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This article has been cited by other articles in PMC. 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. 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.
The case for low carbohydrate diets in diabetes management The epidemic of obesity and diabetes in our society over the past three decades has been accompanied by a decline in fat consumption and an apparent attempt to adopt the traditionally recommended low fat diet [ 12 ].
This apparent failure of low fat diets in curbing the obesity pandemic calls into question the effectiveness and long-term usefulness of such dietary recommendation and has led to renewed interest in alternative dietary interventions, notably those recommending reduced carbohydrate intake.
Low fat diets are generally associated with high carbohydrate intake which in turn is associated with several metabolic abnormalities [ 34 ].
These metabolic abnormalities are more pronounced in the diabetic population, leading to worsening glycemic control, dyslipidemia and increased inflammation to name a few. In this review, we discuss the current evidence for a low carbohydrate diet versus a low fat diet in the management of people with diabetes, highlighting the potential role of low carbohydrate diet in ameliorating various metabolic abnormalities associated with diabetes.
Carbohydrate restriction It is important to understand that there is no clear cut definition of a low carbohydrate diet in the literature. The caloric deficit due to carbohydrate restriction may be balanced with increased intake of proteins and fats although the distribution is not always clear in the application of popular diets and, in at least two studies, no increase in dietary intake of proteins or fats was observed presumably due to effect of LoCHO diet on appetite and satiety [ 912 ] It is interesting that despite advocating ad libitum fat and protein intake, a LoCHO diet may be hypocaloric either by design or by spontaneous reduction of intake [ 8 - 12 ].
In the Diabetes Prevention Program DPP and the Finnish trials, lifestyle intervention including modest weight loss was effective in preventing the development of diabetes in a high risk population [ 1516 ]. Weight control, per se, is thus a critical component for achieving glycemic control, improving insulin resistance and modifying CVD risk in patients with diabetes and insulin resistance as well as for diabetes prevention [ 1417 ].
Traditionally, increased fat intake has been considered as the main cause for excess energy intake and obesity but the trends in food intake during the obesity epidemic do not support this notion [ 218 ]. While fat intake has decreased, carbohydrate intake has increased simultaneously.
This rise in dietary intake of carbohydrates, and especially highly refined carbohydrate, is a likely culprit in promoting weight gain and obesity [ 19 ].
However any weight loss resulting from a low-carbohydrate diet probably comes merely from reduced overall calorie intake. A -analysis of five clinical trials including individuals found that low fat and low carbohydrate diets are equally effective for weight loss up to one year. However, many studies do not support the idea that low-fat diets are very effective for weight loss (4, 5, 6). In fact, strong evidence points toward low-carb diets being more effective. These diets typically limit carbohydrate intake to less than 20–30% of total calorie intake, and are higher in protein and fat (7, 8). Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue or lean mass, namely bone mineral deposits, muscle, tendon, and other connective tissue. Weight loss can either occur unintentionally due to malnourishment or an underlying disease or .
Weight change is governed by two factors:The low-carb group spontaneously reduced their calorie intake, so that the 2 groups ate about the same number of calories, again showing the power of reducing hunger and body weight set point.
However, many studies do not support the idea that low-fat diets are very effective for weight loss (4, 5, 6). In fact, strong evidence points toward low-carb diets being more effective.
These diets typically limit carbohydrate intake to less than 20–30% of total calorie intake, and are higher in protein and fat (7, 8). Low carbohydrate diets are popular for weight loss and weight management but are not recommended in leading guidelines due to the perception that increases in dietary fat intake may lead to an adverse cardiovascular risk profile.
Jul 14, · In a recent study, for example, significantly greater weight loss was demonstrated with low carbohydrate intervention (intake ( kcal/day) compared to high carbohydrate (60% calories from carbohydrates) with lower caloric intake .
However any weight loss resulting from a low-carbohydrate diet probably comes merely from reduced overall calorie intake. A -analysis of five clinical trials including individuals found that low fat and low carbohydrate diets are equally effective for weight loss up to one year.
The first weight-loss book to promote calorie counting, and the first weight-loss book to become a bestseller, was the Diet and Health: With Key to the Calories by American physician and columnist Lulu Hunt Peters.