Low-carbohydrate nutrition and metabolism

Westman, Eric; Feinman, Richard D.; Mavropoulos, John C.; Vernon, Mary C; Volek, Jeff S.; Wortman, James; Yancy, William S.; Phinney, Stephen D.

doi:10.1093/ajcn/86.2.276

Cited by 293 publications

(254 citation statements)

References 85 publications

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“…Increased ketogenesis, and therefore insulin resistance, may be expected to increase during carbohydraterestricted diets. 24 However, ketogenesis was not evident in the pilot trial. Participants were asked to test for blood ketones at least weekly and if their blood glucose levels were higher than 15 mmol/L.…”

Section: Discussionmentioning

confidence: 86%

“…The reported mealtime insulin resistance could have been caused by a negative effect on insulin sensitivity due to an increase in saturated fat 24 in the LCC group's diet, but the main study showed there was no increase. Insulin dose requirements may have been partially affected by inaccurate carbohydrate counting, as has been reported elsewhere; 25 another possibility is that in people with a limited carbohydrate intake, gluconeogenesis becomes such an important source of glucose that it becomes necessary to also calculate the protein content of a meal and use an insulin:carbohydrate and protein ratio.…”

Section: Discussionmentioning

confidence: 91%

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From 'pleasure to chemistry': the experience of carbohydrate counting with and without carbohydrate restriction for people with Type 1 diabetes

Cresswell¹,

Krebs²,

Gilmour³

et al. 2015

J Prim Health Care

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INTRODUCTION:Matching carbohydrate intake with insulin dosage is recommended management for people with Type 1 diabetes. However, international interest in restricted carbohydrate diets is growing. General practitioners and practice nurses need to know how to advise people with Type 1 diabetes regarding low-carbohydrate diets. This study aimed to explore the carbohydrate counting experiences of people with Type 1 diabetes in a trial with and without a diet restricted to 75 g of carbohydrate per day.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 91%

From 'pleasure to chemistry': the experience of carbohydrate counting with and without carbohydrate restriction for people with Type 1 diabetes

Cresswell¹,

Krebs²,

Gilmour³

et al. 2015

J Prim Health Care

View full text Add to dashboard Cite

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“…Previous studies comparing the effects of CRD and conventional diets without resistance training reported significant decreases in fat-free mass in both interventions (from -1.4 to -3.2 kg, representing up to 32% of total body mass reduction) 2,6,10,24,25 . However, despite the short duration of the present intervention, CRD associated to resistance training seemed to prevent fat-free mass loss.…”

Section: Discussionmentioning

confidence: 90%

“…The mean carbohydrate intake among the CRD group was 83±43 g at week 8, and all subjects ingested amounts below the upper limit that characterizes a CRD (<150 g daily) 2 . In the CRD group, the ingestion of carbohydrate was below the recommendations of IOM 13 , while protein and fat intakes were above the upper limits.…”

Section: Tc/hdl-c Ratiomentioning

confidence: 93%

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Combined effects of resistance training and carbohydrate-restrictive or conventional diets on weight loss, blood variables and endothelium function

Meirelles

Gomes

2016

Rev. Nutr.

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Objective: To compare the effects of either a carbohydrate-restrictive diets or a conventional hypoenergetic diet combined with resistance training. Methods: Twenty-one overweight and obese adults participated in an eight-week program consisting of progressive resistance training combined with carbohydrate-restrictive diets (initially set at <30 g carbohydrate; n=12) or conventional hypoenergetic diet (30% energetic restriction; carbohydrate/protein/lipid: 51/18/31% of total energy consumption; n=9). It was hypothesized that the carbohydrate-restrictive diets would induce greater weight loss but that both diets would elicit similar effects on selected health markers. Body mass, and body composition, blood variables and flow-mediated brachial artery dilation (flow-mediated brachial artery dilation; by ultrasound) were used to assess changes due to the interventions. Results: Significant within-group reductions in body mass (-5.4±3.5%; p=0.001 versus -3.7±3.0%; p=0.015) and body fat (body fat; -10.2±7.0%; p=0.005 versus -9.6±8.8%; p=0.017) were identified for carbohydrate-restrictive diets and conventional hypoenergetic diet, respectively, but there were no significant differences between groups as the result of the interventions. Fat free mass, blood variables and flow-mediated brachial artery dilation did not significantly change, except for the total cholesterol/high-density lipoprotein ratio, which was reduced 10.4±16.9% in carbohydrate-restrictive diets (p=0.037) and 0.5±11.3% in conventional hypoenergetic diet (p=0.398). Conclusion: Carbohydrate-restrictive diets associated with resistance training was as effective as conventional hypoenergetic diet in decreasing body mass and body fat, as well as maintaining fat free mass, blood variables and flow-mediated brachial artery dilation, however it was more effective at lowering the total cholesterol/low density lipoprotein ratio.

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Comparison of Group Medical Visits Combined With Intensive Weight Management vs Group Medical Visits Alone for Glycemia in Patients With Type 2 Diabetes

et al. 2020

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IMPORTANCE Traditionally, group medical visits (GMVs) for persons with diabetes improved glycemia by intensifying medications, which infrequently led to weight loss. Incorporating GMVs with intensive dietary change could enable weight loss and improve glycemia while decreasing medication intensity.OBJECTIVE To examine whether a program of GMVs combined with intensive weight management (WM) is noninferior to GMVs alone for change in glycated hemoglobin (HbA 1c ) level at 48 weeks (prespecified margin of 0.5%) and superior to GMVs alone for hypoglycemic events, diabetes medication intensity, and weight loss. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial identified via the electronic medical record 2814 outpatients with type 2 diabetes, uncontrolled HbA 1c , and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 27 or higher from Veterans Affairs Medical Center clinics in Durham and Greenville, North Carolina. Between January 12, 2015, and May 30, 2017, 263 outpatients started the intervention.INTERVENTIONS Participants randomized to the GMV group (n = 136) received counseling about diabetes-related topics with medication optimization every 4 weeks for 16 weeks, then every 8 weeks (9 visits). Participants randomized to the WM/GMV group (n = 127) received low-carbohydrate diet counseling with baseline medication reduction and subsequent medication optimization every 2 weeks for 16 weeks followed by an abbreviated GMV intervention every 8 weeks (13 visits). MAIN OUTCOMES AND MEASURESOutcomes included HbA 1c level, hypoglycemic events, diabetes medication effect score, and weight at 48 weeks analyzed using hierarchical generalized mixed models to account for clustering within group sessions. RESULTS Among 263 participants (mean [SD] age, 60.7 [8.2] years; 235 [89.4%] men; 143 [54.4%] black), baseline HbA 1c level was 9.1% (1.3%) and BMI was 35.3 (5.1). At 48 weeks, HbA 1c level was improved in both study arms (8.2% in the WM/GMV arm and 8.3% in the GMV arm; mean difference, −0.1%; 95% CI, −0.5% to 0.2%; upper 95% CI, <0.5% threshold; P = .44). The WM/GMV arm had lower diabetes medication use (mean difference in medication effect score, −0.5; 95% CI, −0.6 to −0.3; P < .001) and greater weight loss (mean difference, −3.7 kg; 95% CI, −5.5 to −1.9 kg; P < .001) than did the GMV arm at 48 weeks and approximately 50% fewer hypoglycemic events (incidence rate ratio, 0.49; 95% CI, 0.27 to 0.71; P < .001) during the 48-week period. CONCLUSIONS AND RELEVANCEIn GMVs for diabetes, addition of WM using a low-carbohydrate diet was noninferior for lowering HbA 1c levels compared with conventional medication management and showed advantages in other clinically important outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01973972

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Low-carbohydrate nutrition and metabolism

Cited by 293 publications

References 85 publications

From 'pleasure to chemistry': the experience of carbohydrate counting with and without carbohydrate restriction for people with Type 1 diabetes

From 'pleasure to chemistry': the experience of carbohydrate counting with and without carbohydrate restriction for people with Type 1 diabetes

Combined effects of resistance training and carbohydrate-restrictive or conventional diets on weight loss, blood variables and endothelium function

Comparison of Group Medical Visits Combined With Intensive Weight Management vs Group Medical Visits Alone for Glycemia in Patients With Type 2 Diabetes

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