CVD / Heart Health

Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-year Non-randomized Clinical Trial

Shaminie J. Athinarayanan, Rebecca N. Adams, Sarah J. Hallberg, Amy L. McKenzie, Nasir H. Bhanpuri, Wayne W. Campbell, Jeff S. Volek, Stephen D. Phinney, James P. McCarter

An open label, non-randomized, controlled study with 262 and 87 participants with T2D were enrolled in the CCI and usual care (UC) groups, respectively.  Studies on long-term sustainability of low-carbohydrate approaches to treat diabetes are limited. The aim was to assess the effects of a continuous care intervention (CCI) on retention, glycemic control, weight, body composition, cardiovascular, liver, kidney, thyroid, inflammatory markers, diabetes medication usage and disease outcomes at 2 years in adults with type 2 diabetes (T2D).

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LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature

Michel de Lorgeril, David M Diamond, Rokuro Hama, Tomohito Hamazaki, Björn Hammarskjöld, Niamh Hynes, Malcolm Kendrick, Peter H Langsjoen, Luca Mascitelli, Kilmer S McCully, Harumi Okuyama ORCID Icon, Paul J Rosch, Tore Schersten, Sherif Sultan & Ralf Sundberg

For half a century, a high level of total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated and that statin treatment, in particular when used as primary prevention, is of doubtful benefit.

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Fasting Lipoprotein and Postprandial Triacylglycerol Responses to a Lowcarbohydrate Diet Supplemented With n-3 Fatty Acids

Jeff S. Volek, PhD, RD; Ana L. Gómez , MS; William J. Kraemer , PhD

Single arm prospective with 10 Participants:  A hypocaloric low-carbohydrate diet rich in MUFA and supplemented with n-3 fatty acids significantly reduced postabsorptive and postprandial TG in men that were not hypertriglyceridemic as a group before the diet.  This may be viewed as a clinically significant positive adaptation in terms of cardiovascular risk status.

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A Randomized Trial of a Low-Carbohydrate Diet for Obesity

Gary D. Foster, PhD; Holly R. Wyatt, MD; James O. Hill, PhD; Brian G. McGuckin, EdM; Carrie Brill, BS; B. Selma Mohammed, MD, PhD; Philippe O. Szapary, MD; Daniel J. Rader, MD; Joel S. Edman, DSc; Samuel Klein, MD

RCT with 63 participants:  The low-carbohydrate diet produced a greater weight loss (4%) than did the conventional diet for the first six months, but the differences were not significant at one year.  The lowcarbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease.

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A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women

Bonnie J. Brehm; Randy J. Seeley; Stephen R. Daniels; David A. D’Alessio

RCT with 53 participants:  Based on these data, a very low carbohydrate diet is more effective than a low fat diet for short-term weight loss and, over 6 months, is not associated with deleterious effects on important cardiovascular risk factors in healthy women.

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Long Term Effects of a Ketogenic Diet in Obese Patients

Hussein M Dashti, MD PhD FICS FACS; Thazhumpal C Mathew, MSc PhD FRCPath; Talib Hussein, MB ChB; Sami K Asfar, MB ChB MD FRCSEd FACS; Abdulla Behbahani, MB ChB FRCS FACSI PhD FICS FACS; Mousa A Khoursheed, MB ChB FRCS FICS; Hilal M Al-Sayer, MD PhD FICS FACS; Yousef Y Bo-Abbas, MD FRCPC; Naji S Al-Zaid, BSc PhD

Single arm prospective with 83 participants:  The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients.  Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol.  Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated.

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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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Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction

Michael L. Dansinger, MD; Joi Augustin Gleason, MS, RD; John L. Griffith, PhD; Harry P. Selker, MD, MSPH; Ernst J. Schaefer, MD

RCT with 160 participants:  Each popular diet modestly reduced body weight and several cardiac risk factors at 1 year. Overall dietary adherence rates were low, although increased adherence was associated with greater weight loss and cardiac risk factor reductions for each diet group.

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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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Weight Loss with a Low- Carbohydrate, Mediterranean, or Low- Fat Diet

Iris Shai, RD, PhD; Dan Schwarzfuchs, MD; Yaakov Henkin, MD; Danit R. Shahar, RD, PhD; Shula Witkow, RD, MPH; Ilana Greenberg, RD, MPH; Rachel Golan, RD, MPH; Drora Fraser, PhD; Arkady Bolotin, PhD; Hilel Vardi, MSc; Osnat Tangi-Rozental, BA; Rachel Zuk-Ramot, RN; Benjamin Sarusi, MSc; Dov Brickner, MD; Ziva Schwartz, MD; Einat Sheiner, MD; Rachel Marko, MSc; Esther Katorza, MSc; Joachim Thiery, MD; Georg Martin Fiedler, MD; Matthias Blüher, MD; Michael Stumvoll, MD; Meir J. Stampfer, MD; Dr.PH

RCT – 3 arm with 322 participants:  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.

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Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 months

Grant D Brinkworth; Manny Noakes; Jonathan D Buckley; Jennifer B Keogh; Peter M Clifton

RCT with 69 participants:  Low Carb group (over a isocaloric low fat diet) had greater decreases in triglycerides, increases in HDL cholesterol, and LDL cholesterol, and a greater but nonsignificant increase in apolipoprotein B. Both dietary patterns resulted in similar weight loss and changes in body composition. The LC diet may offer clinical benefits to obese persons with insulin resistance.

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

William S. Yancy Jr, MD, MHS; Eric C. Westman, MD, MHS; Jennifer R. McDuffie, PhD, RD, MPH; Steven C. Grambow, PhD; Amy S. Jeffreys, MStat; Jamiyla Bolton, MS; Allison Chalecki, RD; Eugene Z. Oddone, MD, MHS

RCT with 146 participants:  Obese and overweight outpatients were assigned to either a low-carbohydrate ketogenic diet (LCKD) or Orlistat therapy combined with a low fat diet (O + LFD). 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.

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Changes in Body Weight and Metabolic Indexes in Overweight Breast Cancer Survivors Enrolled in a Randomized Trial of Low-Fat vs. Reduced Carbohydrate Diets

Cynthia A. Thomson; Alison T. Stopeck; Jennifer W. Bea; Ellen Cussler; Emily Nardi; Georgette Frey; Patricia A. Thompson

RCT with 40 Participants:  A group of overweight female breast cancer survivors were assigned either a low-fat diet or Modified Atkins Diet. All subjects demonstrated improvements in total/HDL cholesterol ratio, and significant reductions inHbA1c, insulin, and HOMA. Triglycerides levels were significantly reduced only in the low-carbohydrate diet group. Significant improvements in weight and metabolic indexes can be demonstrated among overweight breast cancer survivors adherent to either the Modified Atkins Diet or fatrestricted diet.

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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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Effects of a moderate low-carbohydrate diet on preferential abdominal fat loss and cardiovascular risk factors in patients with type 2 diabetes

Tae Sasakabe, Hajime Haimoto, Hiroyuki Umegaki, Kenji Wakai

Single arm prospective with 52 participants:  Six months of a moderate LCD resulted in preferential VAT (visceral adipose tissue) loss only in women, with significant correlations between % change SAT (subcutaneous adipose tissue) and both change HDL and change FBG (fasting blood glucose), as well as between % change VAT and change TG.  Authors results suggest that an LCD has the potential to reduce abdominal fat in patients with T2DM and deterioration of serum lipid profiles.

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Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects

Megan R. Ruth, Ava M. Port, Mitali Shah, Ashley C. Bourland, Nawfal W. Istfan, Kerrie P. Nelson, Noyan Gokce, Caroline M. Apovian

RCT with 55 participants:  Relative to the Low Fat/High Carb group, the High Fat/Low Carb group had greater improvements in blood lipids and systemic inflammation with similar changes in body weight and composition. This small-scale study suggests that HFLC diets may be more beneficial to cardiovascular health and inflammation in free-living obese adults compared to LFHC diets.

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Dietary carbohydrate restriction improves insulin sensitivity, blood pressure, microvascular function, and cellular adhesion markers in individuals taking statins

Kevin D. Ballarda, Erin E. Quanna, Brian R. Kupchaka, Brittanie M. Volka, Diana M. Kawieckia, Maria Luz Fernandez, Richard L. Seip, Carl M. Maresha, William J. Kraemera, Jeff S.Volek

Single arm perspective with 21 participants.  The results of this study suggest that a CRD could be a sustainable lifestyle that complements statin treatment to improve overall cardio-metabolic risk, particularly for individuals with other risk factors indicative of metabolic syndrome, but future research is needed to determine the effects over a longer period of time.

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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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