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LOW CARB DIETS AND DIABETES

This section outlines some of the key research findings regarding the effect of low carb diets and various insulin and diabetes-related health parameters.

 

Low carb diets vary in their definitions and approaches. Some of them are high protein and some are high fat. Noakes and Windt (2016) offering the following definitions:

Low carb diets: less than 26% of total energy intake from carbohydrates / less than 130g of carbohydrates a day.

Very low carb diets: Less than 10% of total energy intake from carbohydrates / 20-50g of carbohydrates a day.

 

RESEARCH FINDINGS:

Low carb diets have been associated with a number of improved diabetes-related health markers including:  

a. Improved glycaemic control

b. Improved insulin sensitivity

c. Reduced blood glucose levels

d. Reduced insulin levels

e. Reduced glycated haemoglobin levels

f. Reduced need for diabetic medication

 

PRACTICAL IMPLICATION: Low carb diets may be an effective treatment for type 2 diabetes.

 

HOWEVER,

All this data should be viewed in light of the data surrounding the various higher carb approaches that have also been associated with improvements in diabetes-related health, including:

The DASH diet

The Mediterranean Diet

The Ornish lifestyle intervention

Plant-based diets

 

Additionally, since a low carb diet is by definition either relatively high in protein and/or dietary fat, it should also be viewed in light of the data surrounding dietary proteins and fats. 

 

 

RESEARCH LIBRARY

a. Low carb diets have been associated with improved glycaemic control

  • Gannon MC, Nuttall FQ. Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition. Nutr Metab (Lond) 2006;3:16. 

  • Guldbrand H, Dizdar B, Bunjaku B, et al. 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. Diabetologia 2012;55:2118–27. 

  • Al-khalifa A, Mathew T, Al-Zaid, Mathew E, Dashti HM, et al. (2009) Therapeutic role of low-carbohydrate ketogenic diet in diabetes. Nutrition 25: 1177-1185.

  • Tay J, Luscombe-Marsh ND, Thompson CH, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr 2015;102:780–90.

  • Boden G, Sargrad K, Homkko C, et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med 2005; 142: 403–411. 

  • Samaha FF, Iqbal N, Seshadri P, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 2003;348:2074-81.

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b. Low carb diets have been associated with improved insulin sensitivity

  • Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med 2005; 142: 403–411.

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c. Low carb diets have been associated with reduced blood glucose levels

  • Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med 2005; 142: 403–411. 

  • Dashti HM, Al-Zaid NS, Mathew TC, Al-Mousawi M, Talib H, Asfar SK et al. Long term effects of ketogenic diet in obese subjects with high cholesterol level. Mol Cell Biochem 2006; 286: 1–9. 

  • Gannon MC, Nuttall FQ: Effect of a high protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes 2004; 53: 2375–2382. 

  • MA Kirk JK, Graves DE, Craven TE, et al.: Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis.J Am Diet Assoc 2008, 108:91–100. 

  • Nielsen JV, Jönsson E, Nilsson AK. Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes--a brief report. Ups J Med Sci. 2005;110(1):69-73.

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d. Low carb diets have been associated with reduced insulin levels

  • Gannon MC, Nuttall FQ: Effect of a high protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes 2004; 53: 2375–2382.

 

e. Low carb diets have been associated with reduced glycated haemoglobin levels

  • Feinman R, Bernstein R, Westman E, Pogozelski WK, Astrup A, et al. (2015) Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition 31: 1-13. 

  • Daly ME, Paisey R, Paisey R, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes—a randomized controlled trial. Diabet Med 2006;23:15–20. 

  • Westman EC, Yancy WS Jr, Mavropoulos JC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond) 2008;5:36. 

  • Snorgaard O, Poulsen GM, Andersen HK, et al. Systematic review and meta-analysis of dietary carbohydrate restrictionin patients with type 2 diabetes. BMJ Open Diabetes Research and Care 2017;5: e000354. doi:10.1136/ bmjdrc-2016-000354 

  • Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med 2005; 142: 403–411. 

  • Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003 Oct;78(4):734-41. 

  • Gannon MC, Nuttall FQ: Effect of a high protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes 2004; 53: 2375–2382. 

  • Kirk JK, Graves DE, Craven TE, et al.: Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis.J Am Diet Assoc 2008, 108:91–100. 

  • Westman EC, Yancy WS Jr, Mavropoulos JC, et al.: The effect of a low-carbohydrate, ketogenic diet versus a low glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond) 2008, 5:36. 

  • Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008;359:229-41. (compared to higher carb intakes)

  • Yancy WS Jr, Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005 Dec 1;2:34.

 

f. Low carb diets have been associated with a reduced need for diabetic medication

  • Daly ME, Paisey R, Paisey R, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes—a randomized controlled trial. Diabet Med 2006;23:15–20. 

  • Westman EC, Yancy WS Jr, Mavropoulos JC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond) 2008;5:36. 

  • Tay J, Luscombe-Marsh ND, Thompson CH, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr 2015;102:780–90.

 

 

FULL REVIEWS

  • Westman et al (2003) A review of low-carbohydrate ketogenic diets. Curr Atheroscler Rep. Nov;5(6):476-83.

  • Noakes TD, Windt J. Br J Sports Med 2016;51:133–139. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review

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