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

Boden, Guenther; Sargrad, Karin; Homko, Carol J.; Mozzoli, Maria; Stein, T. P.

doi:10.7326/0003-4819-142-6-200503150-00006

Cited by 457 publications

(387 citation statements)

References 28 publications

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“…Zone) 5 diets, which have been shown in many studies of free-living individuals to be associated with impressive weight loss and improved cardiovascular risk indicators over a relatively short period of time (up to 6 months). [6][7][8][9][10][11][12][13][14][15][16] Very few data are available relating to longterm (12 months or greater) comparisons of such alternative dietary regimens 6,[17][18][19][20] and only one study has been published that compares HP, HF and the more widely recommended HC-high-fibre diet over a prolonged period. 21 We have previously reported a 6-month comparison of such diets in overweight insulin-resistant women.…”

Section: Introductionmentioning

confidence: 99%

Long-term effects of popular dietary approaches on weight loss and features of insulin resistance

et al. 2005

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Objective: High-carbohydrate (HC)-high-fibre diets are recommended for weight loss and for treating and preventing diseases such as diabetes and cardiovascular disease. We report a randomised trial comparing high-fat (HF) and high-protein (HP) diets with the conventional approach. Research design and methods: A total of 93 overweight insulin-resistant women received advice following randomisation to HF, HP or HC dietary regimes, to achieve weight loss followed by weight maintenance over 12 months. Weight, body composition and measures of carbohydrate and lipid metabolism were investigated. Results: Retention rates were 93% for HP and 75% for HC and HF. Features of the metabolic syndrome improved in all groups during the first 6 months, to a greater extent on HF and HP than an HC. During the second 6 months the HF group had increases in waist circumference (mean difference 4.4 cm (95% CI 3.0, 5.8)), fat mass (2.3 kg (1.5, 3.1)), triglycerides (0.28 mmol/l (0.09, 0.46)) and 2 h glucose (0.70 mmol/l (0.22, 1.18)). Overall there was substantial sustained improvement in waist circumference, triglycerides and insulin in the HP group and sustained but more modest changes on HC. Dietary compliance at 12 months was poor in all groups. Conclusions: HP and HC approaches appear to be appropriate options for insulin-resistant individuals. When recommending HP diets appropriate composition of dietary fat must be ensured. HC diet recommendations must include advice regarding appropriate high-fibre, low glycaemic index foods.

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Section: Introductionmentioning

confidence: 99%

Long-term effects of popular dietary approaches on weight loss and features of insulin resistance

et al. 2005

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“…Most striking, in ad lib . trials, subjects on low CHO diets show a spontaneous reduction in calories without any dissatisfaction [23-25], a goal that is universally considered desirable but generally recognized as difficult to impose by cognitive admonitions on calorie restriction per se [26]. In general, published data support the idea that low CHO diets are at least as effective as other weight reduction methods.…”

Section: Introductionmentioning

confidence: 99%

“…There are, however, many strategies for reducing carbohydrate intake both clinically and in popular diets [34,35]. Whereas high fat is permitted on the Atkins diet and other low carbohydrate diets it is not specifically recommended; as noted above, at least three published studies [23-25] and much anecdotal evidence suggests that, in practice, the major effect is reduction in carbohydrate intake with limited replacement with either fat or protein. In addition, although a deleterious effect of saturated fat, at least in the absence of CHO control, is established [36,37], it has been known since the Seven Countries study [38] that total dietary fat does not correlate with cardiovascular risk and the two effects should not be confused [36,37].…”

Section: Introductionmentioning

confidence: 99%

“…It is clear that CHO restriction is effective in relieving these symptoms. Noteworthy is the recent study of Boden [23] which, while short in duration, carefully measured relevant parameters in patients with diabetes. Patients in this study spontaneously decreased food intake to a substantial degree, were satisfied with the diet, did not show substantial water loss and several were able to reduce or terminate medication.…”

Section: Introductionmentioning

confidence: 99%

“…It is generally agreed that the major effect of a low CHO diet is a spontaneous reduction in calories. In studies mentioned above, subjects did not significantly increase fat or protein intake but merely removed CHO from their diets [23-25]. Foster and Samaha also attributed the better performance of low CHO arm to decreased caloric intake, although this was not actually measured.…”

Section: Introductionmentioning

confidence: 99%

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Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction

2005

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Metabolic Syndrome (MetS) represents a constellation of markers that indicates a predisposition to diabetes, cardiovascular disease and other pathologic states. The definition and treatment are a matter of current debate and there is not general agreement on a precise definition or, to some extent, whether the designation provides more information than the individual components. We consider here five indicators that are central to most definitions and we provide evidence from the literature that these are precisely the symptoms that respond to reduction in dietary carbohydrate (CHO). Carbohydrate restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides (TAG), low HDL and high blood pressure. In addition, low fat, high CHO diets have long been known to raise TAG, lower HDL and, in the absence of weight loss, may worsen glycemic control. Thus, whereas there are numerous strategies for weight loss, a patient with high BMI and high TAG is likely to benefit most from a regimen that reduces CHO intake. Reviewing the literature, benefits of CHO restriction are seen in normal or overweight individuals, in normal patients who meet the criteria for MetS or in patients with frank diabetes. Moreover, in low fat studies that ameliorate LDL and total cholesterol, controls may do better on the symptoms of MetS. On this basis, we feel that MetS is a meaningful, useful phenomenon and may, in fact, be operationally defined as the set of markers that responds to CHO restriction. Insofar as this is an accurate characterization it is likely the result of the effect of dietary CHO on insulin metabolism. Glucose is the major insulin secretagogue and insulin resistance has been tied to the hyperinsulinemic state or the effect of such a state on lipid metabolism. The conclusion is probably not surprising but has not been explicitly stated before. The known effects of CHO-induced hypertriglyceridemia, the HDL-lowering effect of low fat, high CHO interventions and the obvious improvement in glucose and insulin from CHO restriction should have made this evident. In addition, recent studies suggest that a subset of MetS, the ratio of TAG/HDL, is a good marker for insulin resistance and risk of CVD, and this indicator is reliably reduced by CHO restriction and exacerbated by high CHO intake. Inability to make this connection in the past has probably been due to the fact that individual responses have been studied in isolation as well as to the emphasis of traditional therapeutic approaches on low fat rather than low CHO.We emphasize that MetS is not a disease but a collection of markers. Individual physicians must decide whether high LDL, or other risk factors are more important than the features of MetS in any individual case but if MetS is to be considered it should be recognized that reducing CHO will bring improvement. Response of symptoms to CHO ...

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A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss

Yancy¹,

Westman²,

McDuffie³

et al. 2010

Arch Intern Med

136

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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

Cited by 457 publications

References 28 publications

Long-term effects of popular dietary approaches on weight loss and features of insulin resistance

Long-term effects of popular dietary approaches on weight loss and features of insulin resistance

Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction

A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss

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