Adherence to Low-Carbohydrate Diets in Patients with Diabetes: A Narrative Review

Abstract

Evidence suggests that low carbohydrate (<130 g/day of carbohydrate) (LCD) and very low carbohydrate, ketogenic diets (typically <50 g/day of carbohydrate) (VLCKD) can be effective tools for managing diabetes given their beneficial effects on weight loss and glycemic control. VLCKD also result in favorable lipid profile changes. However, these beneficial effects can be limited by poor dietary adherence. Cultural, religious, and economic barriers pose unique challenges to achieving nutritional compliance with LCD and VLCKD. We review the various methods for assessing adherence in clinical studies and obstacles posed, as well as potential solutions to these challenges.

Twelve Months of Time-Restricted Feeding Improves Cognition and Alters Microbiome Composition Independent of Macronutrient Composition

“…The possibility therefore exists that diet-induced cognitive benefits of ketosis are directly related to the efficacy of reversing metabolic deficits rather than due to the elevation of ketone bodies directly improving brain function. As the long-term carbohydrate restriction that is necessary to maintain nutritional ketosis poses huge barriers for extended compliance in community dwelling older adults [ 14 ], it is critical to determine the mechanisms by which this diet confers cognitive resilience. Different dietary paradigms that may increase compliance and therefore efficacy, such as time restricted feeding rather than restriction of either calories or macronutrient content.…”

Is Intermittent Fasting Better Than Continuous Energy Restriction for Adults with Overweight and Obesity?

“…Changing our lifestyle towards healthy eating and more physical activity may help reduce or prevent the development of obesity. 78 Future studies should address the synergistic effects of IF combined with other interventions in weight management as a means to improve adherence 79 to weight loss regimens for long-term weight control.…”

The Very Low Carbohydrate Ketogenic Diet: Effective, but safe?

“…These barriers may not concern some who wish to follow a VLCKD, but literature suggests adherence to low carbohydrate diets is challenging, 3 therefore barriers should be addressed with individuals who are hoping to adhere to this way of eating.…”

“…The decline in efficacy of a ketogenic diet after 12 months is related to decreases in adherence. 3 One might say that the first risk to discuss with patients regarding this eating plan is the likelihood of not being able to follow it past 12 months, although this is not a concern unique to a VLCKD. 4 There are individuals who have the resources to tackle a difficult diet such as this.…”