A ABLC, em conformidade com as evidências científicas mais atuais, considera que a dieta low carb é a melhor intervenção terapêutica para pessoas com diabetes tipo 2, doença extremamente prevalente e caracterizada por resistência à insulina e intolerância à glicose.

Do ponto de vista fisiológico e de acordo com as recomendações das diretrizes médicas para o tratamento do diabetes tipo 1, quanto mais carboidrato consumimos, mais insulina precisamos. Por que não usar o mesmo princípio para as pessoas com diabetes tipo 2?

Além disso, diversos estudos demonstram os benefícios de uma dieta low carb no tratamento do diabetes tipo 2. Infelizmente, na maioria das vezes as conclusões das diretrizes focam em apenas 2 pontos:

1. melhora do controle glicêmico
2. resultado em longo prazo

Alguns estudos mostram melhora do controle glicêmico quando comparam dieta low carb x dieta tradicional. Outros não. Mas isso não é de se estranhar! O controle glicêmico pode ser alcançado independente da dieta, mas as custas do que? 

O resultado a longo prazo entra na questão da aderência. Mudar hábitos é difícil e a ABLC reconhece isso. Mas o fato de alguém não conseguir mudar um hábito não significa que essa mudança não seja a ideal ou a recomendada.

Mas o terceiro ponto,  geralmente negligenciado, é o mais importante:

3. diminuição do número de medicamentos

O controle glicêmico pode até ser igual, mas a quantidade de medicamentos utilizados para atingir esse controle é muito menor no grupo que faz dieta low carb. E quanto maior a restrição de carboidrato, menor a necessidade de medicação.

Recomendar a dieta low carb, além de melhorar o controle do Diabetes tipo 2, tem impacto significativo nos custos do tratamento.

 

Para quem quiser saber mais sobre o assunto, seguem alguns estudos que abordam o tema.

Boa leitura!

 

The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials.

Reducing dietary carbohydrate may produce clinical improvements in the management of type 2 diabetes

Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study

Carbohydrate restriction markedly improves glycemic control in patients with type 2 diabetes (T2D) but necessitates prompt medication changes. Therefore, we assessed the effectiveness and safety of a novel care model providing continuous remote care with medication management based on biometric feedback combined with the metabolic approach of nutritional ketosis for T2D management. These results demonstrate that a novel metabolic and continuous remote care model can support adults with T2D to safely improve HbA1c, weight, and other biomarkers while reducing diabetes medication use.

Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study.

A continuous care treatment including nutritional ketosis in patients with T2D improved most biomarkers of CVD risk after 1 year. The increase in LDL-cholesterol appeared limited to the large LDL subfraction. LDL particle size increased, total LDL-P and ApoB were unchanged, and inflammation and blood pressure decreased.

Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes.

In a 12-month trial, adults with elevated HbA1c and body weight assigned to an LCK diet had greater reductions in HbA1c, lost more weight, and reduced more medications than those instructed to follow an MCCR diet.

Effect of combined use of a low-carbohydrate, high-protein diet with omega-3 polyunsaturated fatty acid supplementation on glycemic control in newly diagnosed type 2 diabetes: a randomized, double-blind, parallel-controlled trial.

The LCHP+ω-3 diet provided greater effects on HbA1c and fasting glucose and faster effects on fasting glucose than both the LCHP and ω-3 diets, indicating the potential necessity of combining an LCHP diet with ω-3 PUFAs in T2D control.

Dietary Approaches for Japanese Patients with Diabetes: A Systematic Review.

All the three randomized controlled trials showed better glucose management with the carbohydrate restricted diet

Dietary Interventions for the Prevention of Type 2 Diabetes in High-Risk Groups: Current State of Evidence and Future Research Needs.

The effect of weight loss via other dietary approaches, such as low-carbohydrate diets, a Mediterranean dietary pattern, intermittent fasting or very-low-energy diets, on the incidence of type 2 diabetes has not been tested. These diets-as described here-could be equally, if not more effective in preventing type 2 diabetes than the tested low-fat diet, and if so, would increase choice for patients.

Effect of low-carbohydrate diet on markers of renal function in patients with type 2 diabetes: A meta-analysis.

In the present meta-analysis, no effect on markers of renal function was found after provision of a LCD compared with a control dietin patients with type 2 diabetes.

Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments.

Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40% yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30% in people with T2D. 

Dietary and nutritional approaches for prevention and management of type 2 diabetes.

Before insulin was developed as a therapy, reducing carbohydrate intake was the main treatment for diabetes. Carbohydrate restriction for the treatment of type 2 diabetes has been an area of intense interest because, of all the macronutrients, carbohydrates have the greatest effect on blood glucose and insulin levels. In a review by the American Diabetes Association, interventions of low carbohydrate (less than 40% of calories) diets published from 2001 to 2010 were identified.15 Of 11 trials, eight were randomised and about half reported greater improvement in HbA1c on the low carbohydrate diet than the comparison diet (usually a low fat diet), and a greater reduction in the use of medicines to lower glucose. Given the hypoglycaemic effect of carbohydrate restriction, patients with diabetes who adopt low carbohydrate diets and their clinicians must understand how to avoid hypoglycaemia by appropriately reducing glucose lowering medications. 

The Effect of Low-Carbohydrate Diet on Glycemic Control in Patients with Type 2 Diabetes Mellitus.

LCD can improve blood glucose more than LFD in Chinese patients with T2DM. It can also regulate blood lipid, reduce BMI, and decrease insulin dose in patients with T2DM.

Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet.

Exceptional glycemic control of T1DM with low rates of adverse events was reported by a community of children and adults who consume a VLCD. The generalizability of these findings requires further studies, including high-quality randomized controlled trials.

Efficacy of a Moderately Low Carbohydrate Diet in a 36-Month Observational Study of Japanese Patients with Type 2 Diabetes.

Over 36 months, the mLCD intervention showed sustained effectiveness (without safety concerns) in improving HbA1c, lipid profile, and liver enzymes in Japanese patients with type 2 diabetes.

Low carbohydrate diet and improved glycaemic control in a patient with type one diabetes.

A low carbohydrate diet was found to substantially reduce HbA1c values and blood glucose (BG) variability, as well as causing a significant reduction in average daily glucose values in a patient with T1DM.Although further research is warranted, lowcarbohydrate diets in patients with T1DM have the potential to positively impact long-term morbidity and mortality through reduction of BG variability and average daily BG values.The diet was well tolerated and not associated with any adverse effects within this study.

The impact of carbohydrate intake and its sources on hemoglobin A1c levels in Japanese patients with type 2 diabetes not taking anti-diabetic medication.

We observed positive correlation of total carbohydrate intake (g/day) with HbA1c in men and women. Our findings warrant interventional studies for moderate low-carbohydrate diets that focus on carbohydrate sources and sex differences in order to efficiently decrease HbA1c in patients with T2DM.

Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis.

Although there are issues with the quality of the evidence, this review suggests that carbohydrate-restricted diets could be offered to people living with diabetes as part of an individualised management plan.

Interest in the Ketogenic Diet Grows for Weight Loss and Type 2 Diabetes.

There’s also increasing interest in the ketogenic diet for diabetesmanagement. Insulin sensitivity improves on the diet—although the mechanisms are not entirely clear— along with glycemic control. “It seems to help people not only lose weight but reduce their requirement for [diabetes] medications, and they get improvements in their hemoglobin A1c [HbA1c], which is an end point for diabetes management,”. Beyond helping people reduce their weight and get control of their blood glucose, ketogenic diets may also be hearthealthy, thanks to improvements in triglycerides, high-density lipoprotein (HDL) cholesterol levels, abdominal circumference, and blood pressure

Efficacy of low carbohydrate diet for type 2 diabetes mellitus management: A systematic review and meta-analysis of randomized controlled trials.

The results suggested a beneficial effect of LCD intervention on glucose control in patients with type 2 diabetes. The LCD intervention also had a positive effect on triglycerides and HDL cholesterol concentrations, but without significant effect on long term weight loss.

[Composition of macronutrients in the diabetic diet].

Considering a low-calorie diet, the effects of high- and low-carbohydrate diets on people with diabetes are similar with regard to weight loss and lowering of HbA1c, however the low-carbohydrate diet is associated with lower glycemic variability and a reduced need for anti-diabetic drugs.

Effects of different dietary approaches on inflammatory markers in patients with metabolic syndrome: A systematic review and meta-analysis.

Low-carbohydrate diets have beneficial effects on insulin and body weight

A critical review of low-carbohydrate diets in people with Type 2 diabetes. 

It was noted in that 95.2% of people on the LCD reduced or stopped anti-hyperglycaemic agents. A LCD appears no different from a highcarbohydrate diet in terms of metabolic markers and glycaemic control.

Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base.

The benefits of carbohydrate restriction in diabetesare immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1

Impact of behavioral interventions in the management of adults with type 2 diabetes mellitus.

The most efficacious interventions appear to be low-carbohydrate/glycemic load diets, combined aerobic and resistance training, and self-monitoring of blood glucose, which educates patients about the impact of their food selections and physical activity on their blood glucose

Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets.

In summary, individuals with metabolic syndrome, insulin resistance and T2D (all diseases of carbohydrate intolerance) are likely to see symptomatic as well as objective improvements in biomarkers of disease risk if they follow a well-formulated very-low-carbohydrate diet. Glucose control improves not only because there is less glucose coming in, but also because systemic insulin sensitivity improves as well.

Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes.

Low-carbohydrate, low-GI, Mediterranean, and high-protein diets are effective in improving various markers of cardiovascularrisk in people with diabetes and should be considered in the overall strategy of diabetes management.

Health effects of low-carbohydrate diets: where should new research go?

In general, the lower carbohydrate treatment condition resulted in lower A1c levels and lower doses of anti-diabetic medications than the higher carbohydrate comparison diet.5

Diets for body weight control and health: the potential of changing the macronutrient composition.

There is increasing evidence that diets with a lower, or even very-low, carbohydrate content can help overweight and obese individuals to lose and maintain lost weight, diabetics to control blood glucose with more ease and prevent the development of diabetic complications, while at the same time improving blood lipid profiles and biomarkers of cardiovascular risk. The present review considers the evolution of our diet and questions whether high-carbohydrate diets are indeed synonymous with health.

Low-carbohydrate diet review: shifting the paradigm.

This review examines and compares the safety and the effectiveness of a LC approach as an alternative to a low-fat (LF), high-carbohydrate diet, the current standard for weight loss and/or chronic disease prevention. In short-term and long-term comparison studies, ad libitum and isocaloric therapeutic diets with varying degrees of carbohydrate restriction perform as well as or better than comparable LF diets with regard to weight loss, lipid levels, glucose and insulin response, blood pressure, and other important cardiovascular risk markers in both normal subjects and those with metabolic and other health-related disorders. The metabolic, hormonal, and appetite signaling effects of carbohydrate reduction suggest an underlying scientific basis for considering it as an alternative approach to LF, high-carbohydrate recommendations in addressing overweight/obesity and chronic disease in America. It is time to embrace LC diets as a viable option to aid in reversing diabetes mellitus, risk factors for heart disease, and the epidemic of obesity.

Low-carbohydrate diets: an update on current research.

Current research suggests that low-carbohydrate diets can be a viable option for achieving weight loss and may have beneficial effects on glycemic control, triglyceride levels, and high-density lipoprotein cholesterol levels in some patients.

Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial.

Compared with a low-fat diet, a low-carbohydrate, Mediterranean-style diet led to more favorable changes in glycemic controland coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2diabetes.

Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet.

Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions

Carbohydrate restriction as the default treatment for type 2 diabetes and metabolic syndrome.

Dietary carbohydrate restriction in the treatment of diabetes and metabolic syndrome is based on an underlying principle of control of insulin secretion and the theory that insulin resistance is a response to chronic hyperglycemia and hyperinsulinemia. As such, the theory is intuitive and has substantial experimental support. It has generally been opposed by health agencies because of concern that carbohydrate will be replaced by fat, particularly saturated fat, thereby increasing the risk of cardiovascular disease as dictated by the so-called diet-heart hypothesis. Here we summarize recent data showing that, in fact, substitution of fat for carbohydrate generally improves cardiovascular riskfactors. Removing the barrier of concern about dietary fat makes carbohydrate restriction a reasonable, if not the preferred method for treating type 2 diabetes and metabolic syndrome. We emphasize the ability of low carbohydrate diets to improve glycemic control, hemoglobin A1C and to reduce medication. We review evidence that such diets are effective even in the absence of weight loss.

Protein in optimal health: heart disease and type 2 diabetes.

Diets with increased protein and reduced carbohydrates have been shown to improve body composition, lipid and lipoprotein profiles, and glycemic regulations associated with treatment of obesity and weight loss. Derived from these outcomes, high-protein, low-carbohydrate diets are also being examined for treatment of heart disease, metabolic syndrome, and type 2 diabetes. High-protein, low-carbohydrate diets have been found to have positive effects on reducing risk factors for heart disease, including reducing serum triacylglycerol, increasing HDL cholesterol, increasing LDL particle size, and reducing blood pressure. These diets appear particularly attractive for use with individuals exhibiting the atherogenic dyslipidemia of metabolic syndrome. High-protein, low-carbohydrate diets have also been investigated for treatment of type 2 diabetes with positive effects on glycemic regulation, including reducing fasting blood glucose, postprandial glucose and insulin responses, and the percentage of glycated hemoglobin.

[Cardiovascular prevention in diabetic patients: an evidenced-based review].

Diabetes mellitus is a condition associated with cardiac complications, especially artherothrombotic disease. Several studies have demonstrated the importance of reducing cardiovascular burden on this population by adopting prevention strategies. This article revised clinical evidences on cardiovascular risk assessment and prevention actions, taking into consideration major recommendations in the field. Life-style changes with low-carbohydrate diet, weight control, and regular physical activity must be implemented.

Beneficial effects of ketogenic diet in obese diabetic subjects.

This study shows the beneficial effects of ketogenic diet in obese diabetic subjects following its long-term administration. Furthermore, it demonstrates that in addition to its therapeutic value, low carbohydrate diet is safe to use for a longer period of time in obese diabetic subjects.

Nutrition in patients with Type 2 diabetes: are low-carbohydrate diets effective, safe or desirable?

Low-carbohydrate diets have been around for over 100 years. They have become very popular recently but the scientific basis for their use remains to be fully established. Although many controversies remain, there is now mounting evidence that these diets can lead to effective weight loss and may thus be a useful intervention for patients who have, or are at risk of, diabetes. The practical aspects of using these diets as a short- to medium-term intervention are discussed.

Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes--a brief report.

CONCLUSION: A low-carbohydrate diet is an effective tool in the treatment of obese patients with type 2 diabetes.

Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes.

In a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in spontaneous reduction in energy intake to a level appropriate to their height; weight loss that was completely accounted for by reduced caloric intake; much improved 24-hour blood glucose profiles, insulin sensitivity, and hemoglobin A1c; and decreased plasma triglyceride and cholesterol levels

A low-carbohydrate/high-fat diet improves glucoregulation in type 2 diabetes mellitus by reducing postabsorptive glycogenolysis.

A low-carbohydrate/high-fat diet improves glucoregulation in type 2 diabetes mellitus by reducing postabsorptive glycogenolysis.

Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes.

a high-protein/low-carbohydrate, weight-maintaining, nonketogenic diet ingested for 5 weeks dramatically reduced the circulating glucose concentration in people with untreated type 2 diabetes

Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity.

When restrict diet was made isocaloric, a low calorie/low carbohydrate diet might be more effective treatment for a reduction of visceral fat, improved insulin sensitivity and increased in HDL-C levels than low calorie/high carbohydrate diet in obese subjects with type 2 diabetes mellitus

The diet-heart hypothesis: a critique.

The low-fat "diet-heart hypothesis" has been controversial for nearly 100 years. The low-fat-high-carbohydrate diet, promulgated vigorously by the National Cholesterol Education Program, National Institutes of Health, and American Heart Association since the Lipid Research Clinics-Primary Prevention Program in 1984, and earlier by the U.S. Department of Agriculture food pyramid, may well have played an unintended role in the current epidemics of obesity, lipid abnormalities, type II diabetes, and metabolic syndromes. This diet can no longer be defended by appeal to the authority of prestigious medical organizations or by rejecting clinical experience and a growing medical literature suggesting that the much-maligned low-carbohydrate-high-protein diet may have a salutary effect on the epidemics in question.

High-protein low-carbohydrate diets: what is the rationale?

Dietary recommendations released by the large majority of international scientific committees and organizations suggest that the diet for the prevention and treatment of the most compelling health problems of our societies (obesity, diabetes, atherosclerosis, cardiovascular diseases and cancer) should be a diet moderately low in caloric content, low in fat content (particularly in saturated fat), poor in total cholesterol and rich in fibre. Despite this uniformity in official recommendations, alternative diets with low carbohydrate and high protein content continue to be extremely popular within consumers and patients. Recently, new studies seem to suggest that high-protein low-carbohydrate diets may have particularly positive effects on reducing body weight and other risk factors for heart disease. Gannon and Nuttall conducted direct comparisons of high-protein low-carbohydrate diets compared with high-carbohydrate low-protein diets in subjects with type 2 diabetes. They found that high-protein low-carbohydrate diets reduced fasting plasma glucose, 24-h glucose area under the curve and haemoglobin A(1c). On the basis of these results, a joint committee of the American Diabetes Association, North American Society for the Study of Obesity and the American Society for Clinical Nutrition suggested that a low-carbohydrate diet may be preferred to a low-fat diet for the induction of weight loss and glycaemic control in subjects with type 2 diabetes

Fad diets in the treatment of diabetes.

Although standard low-fat diets more accurately conform to the idea of a practice supported by social pressure rather than scientific data, it is suggested that we might want to give up altogether unscientific terms like "fad" and "healthy." Far from faddish, diets based on carbohydrate restriction have been the historical treatment for diabetes and are still supported by basic biochemistry, and it is argued that they should be considered the "default" diet, the one to try first, in diseases of carbohydrate intolerance or insulin resistance. The barrier to acceptance of low-carbohydrate diets in the past has been concern about saturated fat, which might be substituted for the carbohydrate that is removed. However, recent re-analysis of much old data shows that replacing carbohydrate with saturated fat is, if anything, beneficial.

One year follow-up after a randomized controlled trial of a 130 g/day low-carbohydrate diet in patients with type 2 diabetes mellitus and poor glycemic control.

In conclusion, we demonstrated that a LCD with 130 g/day of carbohydrate intake for 6 months was more effective than a CRD in Japanese patients with T2DM who could not achieve good glycemic control

Practices should be able to keep money saved from putting patients on low carbohydrate diet, GP says.

Unwin said that his practice’s spending on type 2 diabetes drugs (excluding insulin) was £4194 (€4940; $5260) less per 1000 patients than the average of £7385 per 1000 patients across the clinical commissioning group area and that his practice “also has a significantly better quality of diabetes control than nearby practices

An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A Randomized Controlled Trial.

Individuals with type 2 diabetes improved their glycemic control and lost more weight after being randomized to a very low-carbohydrate ketogenic diet and lifestyle online program rather than a conventional, low-fat diabetes diet online program. Thus, the online delivery of these very low-carbohydrate ketogenic diet and lifestyle recommendations may allow them to have a wider reach in the successful self-management of type 2 diabetes.

Third Exposure to a Reduced Carbohydrate Meal Lowers Evening Postprandial Insulin and GIP Responses and HOMA-IR Estimate of Insulin Resistance.

Evening postprandial insulin and GIP responses and insulin resistance declined by over 30% after three meals that limited daily carbohydrate intake to 30% compared to no such changes after three 60%-carbohydrate meals, an effect that was independent of pre-meal exercise.

Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus.

The interventional weight loss program based on a VLCK diet is most effective in reducing body weight and improvement of glycemic control than a standard hypocaloric diet with safety and good tolerance for T2DM patients

A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control.

Our study demonstrated that 6-month 130 g/day LCD reduced HbA1c and BMI in poorly controlled Japanese patients with T2DM. LCD is a potentially useful nutrition therapy for Japanese patients who cannot adhere to CRD

Low-carbohydrate diet combined with SGLT2 inhibitor for refractory hyperglycemia caused by insulin antibodies.

A low-carbohydrate diet is effective to improve hyperglycemia via insulin-independent actions. We report here that a low-carbohydrate diet combined with an SGLT2 inhibitor was effective and safe to treat refractory hyperglycemia in the perioperative period in a type 2 diabetes patient complicated with a high titer of insulin antibodies.

Concurrent Therapy with a Low-carbohydrate Diet and Miglitol Remarkably Improved the Postprandial Blood Glucose and Insulin Levels in a Patient with Reactive Hypoglycemia due to Late Dumping Syndrome.

herein describe a case in which concurrent therapy with a low-carbohydrate diet using low-glycemic-index food and an alpha-glucosidase inhibitor, miglitol, very effectively ameliorated the postprandial fluctuations in the blood glucose and plasma insulin levels in a patient with reactive hypoglycemia due to late dumping syndrome following total gastrectomy.

A randomised trial of the feasibility of a low carbohydrate diet vs standard carbohydrate counting in adults with type 1 diabetes taking body weight into account.

A low carbohydrate diet is a feasible option for people with type 1 diabetes, and may be of benefit in reducing insulin doses and improving glycaemic control, particularly for those wishing to lose weight.

Low carbohydrate and ketogenic diets in type 2 diabetes.

The 6-month data from a 2-year low-carbohydrate weight-loss study in type 2 diabetes has shown favourable effects on HbA1c and medication use. Similar benefits of a low-carbohydrate weight loss diet in type 2 diabetes were seen in a smaller cohort in which weight loss was the same in both the low carbohydrate and high carbohydrate group but HbA1c was lower by 0.8% in the low carbohydrate diet. A more than 50% reduction in medication occurred in 70% of the low carbohydrate group versus 30% of the high carbohydrate group.

Long-term effects of weight loss with a very-low carbohydrate, low saturated fat diet on flow mediated dilatation in patients with type 2 diabetes: A randomised controlled trial.

(In patients with obesity and T2DM, HighCHO diet and LowCHO diet have similar effects on endothelial function)

Very low-carbohydrate diets in the management of diabetes revisited.

Randomised clinical trials have confirmed that this action based on first principles is effective. The continued recommendation of higher-carbohydrate, fat-restricted diets has been criticised by some scientists, practitioners and patients. Such protocols when compared with very low-carbohydrate diets provide inferior glycaemic control, and their introduction and subsequent increase in carbohydrate allowances has never been based on strong evidence. The trend towards highercarbohydrate diets for people with diabetes may have played a part in the modern characterisation of type 2 diabetes as a chronic condition with a progressive requirement for multiple medications. Here we will introduce some of the evidence for very low-carbohydrate diets in diabetes management and discuss some of the common objections to their use.

Long-term effects of very low-carbohydrate and high-carbohydrate weight-loss diets on psychological health in obese adults with type 2 diabetes: randomized controlled trial.

In obese adults with T2DM, both diets achieved substantial weight loss and comparable improvements in QoL, mood state and affect. These results suggest that either an LC or HC diet within a lifestyle modification programme that includes exercise training improves psychological well-being.) Moreover, other data from the present trial that were previously reported demonstrated that improvements in glycaemic control and metabolic risk factors were greater with the LC diet than with the HC diet [3]. This was evident by a threefold greater reduction in diabetes-related medication requirements and improved diurnal blood glucose stability combined with more favourable changes in the blood lipid profile with the LC diet compared to the HC diet.

Long-Term Effects of a Very Low Carbohydrate Compared With a High Carbohydrate Diet on Renal Function in Individuals With Type 2 Diabetes: A Randomized Trial.

Compared with a traditional HC weight loss diet, consumption of an LC high protein diet does not adversely affect clinical markers of renal function in obese adults with T2DM and no preexisting kidney disease. This raises the clinical relevance of LC diets as a tenable weight management strategy for individuals with T2DM and comorbidities like hypertension and dyslipidemia, to improve glycemic control and reduce CVD and diabetes complications risk.2

The Effects of a Low-Carbohydrate Diet vs. a Low-Fat Diet on Novel Cardiovascular Risk Factors: A Randomized Controlled Trial.

In conclusion, despite the differences in weight changes on diets, a low-carbohydrate diet resulted in similar or greater improvement in inflammation, adipocyte dysfunction, and endothelial dysfunction than a standard low-fat diet among obese persons.

Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial.

Both diets achieved substantial weight loss and reduced HbA1c and fasting glucose. The LC diet, which was high in unsaturated fat and low in saturated fat, achieved greater improvements in the lipid profile, blood glucose stability, and reductions in diabetes medication requirements, suggesting an effective strategy for the optimization of T2D management.

Low-carbohydrate diet and type 2 diabetes risk in Japanese men and women: the Japan Public Health Center-Based Prospective Study.

Low-carbohydrate diet was associated with decreased risk of type 2 diabetes in Japanese women and this association may be partly attributable to high intake of white rice

Association of decrease in carbohydrate intake with reduction in abdominal fat during 3-month moderate low-carbohydrate diet among non-obese Japanese patients with type 2 diabetes.

The effectiveness of a moderate low-carbohydrate diet (M-LCD) has been demonstrated in terms of glycemic control, body weight and serum lipid profiles. We investigated the effect of a 3-month M-LCD on visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and examined an association between decrease in carbohydrate intake and reduction in abdominal fat among patients with Type 2 diabetes mellitus (T2DM). In men, decrease in carbohydrate intake was significantly correlated with VAT loss during a 3-month M-LCD, independently of reduction in energy intake.

Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes.

A low GI diet was associated with less frequent insulin use and lower birth weight than control diets, suggesting that it is the most appropriate dietary intervention to be prescribed to patients with GDM.

For newly diagnosed type 2 diabetes, a low-carbohydrate Mediterranean diet may delay need for medication and improve chance of remission compared to a low-fat diet.

A Low Carbohydrate Mediterranean diet resulted in fewer diabetes medications than a low-fat diet for up to 8 years, which could reduce healthcare costs

Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus.

Weight-changes did not differ between the diet groups while improvements in HRQoL only occurred after one year during treatment with LCD. No changes of HRQoL occurred in the LFD group in spite of a similar reduction in body weight.

Effects of low-carbohydrate and low-fat diets: a randomized trial.

The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet. Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors.

A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial.

Both diets achieved substantial improvements for several clinical glycemic control and CVD risk markers. These improvements and reductions in GV and antiglycemic medication requirements were greatest with the LC compared with HC. This suggests an LC diet with low saturated fat may be an effective dietary approach for T2DM management if effects are sustained beyond 24 weeks.

Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet.

To conclude, advice to follow LCD or LFD had similar effects on weight reduction while effects on inflammation differed. Only LCD was found significantly to improve the subclinical inflammatory state in type 2 diabetes.

The effects of a Mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial.

In patients with newly diagnosed type 2 diabetes, an LCMD resulted in a greater reduction of HbA1c levels, higher rate of diabetes remission, and delayed need for diabetes medication compared with a low-fat diet.

A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes.

Our results suggest that a very low carbohydrate diet coupled with skills to promote behavior change may improve glycemic control in type 2 diabetes while allowing decreases in diabetes medications

A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes.

Our findings suggest that a low-carbohydrate diet is effective in lowering the HbA1c and triglyceride levels in patients with type 2 diabetes who are unable to adhere to a calorie-restricted diet.

A randomized cross-over trial of the postprandial effects of three different diets in patients with type 2 diabetes.

The low-carbohydrate diet induced lower insulin and glucose excursions compared with the low-fat diet (p<0.0005 for both AUC)

Low-carbohydrate and high-fat intake can manage obesity and associated conditions: occasional survey.

These data show that significant and rapid weight loss is possible on an unsupervised eating plan that severely restricts daily carbohydrate intake to approximately &lt;75 g/day. Better weight loss on a carbohydrate-restricted LCHF eating plan than on an iso-caloric high-carbohydrate, low-fat (HCLF) diet is well described in the literature, probably due to a paradoxical reduction of hunger by carbohydrate restriction. A randomised controlled clinical trial is urgently required to disprove the hypothesis that the LCHF eating plan can reverse cases of T2DM, metabolic syndrome and hypertension without pharmacotherapy

Improvements in glucose metabolism and insulin sensitivity with a low-carbohydrate diet in obese patients with type 2 diabetes.

A low-carbohydrate diet was well tolerated and achieved weight loss over 24 weeks in subjects with diabetes. Glycemic control improved with a reduction in requirements for hypoglycemic agents.

Effects of low-carbohydrate/high-monounsaturated fatty acid liquid diets on diurnal glucose variability and insulin dose in type 2 diabetes patients on tube feeding who require insulin therapy.

Study results demonstrated that the LC/HMD not only narrowed the range of glucose variability, but also decreased the required insulin dose and HbA1c values in diabetes patients on tube feeding who required insulin therapy, suggesting the LC/HMD may be useful in long-term glycemic control in these patients

Short-term changes after a weight reduction intervention in advanced diabetic nephropathy.

After a short-term intensive weight reduction intervention (12-week very low calorie ketogenic weight reduction diet) in patients with advanced diabetic nephropathy, improvements were observed in markers of glomerular filtration, diabetes status, and risk factors for kidney disease progression, as well as other general indicators of health and well-being.

Two diets with different haemoglobin A1c and antiglycaemic medication effects despite similar weight loss in type 2 diabetes.

Lowering dietary carbohydrate intake demonstrated benefits on glycaemic control beyond its weight loss effects, while at the same time lowering antiglycaemic medication requirements

Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial.

A low-carbohydrate diet is as safe as Mediterranean or low-fat diets in preserving/improving renal function among moderately obese participants with or without type 2 diabetes, with baseline serum creatinine <176 μmol/L. Potential improvement is likely to be mediated by weight loss-induced improvements in insulin sensitivity and blood pressure.

Treatment of diabetes and diabetic complications with a ketogenic diet.

Accumulating evidence suggests that low-carbohydrate, high-fat diets are safe and effective to reduce glycemia in diabetic patients without producing significant cardiovascular risks. Most of these studies have been carried out specifically restricting carbohydrates, which tends to lead to increased protein intake, thus reducing the ketosis. However, diets that limit protein as well as carbohydrates, entailing a composition very high in fat, appear even more effective to reduce glucose and whole-body glucose metabolism in humans

Worldwide dietary therapies for adults with epilepsy and other disorders.

During the 3rd International Symposium on Dietary Therapies held in Chicago, Illinois, there was a first-ever, half-day session devoted to the management of adults with epilepsy and other disorders with dietary treatments. Speakers from 3 different continents shared their successes, challenges, and future directions in their management of these patients. Diets used to treat adults included the classic ketogenic diet, the modified Atkins diet, and a low glycemic index treatment. The utility of dietary therapies was demonstrated not only in patients with epilepsy but also patients with propriospinal myoclonus, astrocytoma, type 2 diabetes, obesity, hyperlipidemia, and metabolic disorder. The session provided evidence that dietary therapies are safe and effective in adults

Effects of different proportion of carbohydrate in breakfast on postprandial glucose excursion in normal glucose tolerance and impaired glucose regulation subjects.

The aim of the study was to compare the effects of different proportions of carbohydrate in breakfast on postprandial blood glucose fluctuations in impaired glucose regulation (IGR) and normal glucose tolerance (NGT) subjects. The postprandial fluctuations of glucose increased gradually with increased proportions of carbohydrate in breakfast in both IGR and NGT subjects. The proportion of carbohydrate in breakfast contributes to glucose excursions in the NGT and IGR subjects. In the IGR subjects, a HC meal should be avoided and a LC meal should be recommended to prevent development of diabetes

Low-carbohydrate diet for the treatment of gestational diabetes mellitus: a randomized controlled trial.

Treatment of women with GDM using a low-CHO diet did not reduce the number of women needing insulin and produced similar pregnancy outcomes. In GDM, CHO amount (40 vs. 55% of calories) did not influence insulin need or pregnancy outcomes

Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes.

The LCD and LCKD had beneficial effects on all the parameters examined. Interestingly, these changes were more significant in subjects who were on the LCKD as compared with those on the LCD. Changes in the level of creatinine were not statistically significant. CONCLUSION: This study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects. The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels

In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss.

Weight changes did not differ between the diet groups, while insulin doses were reduced significantly more with the LCD at 6 months, when compliance was good. Thus, aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk compared with the traditional LFD and this approach could constitute a treatment alternative.

The effect of a low-carbohydrate/high-monounsaturated fatty acid liquid diet and an isoleucine-containing liquid diet on 24-h glycemic variability in diabetes patients on tube feeding: a comparison by continuous glucose monitoring.

LCD and ICD led to significant decreases in mean glucose levels, compared with HCD. However, of the diets compared, LCD had the greatest effect on glycemic variability in these patients on tube feeding

Diabetes-specific quality of life after a low-carbohydrate and low-fat dietary intervention.

Participants with diabetes have various options for weight loss. Dietary interventions with either low-carbohydrate or low-fat diets may lead to some improvements in QOL in patients with type 2 diabetes

The influence of dietary carbohydrate content on glycaemia in patients with glucokinase maturity-onset diabetes of the young.

This short-term observational study suggested that diets with a modestly limited carbohydrate content may improve glycaemic control in patients with GCK MODY

Successful treatment of type 1 diabetes and seizures with combined ketogenic diet and insulin.

We report the case of a 2-year-old girl who presented to the emergency department with 1-week history of decreased activity, polyuria, and decreased oral intake. Her past medical history was remarkable for epilepsy, for which she was started on the KD with a significant improvement. Under this combined therapy, the patient remained seizure-free with no new episodes of DKA.

Differential effects of low-carbohydrate and low-fat diets on inflammation and endothelial function in diabetes.

Low-carbohydrate and low-fat diets both have beneficial effects on CVD markers. There may be different mechanisms through which weight loss with these diets potentially reduces CVD risk

The effect of the Spanish Ketogenic Mediterranean Diet on nonalcoholic fatty liver disease: a pilot study.

We conclude that the SKMD could be an effective and safe way to treat patients suffering from MS and the associated NAFLD

A pilot study of the Spanish Ketogenic Mediterranean Diet: an effective therapy for the metabolic syndrome.

We conclude that the SKMD could be an effective and safe way to cure patients suffering from metabolic syndrome

Reversal of diabetic nephropathy by a ketogenic diet.

These studies demonstrate that diabetic nephropathy can be reversed by a relatively simple dietary intervention. Whether reduced glucose metabolism mediates the protective effects of the ketogenic diet remains to be determined. (In mouse models)

https://pdfs.semanticscholar.org/09ed/a493a64e81bac6e8da2c0b09cca64cd30a43.pdf

The Early History of the High-fat Diet for Diabetes

Why were "starvation diets" promoted for diabetes in the pre-insulin period?

At the beginning of the 20th century, physicians had no useful weapon against diabetes except the ability to easily measure sugar in urine. These tests became widely used in insurance examinations, uncovering a far higher incidence of diabetes in the adult population than previously recognized. Once diagnosed, the usual medical advice was for obese patients to lose weight and for all diabetics to reduce dietary starch and sugar. 

High-protein low-carbohydrate diets: what is the rationale?

Dietary recommendations released by the large majority of international scientific committees and organizations suggest that the diet for the prevention and treatment of the most compelling health problems of our societies (obesity, diabetes, atherosclerosis, cardiovascular diseases and cancer) should be a diet moderately low in caloric content, low in fat content (particularly in saturated fat), poor in total cholesterol and rich in fibre. Despite this uniformity in official recommendations, alternative diets with low carbohydrate and high protein content continue to be extremely popular within consumers and patients. Recently, new studies seem to suggest that high-protein low-carbohydrate diets may have particularly positive effects on reducing body weight and other risk factors for heart disease. Gannon and Nuttall conducted direct comparisons of high-protein low-carbohydrate diets compared with high-carbohydrate low-protein diets in subjects with type 2 diabetes. They found that high-protein low-carbohydrate diets reduced fasting plasma glucose, 24-h glucose area under the curve and haemoglobin A(1c). On the basis of these results, a joint committee of the American Diabetes Association, North American Society for the Study of Obesity and the American Society for Clinical Nutrition suggested that a low-carbohydrate diet may be preferred to a low-fat diet for the induction of weight loss and glycaemic control in subjects with type 2 diabetes

The effect of high-protein, low-carbohydrate diets in the treatment of type 2 diabetes: a 12 month randomised controlled trial.

Although we found no effect of diet composition on HbA1c, we observed a a reduction in the requirement for hypoglycaemic medications in the HP group.

Dietary prescriptions for the overweight patient: the potential benefits of low-carbohydrate diets in insulin resistance.

While a variety of dietary approaches will result in weight and cardiac risk factor reduction, individuals who have been identified as insulin-resistant may derive additional short-term weight loss results from a low-carbohydrate diet compared to a low-fat diet.

In the face of contradictory evidence: report of the Dietary Guidelines for Americans Committee.

An objective assessment of evidence in the DGAC Report does not suggest a conclusive proscription against low-carbohydrate diets. The DGAC Report does not provide sufficient evidence to conclude that increases in whole grain and fiber and decreases in dietary saturated fat, salt, and animal protein will lead to positive health outcomes. Lack of supporting evidence limits the value of the proposed recommendations as guidance for consumers or as the basis for public health policy. It is time to reexamine how US dietary guidelines are created and ask whether the current process is still appropriate for our needs.

Impact of high-fat /low-carbohydrate, high-, low-glycaemic index or low-caloric meals on glucose regulation during aerobic exercise in Type 2 diabetes.

This study underlines the beneficial effect of low-GI foods and the differential impact of pre-exercise meal macronutrient composition on BG decrease. This may protect against exercise-induced hypoglycaemia, and reiterates the safety of exercising while fasting in T2DM patients.

Influence of fat and carbohydrate proportions on the metabolic profile in patients with type 2 diabetes: a meta-analysis.

Our findings suggested that replacing fat with carbohydrate could deteriorate insulin resistance while the adverse effect on triglycerides from the LFHC diet could be avoided by restricting energy intake to a degree sufficient for the attainment of weight reduction.

"Most people are simply not designed to eat pasta": evolutionary explanations for obesity in the low-carbohydrate diet movement.

GPs who advise patients on the benefits of a low carbohydrate diet to manage type 2 diabetes should be entitled to keep all or part of any resulting savings in their drugs bill, an independent forum of MPs and peers has heard. David Unwin, a GP in Southport and the Royal College of General Practitioners’ champion for collaborative care and support planning in obesity and diabetes, made the proposal on 28 March at the All Party Parliamentary Food and Health Forum.

Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial.

Successful weight loss can be achieved with either a low-fat or low-carbohydrate diet when coupled with behavioral treatment. A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at 2 years.

Type 1 diabetes and epilepsy: efficacy and safety of the ketogenic diet.

Glycosylated hemoglobin (HbA1c) levels improved, and glycemic control was excellent, without severe side effects. Our experience indicates that diabetes does not preclude the use of the KD.

A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study.

An intensive 12-month dietary intervention in a community-based setting was effective in improving most modifiable cardiovascular risk factors in all the dietary groups. Only the LCM improved HDL levels and was superior to both the ADA and TM in improving glycaemic control.

Carbohydrate for weight and metabolic control: where do we stand?

There is increasing evidence that changes in the macronutrient composition of the diet (decreasing carbohydrate and increasing unsaturated fats and/or protein) play a role that facilitates weight loss, increases insulin sensitivity and glucose tolerance, and improves cardiovascular risk factors, such as blood pressure, blood lipid profile, and inflammatory markers, often independent of weight loss. Low-carbohydrate diets, whether they be high in unsaturated fats and/or protein, are not recommended by the American Diabetes Association; however, despite this the Joslin Diabetes Center currently advocates a diet composition of approximately 40% carbohydrate, 30% fat, and 30% protein energy for overweight and obese adults with type 2 diabetes or prediabetes or those at high risk of developing type 2 diabetes

Dietary strategies for patients with type 2 diabetes in the era of multi-approaches; review and results from the Dietary Intervention Randomized Controlled Trial (DIRECT).

Patients who were randomized to the low-carbohydrate diet, which had the minimal intake of carbohydrates, achieved a significant reduction of hemoglobin A1C. Although improvements were observed in all groups, the low-fat diet was likely to be less beneficial in terms of glycemic control and lipid metabolism.

A randomized trial of a low-carbohydrate diet vs orlistat plus a low-fat diet for weight loss.

In a sample of medical outpatients, an LCKD led to similar improvements as O + LFD for weight, serum lipid, and glycemic parameters and was more effective for lowering blood pressure.

Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes.

Among patients with type 2 diabetes, after 1 year a low-carbohydrate diet had effects on weight and A1C similar to those seen with a low-fat diet. There was no significant effect on blood pressure, but the low-carbohydrate diet produced a greater increase in HDL cholesterol. Of the participants using insulin, the dose was reduced by a mean ± SD of 10 ± 14 units in the low-carbohydrate arm and increased by 4 ± 19 units in the low-fat arm at 12 months

A review of low and reduced carbohydrate diets and weight loss in type 2 diabetes.

Conclusions are limited by study design and small numbers, but it appears that reduced carbohydrate diets are safe and effective over the short term for people with type 2 diabetes.

[Low carbohydrate diet slowed down the progression of renal insufficiency in type 2 diabetes. A case--difficult to draw conclusions].

[Insulin-using woman with type 2 diabetes and weight problems].

(With a low carbohydrate diet and exercise this woman no longer has diabetes or severe overweight. It is our opinion that many patients with type 2 diabetes can manage without medication (especially insulin) by reducing the intake of carbohydrates considerably.)

A comparison of the effectiveness, tolerability and safety of high and low carbohydrate diets in women with gestational diabetes.

(Both high and low carbohydrate diets are effective and safe. A diet with carbohydrate limitation should be recommended to women who experience the highest glycaemia levels after breakfast)

A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects.

(Low-carbohydrate diets are effective for weight reduction in people without diabetes, but there is limited evidence for people with Type 2 diabetes. Analysis was by intention to treat with last observation carried forward. Twenty-two of the participants (85%) completed the study. Weight loss was greater (6.9 vs. 2.1 kg, P = 0.003) in the low-carbohydrate group. In conclusion, there is evidence to support the hypothesis that low-carbohydrate diets may confer greater benefit in terms of weight loss compared with healthy-eating advice, and are not dangerous in the short term for people with and without Type 2 diabetes

Low-carbohydrate nutrition and metabolism.

(The persistence of an epidemic of obesity and type 2 diabetes suggests that new nutritional strategies are needed if the epidemic is to be overcome. A promising nutritional approach suggested by this thematic review is carbohydrate restriction. Recent studies show that, under conditions of carbohydrate restriction, fuel sources shift from glucose and fatty acids to fatty acids and ketones, and that ad libitum-fed carbohydrate-restricted diets lead to appetite reduction, weight loss, and improvement in surrogate markers of cardiovascular disease)

Effects of dietary protein on glucose homeostasis.

(Recent intervention trials revealed that, in the short-term, the intake of proteins at the expense of carbohydrates increases satiety and thereby lowers intake of calories. High protein intake augments prandial insulin secretion and might thereby improve glycaemic control in type 2 diabetic patients)

Dietary treatment of diabetes mellitus in the pre-insulin era (1914-1922).

(Before the discovery of insulin, one of the most common dietary treatments of diabetes mellitus was a high-fat, low-carbohydrate diet. A review of Frederick M. Allen's case histories shows that a 70% fat, 8% carbohydrate diet could eliminate glycosuria among hospitalized patients. A reconsideration of the role of the high-fat, low-carbohydrate diet for the treatment of diabetes mellitus is in order.)

A low carbohydrate diet in type 1 diabetes: clinical experience--a brief report.

(The present report shows that a 70-90 g carbohydrate diet is a feasible long-term alternative in the treatment of type 1 diabetes and leads to improved glycaemic control.)

The metabolic response to a high-protein, low-carbohydrate diet in men with type 2 diabetesmellitus.

(We recently reported that in subjects with untreated type 2 diabetes mellitus, a 5-week diet of 20:30:50 carbohydrate-protein-fat ratio resulted in a dramatic decrease in 24-hour integrated glucose and total glycohemoglobin compared with a control diet of 55:15:30. The lack of negative effects, improved glucose control, and a positive nitrogen balance suggest beneficial effects for subjects with type 2 diabetes mellitus at risk for loss of lean body mass.)

Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes--a randomized controlled trial.

(Carbohydrate restriction was an effective method of achieving short-term weight loss compared with standard advice)

Cost-effectiveness of a low-carbohydrate diet and a standard diet in severe obesity.

(The low-carbohydrate diet was not more cost-effective for weight loss than the standard diet in the patient population studied)

Low carbohydrate diets, pro: time to rethink our current strategies.

(The successful experiences by many individuals who have limited their carbohydrate intake and mounting scientific studies supporting low- or controlled-carbohydrate diets' physiologic and metabolic action warrant a closer look at this dietary regimen as a potentially viable option to current conventional approaches. For individuals with high serum triglyceride and low high-density lipoprotein (HDL) levels, truncal obesity, or insulin resistance (metabolic syndrome or hyperinsulinemia), reducing carbohydrate intake has been shown to improve these parameters without adverse clinical effects. Studies are beginning to validate the benefit of controlling carbohydrate intake for individuals with type 2 diabetes. The controlled-carbohydrate regimen could be a viable alternative dietary approach for weight management used by clinicians managing patients who are failing with conventional approaches.)

Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomised controlled trial.

(This study indicates that in tube-fed insulin-treated type II diabetic patients, the new low-carbohydrate, high MUFA formula results in a more effective glycaemic control than the standard diet, while being comparable in safety.)

Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes. A brief report.

(A low-carbohydrate diet is an effective tool in the treatment of obese patients with type 2 diabetes.)

The cardiovascular continuum in Asia--a new paradigm for the metabolic syndrome.

(Recent studies suggest that low-carbohydrate diets are more effective than low fat diets in inducing weight loss, suggesting that excessive carbohydrate rather than fat is the cause of obesity. Strategies to combat cardiovascular disease should now focus on tackling the epidemic of obesity and developing innovative and effective lifestyle and pharmacological interventions.)

The effect of different nutritional feeds on the postprandial glucose response in healthy volunteers and patients with type II diabetes.

(Special feeds with a low CHO, high MUFA and high fibre content improve glycaemic balance and therefore should be considered in diabetic patients who are in need of nutritional support.)

The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial.

(Participants on a low-carbohydrate diet had more favorable overall outcomes at 1 year than did those on a conventional diet. Weight loss was similar between groups, but effects on atherogenic dyslipidemia and glycemic control were still more favorable with a low-carbohydrate diet after adjustment for differences in weight loss.)

Treatment of type 2 diabetes in childhood using a very-low-calorie diet.

The ketogenic VLCD is an effective short-term, and possibly long-term, therapy for pediatric patients with type 2 diabetes. Blood glucose control and BMI improve, allowing the discontinuation of exogenous insulin and other antidiabetic agents. This diet, although strict, has potential as an alternative to pharmacologic therapies for this emerging subset of diabetic individuals.

Utility of a short-term 25% carbohydrate diet on improving glycemic control in type 2 diabetesmellitus.

Subjects with type 2 diabetes, either treated with diet alone (n=9) or second generation sulfonylurea agents (n= 19), which were discontinued, were placed on a diet based on ideal body weight and comprised of 25% carbohydrate. After a mean of 8 weeks, they were then switched to a caloricly equivalent diet, but composed of 55% carbohydrate. Compared to baseline diet, after 8 weeks of a 25% diet, subjects showed significantly improved glycemia as evidenced by fasting blood glucose values (p<0.005) and hemoglobin A1c levels (p<0.05). Those previously treated with oral hypoglycemic agents showed, in addition, a significant decrease in weight and diastolic blood pressure despite the discontinuation of the oral agent. When then placed on a 55% carbohydrate diet, the hemoglobin A1c rose significantly over the ensuing next 12 weeks (p<0.05). CONCLUSION: A low carbohydrate, caloricly-restricted diet has beneficial short-term effects in subjects with type 2 who have failed either diet or sulfonylurea therapy and may obviate the necessity for insulin. Our study also affirms the need for reassessing the role of diet whenever type 2 diabetic patients manifests hyperglycemia, despite conventional oral treatment or diet management.

High-fat versus high-carbohydrate enteral formulae: effect on blood glucose, C-peptide, and ketones in patients with type 2 diabetes treated with insulin or sulfonylurea.

We conclude that the partial replacement of complex digestible carbohydrates with monounsaturated fatty acids in the enteral formulae for supplementation of oral diet may improve glycemic control in patients with type 2 diabetes

The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes.

Carbohydrate restriction in patients with diet-controlled GDM results in improved glycemic control, less need for insulin therapy, a decrease in the incidence LGA infants, and a decrease in cesarean deliveries for cephalopelvic disproportion and macrosomia.

Effects of diet composition and ketosis on glycemia during very-low-energy-diet therapy in obese patients with non-insulin-dependent diabetes mellitus.

These data indicate that in obese patients with NIDDM, high-ketogenic VLEDs have a more clinically favorable effect on glycemia than do low-ketogenic VLEDs.

Lack of glucose elevation after simulated tube feeding with a low-carbohydrate, high-fat enteral formula in patients with type I diabetes.

A low-carbohydrate, fiber-containing enteral feeding formula can limit hyperglycemia in patients with type I diabetes.