Following a Low Carbohydrate, High Fat Diet Compared to Reduced Calorie, High Carbohydrate Diet as a Nutritional Intervention in Type Two Diabetes Mellitus Patients: A Systematic Review

Abstract

There is evidence supporting individuals with type 2 diabetes benefit from lifestyle changes through a nutrition intervention that improves diabetic (blood glucose and HgbA1c) and cardiovascular (total cholesterol, HDL, LDL, and triglycerides) biomarkers. The objective of this systematic review was to evaluate if patients with type 2 diabetes following a low carbohydrate, high fat eating pattern is more effective than following a reduced caloric, high carbohydrate eating pattern in the improvement of diabetic (blood glucose and HgbA1c) and cardiovascular (total cholesterol, HDL, LDL, and triglycerides) biomarkers. A literature search was conducted on peer-reviewed research trials registered in PubMed, from January 2007 to September 2019 using combinations of the search terms: Diabetes Mellitus, Type 2 AND Diet, Ketogenic; OR Diet, Carbohydrate-Restricted. The literature was analyzed in chronological order; grouping in four year increments from 2007 to 2019. The thirty-six articles reviewed provide evidence to support the use of a low carbohydrate diet in patients with type 2 diabetes versus a reduced caloric diet. This systematic review highlighted diabetic (HgbA1c and fasting blood glucose) and cardiovascular biomarkers (HDL) of type 2 diabetic patients improve significantly when following a low-carbohydrate, high fat diet versus a reduced calorie, high carbohydrate intake.

Very low carbohydrate (ketogenic) diets in type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

“…In general behavioural terms and specifically in dietary modification, the more restriction the likelihood of long‐term adherence is lower 49,50 . Therefore, while the studies reported in this and other meta‐analyses 26,51 broadly show greater improvements in glycaemic control and sometimes weight and lipids with VLC/KDs, studies are generally limited to 6 or 12 months, dropout rates in the ketogenic group can be as high as 54%, 32 and reported carbohydrate intake is often greater than what would constitute a KD by the end of the study (Table 1). Dansinger et al have previously shown that weight loss is more related to adherence to a diet than to the actual dietary composition, and in their 12‐month study the VLC/KD had the lowest adherence 52 …”

“…Therefore, the value of VLC/KD for weight loss, glycaemic control and CVD risk in these groups is uncertain. 13,14,25,26 This study aimed to estimate the effect of VLC/KD compared with diets higher in carbohydrate, assessed by meta-analysis of randomized controlled trials (RCTs) in people with pre-diabetes or T2D, on glycated haemoglobin (HbA1c) and related metabolic variables.…”

“…Although there have been meta‐analyses of restricted carbohydrate intake diets, 14,21‐24 none have specifically focused on glycaemic control, weight and CVD risk outcomes in people with pre‐diabetes or T2D prescribed a VLC/KD. Therefore, the value of VLC/KD for weight loss, glycaemic control and CVD risk in these groups is uncertain 13,14,25,26 …”

“…Therefore, the value of VLC/KD for weight loss, glycaemic control and CVD risk in these groups is uncertain. 13 , 14 , 25 , 26 …”

Dietary Management of Type 2 Diabetes in the MENA Region: A Review of the Evidence

“…The effectiveness of low-carbohydrate diets in the management of glycemia has been extensively studied; however, findings have been inconclusive. Some studies asserted the superiority of low carbohydrate diets in glycemic control compared to other diets (usually low-fat diets), suggesting a dose-dependent relationship whereby a greater carbohydrate restriction results in better glycemic control, while others warned against the unsustainability of this approach’s effects or indicated no advantage at all [ 89 , 101 , 102 , 103 , 104 , 105 ]. Moreover, depending on the choice of foods that replace carbohydrates, low carbohydrate diets may be associated with adverse metabolic outcomes and micronutrient deficiencies [ 106 ].…”