<p>Diet, Diabetes Status, and Personal Experiences of Individuals with Type 2 diabetes Who Self-Selected and Followed a Low Carbohydrate High Fat diet</p>

Abstract

Background: Low carbohydrate high fat (LCHF) diets are increasing in popularity amongst patients with type 2 diabetes (T2D), however it is unclear what constitutes a sustainable LCHF diet in a real-world setting. Methods: This descriptive multi-method study characterized the diets, T2D status, and personal experiences of individuals with T2D who claimed to have followed an LCHF diet for at least 6 months. Participants completed a medications history, mixed-method dietary assessment, provided a blood sample, and were interviewed in-depth about their experiences with the diet (First-Assessment). Past medical records were obtained corresponding to T2D diagnosis and prior to starting their LCHF diets. Additionally, participants were followed up 15 months later to assess T2D remission (Follow-Up). Results: Twenty-eight participants completed First-Assessment and 24 completed Follow-Up. Habitual carbohydrate intake was 20 to 50 g/d for 10 participants and 50 to 115 g/d for 17 participants. Commonly reported foods were full-fat dairy, non-starchy vegetables, coconut oil, eggs, nuts, olives and avocados, olive oil, and red meat and poultry with fat. Median (interquartile range) for HbA1c was 7.5 (6.5-9.5) % prior to starting their diets, 5.8 (5.4-6.2) % at First-Assessment and 5.9 (5.3-6.6) % at Follow-Up. Reported body weight and glucose-lowering medication requirements were considerably lower at both assessments than when starting the diet. At Follow-Up, 24 participants had been following their LCHF diets for 35 (26-53) months, the majority of which were in full or partial T2D remission. Participants perceived reduced hunger and cravings as one of the most important aspects of their diets. Of concern, many participants felt unsupported by their doctors. Conclusion: This study described the foods and characteristics of an LCHF "lifestyle" that was sustainable and effective for certain T2D patients in a real-world setting. Plain Language SummaryUntil recently, low carbohydrate high fat (LCHF) diets were not supported by most T2D dietary guidelines, and the high fat component of these diets is still controversial due to concerns over long-term health outcomes. Despite this, there are a growing number of individuals following their own version of an LCHF diet to manage their T2D. The aim of this study was to characterize the diets, health, and personal experiences of individuals with T2D who claimed to have followed an LCHF diet for at least the previous 6 months.A total of 28 participants completed the study and 24 of these participants were assessed for a second time after 15 months. We found that:

Exploring the Perceptions of Women from Under-Resourced South African Communities about Participating in a Low-Carbohydrate High-Fat Nutrition and Health Education Program: A Qualitative Focus Group Study

“…There is a general perception that the foods included in an LCHF diet are expensive and that most of the people who decide to follow this lifestyle in South Africa are reasonably affluent [22]. This is consistent with the perception that LCHF diets are too expensive for people living in under-resourced communities [23].…”

“…Similarly, the lack of support, and conflicting advice from doctors caused confusion and frustration among participants. These experiences with peers and doctors are remarkably similar to that of a much more affluent group of individuals with type 2 diabetes who had also followed an LCHF diet [22]. In both studies, family, peers and/or doctors became more supportive of the participants' efforts after observing their health and weight improvements.…”

“…Experiencing their own health and weight improvements during the program and being able to achieve this with less hunger and more energy than expected, was likely a strong motivating factor for participants to so convincingly accept an LCHF diet and to adhere to it. That LCHF diets can increase control overeating, through reduced hunger and cravings has been well documented before [20,22,51]. Dietary intervention programs should however be cognizant of the way they measure and use individual health parameters as motivation, such that participants feel comfortable.…”

“…Total calorie intake is often regulated by eating to satiety and not beyond, rather than actively restricting calories. Indeed, the diet is mostly promoted as one which increases control of eating and satiety [20][21][22].…”

Ketogenic Diet-mediated Steroid Metabolism Reprogramming Improves the Immune Microenvironment and Myelin Growth of Spinal Cord Injury Rats Through Gene Analysis and Co-expression Network Analysis

“…We found that Sham_KD and Sham_SD rats were also KEGG-enriched in these two signalling pathways (AD and PD; Additional le 8: Table S5). Although it is known that a KD promotes high ketone body levels, high fat, low carbohydrates, low calories and other "immediacy" properties [29][30], this study suggests that the ketogenic diet may mediate steroid metabolism reprogramming to treat spinal cord injury rats This study is the rst to reach this conclusion. Steroids include sterols (such as cholesterol, lanosterol, sitosterol, stigmasterol, and ergosterol), bile acids and bile alcohols, steroid hormones (such as adrenal cortex hormones, androgens, and oestrogen), insect ecdysone, cardiac glycosides, saponins, and toad poison [31][32][33].…”