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.
LM Morgan; BA Griffin; DJ Millward; A DeLooy; KR Fox; S Baic; MP Bonham4; JMW Wallace; I MacDonald; MA Taylor; H Truby
RCT – 4 arm: The Atkins (low-carbohydrate) diet was followed by marked reductions in plasma TAG (–38.2% 6 months). This diet was associated with an increase in LDL particle size, a change that has been linked to reduced CVD risk.
Frank M. Sacks, MD; George A. Bray, MD; Vincent J. Carey, PhD; Steven R. Smith, MD; Donna H. Ryan, MD; Stephen D. Anton, PhD; Katherine McManus, MS, RD; Catherine M. Champagne, PhD; Louise M. Bishop, MS, RD; Nancy Laranjo, BA; Meryl S. Leboff, MD; Jennifer C. Rood, PhD; Lilian de Jonge, PhD; Frank L. Greenway, MD; Catherine M. Loria, PhD; Eva Obarzanek, PhD; Donald A. Williamson, PhD
Randomozed, three arms: 811 overweight adults to one of four diets; the targeted percentages of energy derived from fat, protein, and carbohydrates in the four diets were 20, 15, and 65%; 20, 25, and 55%; 40, 15, and 45%; and 40, 25, and 35%. At end of study, diets higher in protein and fat showed greater weight loss and reduced waist circumference than diet high in carbohdyrates.
Jeff S. Volek; Kevin D. Ballard; Ricardo Silvestre; Daniel A. Judelson; Erin E. Quann; Cassandra E. Forsythe; Maria Luz Fernandez; William J. Kraemer
RCT with 40 participants: These findings show that a 12-week low-carbohydrate diet improves postprandial vascular function more than a LFD in individuals with atherogenic dyslipidemia.
M. Siegel, MD; Whitney Rich, RD; Evelyn C. Joseph, MD; Joan Linhardt; Jamie Knight; Jane Khoury, PhD; Stephen R. Daniels, MD, PhD
Single arm prospective: The LCD appears to be an effective and practical office-based intervention in obese teenagers.
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.
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.
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.
Cassandra E. ForsytheStephen; D. Phinney; Richard D. Feinman; Brittanie M. Volk; Daniel Freidenreich; Erin QuannKevin Ballard; Michael J. Puglisi; Carl M. Maresh; William J. Kraemer; Douglas M. Bibus; Maria Luz Fernandez; Jeff S. Volek
Randomized crossover with 8 participants: Authors showed that a hypocaloric carbohydrate restricted diet (CRD) had two striking effects: (1) a reduction in plasma saturated fatty acids (SFA) despite higher intake than a low fat diet, and (2) a decrease in inflammation despite a significant increase in arachidonic acid (ARA). These findings are consistent with the concept that dietary saturated fat is efficiently metabolize in the presence of low carbohydrate, and that a CRD results in better preservation of plasma ARA.
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.
Nancy F. Krebs, MD, MS; Dexiang Gao, PhD; Jane Gralla, PhD; Juliet S. Collins; MD, Susan L. Johnson, PhD
RCT with 46 participants: Significant reduction in BMI-Z-score was achieved in both groups during intervention, and was significantly greater for the HPLC (high protein low carbohydrate) group. Both groups maintained significant BMI-Z reduction at follow-up; changes were not significantly different between groups. The HPLC diet is a safe and effective option for medically supervised weight loss in severely obese adolescents.
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).
Gary D. Foster, PhD; Holly R. Wyatt, MD; James O. Hill, PhD; Angela P. Makris, PhD, RD; Diane L. Rosenbaum, BA; Carrie Brill, BS; Richard I. Stein, PhD; B. Selma Mohammed, MD, PhD; Bernard Miller, MD; Daniel J. Rader, MD; Babette Zemel, PhD; Thomas A. Wadden, PhD; Thomas Tenhave, PhD; Craig W. Newcomb, MS; Samuel Klein, MD
RCT with 307 participants: 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. Weight loss was approximately 11 kg (11%) at 1 year and 7 kg (7%) at 2 years. During the first 6 months, the low carbohydrate diet group had greater reductions in diastolic blood pressure, triglyceride levels, and very-low-density lipoprotein cholesterol levels, lesser reductions in low density lipoprotein cholesterol levels, and more adverse symptoms than did the low-fat diet group. The low carbohydrate diet group had greater increases in high-density lipoprotein cholesterol levels at all time points, approximating a 23% increase at 2 years.
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.
F. L. Santos, S. S. Esteves, A. da Costa Pereira, W. S. Yancy Jr, J. P. L. Nunes
Meta-analysis: LCD was shown to have favourable effects on body weight and major cardiovascular risk factors.
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.
Allon N. Friedman, Lorraine G. Ogden, Gary D. Foster, Samuel Klein, Richard Stein, Bernard Miller, James O. Hill, Carrie Brill, Brooke Bailer, Diane R. Rosenbaum, Holly R. Wyatt
RCT with 307 participants: In healthy obese individuals, a low-carbohydrate highprotein weight-loss diet over 2 years was not associated with noticeably harmful effects on GFR, albuminuria, or fluid and electrolyte balance compared with a low-fat diet.
Cara B. Ebbeling, PhD; Janis F. Swain, MS, RD; Henry A. Feldman, PhD; William W. Wong, PhD; David L. Hachey, PhD; Erica Garcia-Lago, BA; David S. Ludwig, MD, PhD
3 way randomized crossover with 21 participants: Individuals on the very low carb diet had the highest resting metabolism.
Carolyn O. Walsh, Cara B. Ebbeling, Janis F. Swain, Robert L. Markowitz, Henry A. Feldman, David S. Ludwig
Randomized Crossover with 8 participants: These findings suggest that a Low Fat diet may adversely affect postprandial Energy Availability and risk for weight regain during weight loss maintenance.
RCT – 3 arm with 318 participants: 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.
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.
Antonio Paoli, Antonino Bianco, Keith A Grimaldi, Alessandra Lodi, Gerardo Bosco
Single arm perspective with 89 participants: The data from this study demonstrate that the majority of subjects showed significant weight loss (10%) as a result of a two-phase VLCKD and were compliant both during the six month weight loss phase and the six month normocaloric maintenance phase, with no weight regain. We can suggest that the proposed protocol was generally successful because of (a) the protein mass protective effects of a VLCKD and (b) the prescription of a traditional Mediterranean diet in the post weight-loss phase was especially important for achieving “weight loss success”, i.e., continued weight loss for at least one year.
Nassib Bezerra Bueno, Ingrid Sofia Vieira de Melo, Suzana Lima de Oliveira, Terezinha da Rocha Ataide
Metas Analysis: Individuals assigned to a VLCKD achieve a greater weight loss than those assigned to a LFD in the long term; hence, a VLCKD may be an alternative tool against obesity.
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.
Olubukola Ajala, Patrick English, Jonathan Pinkney
Low-carbohydrate are as effective as low-GI, Mediterranean, and high protein diets in improving various markers of cardiovascular risk in people with diabetes and should be considered in the overall strategy of diabetes management.