Carbohydrate-restricted diets for obesity and related diseases: An update

  • Christy L. Boling
  • Eric C. Westman
  • William S. YancyJr


Basic, clinical, and epidemiologic research on carbohydrate-restricted dietary patterns continues to grow, evaluating the impact of this way of eating on weight loss, obesity-associated comorbidities, and development of any adverse effects. Randomized, controlled, dietary weight loss trials conducted in adults in the past 2 years reinforce previous findings that carbohydrate-restricted diets (CRDs) promote weight loss while increasing serum high-density lipoprotein cholesterol, lowering serum triglycerides, and improving glucose homeostasis. Studies showing that reduction of dietary carbohydrate leads to reduced postprandial serum glucose and insulin levels have spurred further research on CRDs in patients with type 2 diabetes. Emerging interest into the effect of diet on endothelial function has spawned studies that are harnessing new technologies, such as flow-mediated vascular dilation, to gain insight into the impact of diet on long-term cardiovascular disease outcomes. Studies on the effect of a CRD on appetite, health-related quality of life, bone density and turnover, acid-base metabolism, and potassium equilibrium help clinicians better weigh the perceived risks of the diet with the recognized benefits. This review synthesizes important clinical and physiologic studies on CRDs published between January 2007 and May 2009.

References and Recommended Reading

  1. 1.
    Westman EC, Mavropoulos J, Yancy WS, Volek JS: A review of low-carbohydrate ketogenic diets. Curr Atheroscler Rep 2003, 5:476–483.CrossRefPubMedGoogle Scholar
  2. 2.
    Westman EC, Feinman RD, Mavropoulos JC, et al.: Lowcarbohydrate nutrition and metabolism. Am J Clin Nutr 2007, 86:276–284.PubMedGoogle Scholar
  3. 3.
    Tay J, Brinkworth GD, Noakes M, et al.: Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am Coll Cardiol 2008, 51:59–67.CrossRefPubMedGoogle Scholar
  4. 4.
    Westman EC, Yancy WS Jr, Mavropoulos JC, et al.: The effect of a low-carbohydrate, ketogenic diet versus a lowglycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond) 2008, 5:36.CrossRefGoogle Scholar
  5. 5.
    Gardner CD, Kiazand A, Alhassan S, et al.: Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA 2007, 297:969–977.CrossRefPubMedGoogle Scholar
  6. 6.
    Shai I, Schwarzfuchs D, Henkin Y, et al.: Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008, 359:229–241.CrossRefPubMedGoogle Scholar
  7. 7.
    Sacks FM, Bray GA, Carey VJ, et al.: Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009, 360:859–873.CrossRefPubMedGoogle Scholar
  8. 8.
    Boling CL, Westman EC, Yancy S: Comparison of weight loss diets [comment]. N Engl J Med 2009, 360:2247; author reply 2247–2248.CrossRefPubMedGoogle Scholar
  9. 9.
    Krieger JW, Sitren HS, Daniels MJ, Langkamp-Henken B: Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression 1. Am J Clin Nutr 2006, 83:260–274.PubMedGoogle Scholar
  10. 10.
    Nordmann AJ, Nordmann A, Briel M, et al.: Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006, 166:285–293.CrossRefPubMedGoogle Scholar
  11. 11.
    Kirk JK, Graves DE, Craven TE, et al.: Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. J Am Diet Assoc 2008, 108:91–100.CrossRefPubMedGoogle Scholar
  12. 12.
    Mensink RP, Zock PL, Kester AD, Katan MB: Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003, 77:1146–1155.PubMedGoogle Scholar
  13. 13.
    Volek JS, Phinney SD, Forsythe CE, et al.: Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids 2009, 44:297–309.CrossRefPubMedGoogle Scholar
  14. 14.
    de Luis DA, Aller R, Izaola O, et al.: Effects of a low-fat versus a low-carbohydrate diet on adipocytokines in obese adults. Hormone Res 2007, 67:296–300.CrossRefPubMedGoogle Scholar
  15. 15.
    Keogh JB, Brinkworth GD, Noakes M, et al.: Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. Am J Clin Nutr 2008, 87:567–576.PubMedGoogle Scholar
  16. 16.
    Phillips SA, Jurva JW, Syed AQ, et al.: Benefit of low-fat over low-carbohydrate diet on endothelial health in obesity. Hypertension 2008, 51:376–382.CrossRefPubMedGoogle Scholar
  17. 17.
    Wood RJ, Fernandez ML, Sharman MJ, et al.: Effects of a carbohydrate-restricted diet with and without supplemental soluble fiber on plasma low-density lipoprotein cholesterol and other clinical markers of cardiovascular risk. Metab Clin Exper 2007, 56:58–67.Google Scholar
  18. 18.
    Stern L, Iqbal N, Seshadri P, et al.: The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 2004, 140:778–785.PubMedGoogle Scholar
  19. 19.
    Stoernell CK, Tangney CC, Rockway SW: Short-term changes in lipoprotein subclasses and C-reactive protein levels of hypertriglyceridemic adults on low-carbohydrate and low-fat diets. Nutr Res 2008, 28:443–449.CrossRefPubMedGoogle Scholar
  20. 20.
    Deanfield JE, Halcox JP, Rabelink TJ: Endothelial function and dysfunction: testing and clinical relevance. Circulation 2007, 115:1285–1295.PubMedGoogle Scholar
  21. 21.
    Benjamin EJ, Larson MG, Keyes MJ, et al.: Clinical correlates and heritability of flow-mediated dilation in the community: the Framingham Heart Study. Circulation 2004, 109:613–619.CrossRefPubMedGoogle Scholar
  22. 22.
    Rankin JW, Turpyn AD: Low carbohydrate, high fat diet increases C-reactive protein during weight loss. J Am Coll Nutr 2007, 26:163–169.PubMedGoogle Scholar
  23. 23.
    Plotnick GD, Corretti MC, Vogel RA: Effect of antioxidant vitamins on the transient impairment of endothelium-dependent brachial artery vasoactivity following a single high-fat meal. JAMA 1997, 278:1682–1686.CrossRefPubMedGoogle Scholar
  24. 24.
    Focardi M, Dick GM, Picchi A, et al.: Restoration of coronary endothelial function in obese Zucker rats by a low-carbohydrate diet. Am J Physiol 2007, 292:H2093–2099.Google Scholar
  25. 25.
    Larosa JC, Fry AG, Muesing R, Rosing DR: Effects of high-protein, low-carbohydrate dieting on plasma lipoproteins and body weight. J Am Diet Assoc 1980, 77:264–270.PubMedGoogle Scholar
  26. 26.
    Knuth ND, Shrivastava CR, Horowitz JF: Reducing dietary fat from a meal increases the bioavailability of exogenous carbohydrate without altering plasma glucose concentration. J Appl Physiol 2009, 106:122–129.CrossRefPubMedGoogle Scholar
  27. 27.
    Essah PA, Levy JR, Sistrun SN, et al.: Effect of macronutrient composition on postprandial peptide YY levels. J Clin Endocrinol Metab 2007, 92:4052–4055.CrossRefPubMedGoogle Scholar
  28. 28.
    Pironi L, Stanghellini V, Miglioli M, et al.: Fat-induced ileal brake in humans: a dose-dependent phenomenon correlated to the plasma levels of peptide YY. Gastroenterology 1993, 105:733–739.PubMedGoogle Scholar
  29. 29.
    Brubaker PL, Drucker DJ, Asa SL, Greenberg GR: Regulation of peptide-YY synthesis and secretion in fetal rat intestinal cultures. Endocrinology 1991, 129:3351–3358.CrossRefPubMedGoogle Scholar
  30. 30.
    Halyburton AK, Brinkworth GD, Wilson CJ, et al.: Lowand high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance. Am J Clin Nutr 2007, 86:580–587.PubMedGoogle Scholar
  31. 31.
    Johnstone AM, Horgan GW, Murison SD, et al.: Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am J Clin Nutr 2008, 87:44–55.PubMedGoogle Scholar
  32. 32.
    D’Anci KE, Watts KL, Kanarek RB, Taylor HA: Low-carbohydrate weight-loss diets. Effects on cognition and mood. Appetite 2009, 52:96–103.CrossRefPubMedGoogle Scholar
  33. 33.
    Yancy WS Jr, Almirall D, Maciejewski ML, et al.: Effects of two weight-loss diets on health-related quality of life. Qual Life Res 2009, 18:281–289.CrossRefPubMedGoogle Scholar
  34. 34.
    Galletly C, Moran L, Noakes M, et al.: Psychological benefits of a high-protein, low-carbohydrate diet in obese women with polycystic ovary syndrome-a pilot study. Appetite 2007, 49:590–593.CrossRefPubMedGoogle Scholar
  35. 35.
    Carter JD, Vasey FB, Valeriano J: The effect of a low-carbohydrate diet on bone turnover. Osteoporos Int 2006, 17:1398–1403.CrossRefPubMedGoogle Scholar
  36. 36.
    Yancy WS Jr, Olsen MK, Dudley T, Westman EC: Acid-base analysis of individuals following two weight loss diets. Eur J Clin Nutr 2007, 61:1416–1422.CrossRefPubMedGoogle Scholar
  37. 37.
    Davis NJ, Cohen HW, Wylie-Rosett J, Stein D: Serum potassium changes with initiating low-carbohydrate compared to a low-fat weight loss diet in type 2 diabetes. South Med J 2008, 101:46–49.PubMedGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  • Christy L. Boling
    • 1
  • Eric C. Westman
  • William S. YancyJr
  1. 1.Center for Health Services Research in Primary CareVeterans Affairs Medical Center (152)DurhamUSA

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