary concepts and strategies have been claimed, but results from randomized controlled studies and particularly from longer-term-controlled interventions in humans are often lacking. However, some of these concepts are supported by recent research, at least in animal models and short-term studies in humans. This paper provides an update of the current literature regarding the role of nutrition in the modulation of insulin resistance, which includes the discussion of weight-loss-independent metabolic effects of commonly used dietary concepts.
    09/2012; 2012(5):424780. DOI:10.6064/2012/424780
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