Importance of low carbohydrate diets in diabetes management

Abstract

Dietary strategies are fundamental in the management of diabetes. Historically, strict dietary control with a low carbohydrate diet was the only treatment option. With increasingly effective medications, the importance of dietary change decreased. Recommendations focused on reducing dietary fat to prevent atherosclerotic disease, with decreasing emphasis on the amount and quality of carbohydrate. As the prevalence of obesity and diabetes escalates, attention has returned to the macronutrient composition of the diet. Very low carbohydrate diets (VLCD's) have demonstrated effective initial weight loss and improvement in glycemic control, but difficult long-term acceptability and worsening lipid profile. Modifications to the very low carbohydrate (VLC) have included limiting saturated fat and increasing carbohydrate (CHO) and protein.Reducing saturated fat appears pivotal in reducing low-density lipoprotein (LDL) cholesterol and may mitigate adverse effects of traditional VLCD's. Increased dietary protein enhances satiety, reduces energy intake, and improves glycemic homeostasis, but without sustained improvements in glycemic control or cardiovascular risk over and above the effect of weight loss. Additionally, recent studies in type 1 diabetes mellitus suggest promising benefits to diabetes control with low carbohydrate diets, without concerning effects on ketosis or hypoglycemia. Dietary patterns may highlight pertinent associations. For example, Mediterranean-style and paleolithic-type diets, low in fat and carbohydrate, are associated with reduced body weight and improved glycemic and cardiovascular outcomes in type 2 diabetes mellitus (T2DM). A feature of these dietary patterns is low refined CHO and sugar and higher fiber, and it is possible that increasing sugar consumption is having a substantial effect on global escalations in obesity and T2DM. Dietary recommendations in type 1 diabetes and T2DM are changing. Dietary CHO is unquestionably important, but long-term acceptability of any diet is critical to sustain improvements in health benefits. Personalized dietary management, using a variety of dietary approaches, may be the key to optimal diabetes outcomes.

Obese Older Type 2 Diabetes Mellitus Patients with Muscle Insulin Resistance Benefit from an Enriched Protein Drink during Combined Lifestyle Intervention: The PROBE Study

“…Hepatic insulin sensitivity also improved significantly upon consumption of the protein + drink in the MIR subgroup, suggesting that the relative increase in dietary protein and maybe the relative decrease in carbohydrate intake, also plays a role in hepatic insulin sensitivity. The lower relative carbohydrate content of subjects’ diets in the protein + group as compared to control (daily about 20 g of carbohydrates less in the protein + group) may have contributed to the reduction in fasting plasma glucose and insulin, adipose tissue insulin resistance, and the increase in systemic insulin sensitivity [ 38 , 39 ]. While we observed these beneficial effects of the protein + drink compared to the control drink in the MIR subgroup, we did not observe them in the no-MIR subgroup, suggesting that these protein + drink effects may be MIR subgroup-specific.…”

Untitled

“…Reducing carbohydrate intake can reduce sugar levels in the blood and resultant reduced for-insulin needs/medication [55]. Some people may experience side effects such as fatigue, headache, nausea, constipation, bad breath, muscle cramps, or nutrient deficiencies [56]. Moreover, some studies have suggested that very low-carbohydrate diets (<50 grams per day) may increase the risk of diabetic ketoacidosis (DKA), a serious condition that happens when too many ketones (acids) produce in our body due to a lack of insulin [55,56].…”

“…Acupuncture is a form of TM that originated in Indian and China more than 2000 years ago. It involves the insertion of fine needles into specific points on the body called acupoints which are believed to correspond to different organs or systems in the body [56]. Acupuncture aims to restore the balance of qi (vital energy) and blood flow in the body thus promoting health and healing.…”

“…However, some studies have shown no significant difference or inconsistent results of acupuncture on diabetes outcomes. Therefore, more high-quality randomized controlled trials are needed to confirm the efficacy and safety of acupuncture for diabetes [56]. It is generally considered safe when performed by a trained acupuncturist using sterile needles.…”