The case for low carbohydrate diets in diabetes management

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.

Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis

“…Thus, protein intake of high biological value and from healthy dietary choices, such as from eggs, fish, lean meat (e.g., poultry), and whey protein (or other non-fat dairy protein), when eaten together with meals, may lower post-prandial lipogenesis and inflammation [ 107 ]. It is also known that proteins of high biological value, i.e., containing the essential amino acids in required amounts, can reduce post-meal glycemic response and improve satiety due to their effect on prolonged gastric-retention and gastro-intestinal transit time [ 108 , 109 ].…”

The Effects of Different Degrees of Carbohydrate Restriction and Carbohydrate Replacement on Cardiometabolic Risk Markers in Humans—A Systematic Review and Meta-Analysis

“…In only six studies, the LCD groups showed significant weight losses [40][41][42][43]45,46]. Gardner et al [42] compared an ad libitum LCD to [1] an energy-restricted MCD and to [2] an isocaloric MCD without energy restriction. Significant weight loss was only observed in the first comparison.…”

“…Low-carbohydrate diets (LCDs) have been proposed in the management of obesity, diabetes, and cardiovascular diseases (CVD) [1][2][3]. However, randomized controlled trials (RCTs) have shown conflicting results on the effects of LCDs on weight loss, glycemic control, and serum lipid profiles, while positive effects have mainly been observed in short-term studies [4].…”

Dietary Approaches to the Management Of type 2 Diabetes (DIAMOND): protocol for a randomised feasibility trial

“…There is limited high-quality evidence for the optimal macronutrient intake for patients with diabetes wishing to lose weight, or improve their glycaemic control 3 10–12. Reductions in glycaemic load, through restriction of total carbohydrate and/or changes in the type of carbohydrate to lower the glycaemic index, may have a beneficial effect, due to the direct effect of carbohydrate consumption on postprandial blood glucose levels,13 leading to a growing interest in carbohydrate-restricted diets for patients with diabetes. This is reflected in the wealth of recent reviews comparing the effects of low-carbohydrate versus high-carbohydrate diets in patients with diabetes 11 14–21.…”