Alternative Dietary Patterns for Americans: Low-Carbohydrate Diets

Abstract

The decades-long dietary experiment embodied in the Dietary Guidelines for Americans (DGA) focused on limiting fat, especially saturated fat, and higher carbohydrate intake has coincided with rapidly escalating epidemics of obesity and type 2 diabetes (T2D) that are contributing to the progression of cardiovascular disease (CVD) and other diet-related chronic diseases. Moreover, the lack of flexibility in the DGA as it pertains to low carbohydrate approaches does not align with the contemporary trend toward precision nutrition. We argue that personalizing the level of dietary carbohydrate should be a high priority based on evidence that Americans have a wide spectrum of metabolic variability in their tolerance to high carbohydrate loads. Obesity, metabolic syndrome, and T2D are conditions strongly associated with insulin resistance, a condition exacerbated by increased dietary carbohydrate and improved by restricting carbohydrate. Low-carbohydrate diets are grounded across the time-span of human evolution, have well-established biochemical principles, and are now supported by multiple clinical trials in humans that demonstrate consistent improvements in multiple established risk factors associated with insulin resistance and cardiovascular disease. The American Diabetes Association (ADA) recently recognized a low carbohydrate eating pattern as an effective approach for patients with diabetes. Despite this evidence base, low-carbohydrate diets are not reflected in the DGA. As the DGA Dietary Patterns have not been demonstrated to be universally effective in addressing the needs of many Americans and recognizing the lack of widely available treatments for obesity, metabolic syndrome, and T2D that are safe, effective, and sustainable, the argument for an alternative, low-carbohydrate Dietary Pattern is all the more compelling.

The Effects of Carbohydrate versus Fat Restriction on Lipid Profiles in Highly Trained, Recreational Distance Runners: A Randomized, Cross-Over Trial

“…We expected the LCHF intervention to increase circulating BHB within a predicted nutritional ketosis range (0.5–4.0 mM), Studies and reviews of well-formulated KD suggest that a protein range between 1.2–1.5 g/kg bodyweight to spare lean body mass losses while concurrently promoting BHB maintenance within nutritional ketosis range [ 12 , 30 ]. Phinney et al [ 5 ] provided recreational and competitive cyclists with 1.75 g protein/kg/day and detected a 2.2 mmol/L serum BHB average for 4 weeks.…”

Comparative efficacy of different eating patterns in the management of type 2 diabetes and prediabetes: An arm-based Bayesian network meta-analysis

“…Participants usually decreased their food intake in LCD intervention because of the increased satiety, which led to a spontaneous caloric restriction [154, 155]. Therefore, how to distinguish the effects of carbohydrate and caloric restriction in an LCD trial was always the focus, usually by introducing isocaloric arms.…”

Dietary Therapy in Prevention of Cardiovascular Disease (CVD)—Tradition or Modernity? A Review of the Latest Approaches to Nutrition in CVD

“…It has been proven that these diets have a beneficial effect on body weight, leading to its reduction. Moreover, limiting carbohydrate intake lowers C-reactive protein and triglyceride concentrations, thus preventing vascular endothelial dysfunction and metabolic complications [76]. A positive effect of the ketogenic diet on blood pressure has also been reported; moreover, no increase in LDL fraction cholesterol was observed [77,78].…”

“…The reduction of carbohydrate provision in the daily dietary pattern in favor of an increased fat supply has been controversial for years. It is now considered that the amount of carbohydrate intake should be individualized [76]. Several types of diets restrict carbohydrate intake, including low-carbohydrate and high-fat diets and radical ketogenic diets [76].…”

“…It is now considered that the amount of carbohydrate intake should be individualized [76]. Several types of diets restrict carbohydrate intake, including low-carbohydrate and high-fat diets and radical ketogenic diets [76]. Available scientific publications indicate beneficial health effects of low-carbohydrate diets, which are also observed in the cardiovascular system.…”