Diabetes

A clinician’s guide to inpatient low carbohydrate diets for remission of type 2 diabetes : toward a standard of care protocol

Mark Cucuzzella, Adele Hite, Kaitlyn Patterson, Laura Saslow, Rory Heath

Type 2 diabetes (T2DM) is most often treated as a chronic progressive condition. However, both clinical experience and scientific studies have shown that remission indicated by a normalizing of blood glucose levels and safe medication reduction through lifestyle change should be considered an achievable clinical outcome for patients with T2DM. Dietary interventions that include therapeutic levels of carbohydrate reduction can be used by clinicians to help patients reach this goal, as evidenced by clinical experience and clinical trials; however, many clinicians and allied healthcare providers have not been trained in how to administer these therapies.

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Type 1 diabetes mellitus successfully managed with the paleolithic ketogenic diet

Csaba Tóth, Zsófia Clemens

Diabetic patients are, generally, recommended to follow a diet that is low in fat and high in carbohydrates.  Clinical studies, conversely, showed metabolic benefits conferred by carbohydrate-restricted diets including the ketogenic diet and the paleolithic diet in type 2 diabetes.  Much less data on the use of low carbohydrate diets in type 1 diabetes (T1DM) are available.  Two studies by Nielsen et al. showed that a low carbohydrate diet lowers the need for insulin as well as the number of hypoglycemic episodes in T1DM .  It was also suggested that a low carbohydrate diet is sustainable on the long-term

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A Low-carbohydrate, Ketogenic Diet to Treat Type 2 Diabetes

William S YancyJr; Marjorie Foy; Allison M Chalecki; Mary C Vernon; Eric C Westman

Single arm with 28 participants:  In a study of overweight individuals with type 2 diabetes, the LCKD (low carbohydrate ketogenic diet) improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Other results include: mean body weight decreased by 6.6% and fasting serum triglyceride decreased 42%.

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Comparison of High-Fat and High-Protein Diets With a High- Carbohydrate Diet in Insulin-Resistant Obese Women

K. A. McAuley; C. M. HopkinsK; J. Smith; R. T. McLay; S. M. Williams; R. W. Taylor; J. I. Mann

RCT with 96 participants:  In routine practice a reduced-carbohydrate, higher protein diet may be the most appropriate overall approach to reducing the risk of cardiovascular disease and type 2 diabetes. To achieve similar benefits on a HC diet, it may be necessary to increase fibre-rich wholegrains, legumes, vegetables and fruits, and to reduce saturated fatty acids to a greater extent than appears to be achieved by implementing current guidelines.

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Effect of a Low- Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes

Guenther Boden, MD; Karin Sargrad, MS, RD, CDE; Carol Homko, PhD, RN, CDE; Maria Mozzoli, BS; T. Peter Stein, PhD

Single arm – meabolic ward with 10 participants:  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.

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Short-Term Effects of Severe Dietary Carbohydrate-Restriction Advice in Type 2 Diabetes – a Randomized Controlled Trial

M. E. Daly; R. Paisey; B. A. Millward; C. Eccles; K. Williams; S. Hammersley; K. M. MacLeod; T. J. Gale

RCT with 102 participants:  Weight loss and high-density lipoprotein (HDL) ratio improved was greater in the low-carbohydrate (LC) group over low fat group. Carbohydrate restriction was an effective method of achieving short-term weight loss compared with standard advice.

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The Effect of a Lowcarbohydrate, Ketogenic Diet Versus a Lowglycemic Index Diet on Glycemic Control in Type 2 Diabetes Mellitus

Eric C Westman; William S Yancy Jr; John C Mavropoulos; Megan Marquart; Jennifer R McDuffie

RCT with 84 participants:  Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes. The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.

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Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet

Jeff S. Volek; Stephen D. Phinney; Cassandra E. Forsythe; Erin E. Quann; Richard J. Wood; Michael J. Puglisi; William J. Kraemer; Doug M. Bibus; Maria Luz Fernandez; Richard D. Feinman

RCT with 40 participants:  Both interventions led to improvements in several metabolic markers, but subjects following the CRD had consistently reduced glucose (-12%) and insulin (-50%) concentrations, insulin sensitivity (-55%), weight loss (-10%), decreased adiposity (-14%), and more favorable triacylglycerol (TAG) (-51%), HDL-C (13%) and total cholesterol/HDL-C ratio (-14%) responses. In addition to these markers for MetS, the CRD subjects showed more favorable responses to alternative indicators of cardiovascular risk: postprandial lipemia (-47%), the Apo B/Apo A-1 ratio (-16%), and LDL particle distribution. The results support the use of dietary carbohydrate restriction as an effective approach to improve features of MetS and cardiovascular risk.

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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

Nichola J. Davis, MD, MS; Nora Tomuta, MD; Clyde Schechter, MD; Carmen R. Isasi, MD, PHD; C.J. Segal-Isaacson, EDD, RD; Daniel Stein, MD; Joel Zonszein, MD; Judith Wylie-Rosett, EDD, RD

RCT with 105 participants:  Among patients with type 2 diabetes, after 1 year a lowcarbohydrate 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. Weight loss occurred faster in the low-carbohydrate group than in the low-fat group in the first 3 months.

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Effects of a Low-intensity Intervention That Prescribed a Low Carbohydrate vs. a Low Fat Diet in Obese, Diabetic Participants

Nayyar Iqbal; Marion L. Vetter; Reneé H. Moore; Jesse L. Chittams; Cornelia V. Dalton‐Bakes; Monique Dowd; Catherine Williams‐Smith; Serena Cardillo; Thomas A. Wadden

RCT with 104 Participants:  At this time, participants in the low-carbohydrate group lost 1.5 kg, compared to 0.2 kg in the low-fat group (P = 0.147). Lipids, glycemic indexes, and dietary intake did not differ between groups at month 24 (or at months 6 or 12).

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

Talib A. Hussain, M.B., Ch.B., R.C.G.P.; Thazhumpal C. Mathew, M.Sc., Ph.D., F.R.C.Path.; Ali A. Dashti, M.Sc., Ph.D.; Sami Asfar, M.B., Ch.B., M.D., F.R.C.S., F.A.C.S.; Naji Al-Zaid, B.Sc., Ph.D.; Hussein M. Dashti, M.D., Ph.D., F.I.C.S., F.A.C.S.

Non-randomized 2 arm prospective with 363 participants:  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.

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A Very Low Carbohydrate, Low Saturated Fat Diet for Type 2 Diabetes Management: A Randomized Trial

Jeannie Tay, Natalie D. Luscombe-Marsh, Campbell H. Thompson, Manny Noakes, Jon D. Buckley, Gary A. Wittert, William S. Yancy Jr., Grant D. Brinkworth

RCT with 93 participants.  Both diets achieved substantial improvements for several clinical glycemic control and CVD risk markers.  These improvements and reductions in GV and anti-glycemic 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.   (It should be noted that a Low-Carb/ High[er]-Saturated-Fat diet was not included in the trial).

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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

Laura R. Saslow, Sarah Kim, Jennifer J. Daubenmier, Judith T. Moskowitz, Stephen D. Phinney, Veronica Goldman, Elizabeth J. Murphy, Rachel M. Cox, Patricia Moran, Fredrick M. Hecht

RCT with 34 participants.  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.

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

Laura R. Saslow, Jennifer J. Daubenmier, Judith T. Moskowitz, Sarah Kim, Elizabeth J. Murphy, Stephen D. Phinney, Robert Ploutz-Snyder, Veronica Goldman, Rachel M. Cox, Ashley E. Mason, Patricia Moran & Frederick M. Hecht

RCT with 34 particpants.  The results suggest that adults with prediabetes or noninsulin-dependent type 2 diabetes may be able to improve glycemic control with less medication by following an ad libitum very low-carbohydrate ketogenic diet compared to a moderate-carbohydrate, calorie-restricted low-fat diet. Additional research should examine both clinical outcomes and adherence beyond 12 months.

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A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes

Amy L McKenzie, PhD ; Sarah J Hallberg, DO, MS ; Brent C Creighton, PhD ; Brittanie M Volk, RD, PhD ; Theresa M Link, RD, CDE ; Marcy K Abner, RD ; Roberta M Glon, RN, BSN ; James P McCarter, MD, PhD ; Jeff S Volek, RD, PhD ; Stephen D Phinney, MD, PhD

This study, non-randomized parallel arm prospective with 262 participants, demonstrates an individualized program delivered and supported remotely that incorporates nutritional ketosis can be highly effective in improving glycemic control and weight loss in adults with T2D while significantly decreasing medication use.

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Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet

Belinda S. Lennerz, Anna Barton, Richard K. Bernstein, R. David Dikeman, Carrie Diulus, Sarah Hallberg, Erinn T. Rhodes, Cara B. Ebbeling, Eric C. Westman, William S. Yancy Jr, David S. Ludwig

To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low–carbohydrate diet (VLCD).

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Treatment of diabetes and diabetic complications with a ketogenic diet

Mobbs CV, Mastaitis J, Isoda F, Poplawski M

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.

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