Low and reduced carbohydrate diets: challenges and opportunities for type 2 diabetes management and prevention

Churuangsuk, C. , Lean, M. E.J. and Combet, E. (2020) Low and reduced carbohydrate diets: challenges and opportunities for type 2 diabetes management and prevention. Proceedings of the Nutrition Society, 79(4), pp. 498-513. (doi: 10.1017/S0029665120000105) (PMID:32131904)

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Low-carbohydrate diets (LCD) have been promoted for weight control and type 2 diabetes (T2D) management, based on an emerging body of evidence, including meta-analyses with an indication of publication bias. Proposed definitions vary between 50 and 130 g/d, or <10 and <40 % of energy from carbohydrate, with no consensus on LCD compositional criteria. LCD are usually followed with limited consideration for other macronutrients in the overall diet composition, introducing variance in the constituent foods and in metabolic responses. For weight management, extensive evidence supports LCD as a valid weight loss treatment, up to 1–2 years. Solely lowering carbohydrate intake does not, in the medium/long term, reduce HbA1c for T2D prevention or treatment, as many mechanisms interplay. Under controlled feeding conditions, LCD are not physiologically or clinically superior to diets with higher carbohydrates for weight-loss, fat loss, energy expenditure or glycaemic outcomes; indeed, all metabolic improvements require weight loss. Long-term evidence also links the LCD pattern to increased CVD risks and mortality. LCD can lead to micronutrient deficiencies and increased LDL-cholesterol, depending on food selection to replace carbohydrates. Evidence is limited but promising regarding food choices/sources to replace high-carbohydrate foods that may alleviate the negative effects of LCD, demanding further insight into the dietary practice of medium to long term LCD followers. Long-term, high-quality studies of LCD with different food sources (animal and/or plant origins) are needed, aiming for clinical endpoints (T2D incidence and remission, cardiovascular events, mortality). Ensuring micronutrient adequacy by food selection or supplementation should be considered for people who wish to pursue long-term LCD.

Item Type:Articles
Additional Information:C.C. is in receipt of a scholarship from Prince of Songkla University, Faculty of Medicine, Thailand.
Glasgow Author(s) Enlighten ID:Lean, Professor Michael and Combet Aspray, Professor Emilie and Churuangsuk, Chaitong
Authors: Churuangsuk, C., Lean, M. E.J., and Combet, E.
College/School:College of Medical Veterinary and Life Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Proceedings of the Nutrition Society
Publisher:Cambridge University Press
ISSN (Online):1475-2719
Published Online:05 March 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Proceedings of the Nutrition Society 79(4): 498-513
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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