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Effects of very low-carbohydrate vs. high-carbohydrate weight loss diets on psychological health in adults with obesity and type 2 diabetes: a 2-year randomized controlled trial

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Abstract

Aims

Very low-carbohydrate (LC) diets are popular for type 2 diabetes (T2DM) management; however, long-term effects on psychological health remain largely unknown. This study reports the effects of a LC diet on mood and cognitive function after 2 years and explores the potential predictors of changes in psychological health.

Methods

115 adults (57% males; age: 58.5 ± 7.1 years) with obesity and T2DM were randomized to consume an energy reduced (~ 500 to 1000 kcal/day deficit), LC diet [14% energy as carbohydrate, 28% protein, 58% fat (< 10% saturated fat)] or an isocaloric high unrefined carbohydrate, low-fat diet [HC: 53% carbohydrate, 17% protein, 30% fat (< 10% saturated fat)] for 2 years. Both diets were combined with aerobic/resistance exercise (1 h, 3 days/week). Mood/well-being [Beck Depression Inventory (BDI), Spielberger State Anxiety Inventory (SAI), Profile of Mood States (POMS)], diabetes-related quality of life [Diabetes-39 (D-39)] and distress [Problem Areas in Diabetes (PAID) Questionnaire], and cognitive function were assessed during and post-intervention.

Results

61 (LC: 33, HC: 28) participants completed the study. Weight loss was 9.1% after 12 months and 6.7% after 2 years with no difference between diet groups. There were no differences between the groups for the changes in any psychological health outcome (smallest p ≥ 0.19 for all time x diet interactions). Overtime, improvements in BDI, POMS [Total Mood Disturbance (TMD); four subscales], PAID, and D-39 (three subscales) scores occurred (p ≤ 0.05, time). Stepwise regression analysis showed improvements in BDI, POMS (TMD; two subscales), D-39, SAI, and PAID scores were significantly (p < 0.05) correlated with reductions in body weight and glycated hemoglobin.

Conclusion

In adults with obesity and T2DM, energy-restricted LC and HC diets produced comparable long-term improvements on a comprehensive range of psychological health outcomes. The findings suggest both diets can be used as a diabetes management strategy as part of a holistic lifestyle modification program without concern of negative effects on mental well-being or cognition.

Trial registration

ACTRN12612000369820, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362168&isReview=true. Data described in the manuscript, code book, and analytic code will not be made available because approval has not been granted by participants.

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References

  1. Guariguata L, Whiting D, Weil C, Unwin N (2011) The International Diabetes Federation diabetes atlas methodology for estimating global and national prevalence of diabetes in adults. Diabetes Res Clin Pract 94(3):322–332. https://doi.org/10.1016/j.diabres.2011.10.040

    Article  PubMed  Google Scholar 

  2. Sainsbury E, Kizirian NV, Partridge SR, Gill T, Colagiuri S, Gibson AA (2018) Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract 139:239–252. https://doi.org/10.1016/j.diabres.2018.02.026

    Article  PubMed  CAS  Google Scholar 

  3. Meng Y, Bai H, Wang S, Li Z, Wang Q, Chen L (2017) Efficacy of low carbohydrate diet for type 2 diabetes mellitus management: a systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 131:124–131. https://doi.org/10.1016/j.diabres.2017.07.006

    Article  PubMed  CAS  Google Scholar 

  4. Huntriss R, Campbell M, Bedwell C (2018) The interpretation and effect of a low-carbohydrate diet in the management of type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Eur J Clin Nutr 72(3):311–325. https://doi.org/10.1038/s41430-017-0019-4

    Article  PubMed  CAS  Google Scholar 

  5. Snorgaard O, Poulsen GM, Andersen HK, Astrup A (2017) Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care 5(1):e000354. https://doi.org/10.1136/bmjdrc-2016-000354

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tabak AG, Akbaraly TN, Batty GD, Kivimaki M (2014) Depression and type 2 diabetes: a causal association? Lancet Diabetes Endocrinol 2(3):236–245. https://doi.org/10.1016/S2213-8587(13)70139-6

    Article  PubMed  Google Scholar 

  7. Chung CC, Pimentel D, Jor’dan AJ, Hao Y, Milberg W, Novak V (2015) Inflammation-associated declines in cerebral vasoreactivity and cognition in type 2 diabetes. Neurology 85(5):450–458. https://doi.org/10.1212/WNL.0000000000001820

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Brinkworth GD, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert G, Wilson CJ (2016) Long-term effects of very low-carbohydrate and high-carbohydrate weight-loss diets on psychological health in obese adults with type 2 diabetes: randomized controlled trial. J Intern Med 280(4):388–397. https://doi.org/10.1111/joim.12501

    Article  PubMed  CAS  Google Scholar 

  9. Tay J, Zajac IT, Thompson CH, Luscombe-Marsh ND, Danthiir V, Noakes M, Buckley JD, Wittert GA, Brinkworth GD (2016) A randomised-controlled trial of the effects of very low-carbohydrate and high-carbohydrate diets on cognitive performance in patients with type 2 diabetes. Br J Nutr. https://doi.org/10.1017/S0007114516004001

    Article  PubMed  Google Scholar 

  10. Tay J, Thompson CH, Luscombe-Marsh ND, Wycherley TP, Noakes M, Buckley JD, Wittert GA, Yancy WS Jr, Brinkworth GD (2018) Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: a 2-year randomized clinical trial. Diabetes Obes Metab 20(4):858–871. https://doi.org/10.1111/dom.13164

    Article  PubMed  CAS  Google Scholar 

  11. Report of a WHO consultation (2000) Obesity: preventing and managing the global epidemic. World Health Organ Tech Rep Ser 894:i-xii, 1–253

  12. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    Article  CAS  Google Scholar 

  13. Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert GA, Yancy WS Jr, Brinkworth GD (2015) Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr 102(4):780–790. https://doi.org/10.3945/ajcn.115.112581

    Article  PubMed  CAS  Google Scholar 

  14. McNair DM, Lorr M, Droppleman FF (1971) Manual: profile of mood states. Educational and Industrial Testing Service, San Diego

    Google Scholar 

  15. Nyenhuis DL, Yamamoto C, Luchetta T, Terrien A, Parmentier A (1999) Adult and geriatric normative data and validation of the profile of mood states. J Clin Psychol 55(1):79–86. https://doi.org/10.1002/(SICI)1097-4679(199901)55:1%3c79::AID-JCLP8%3e3.0.CO;2-7

    Article  PubMed  CAS  Google Scholar 

  16. McNair DM, Heuchert P (2013) Profile of mood states: technical update. MHS, North Tonawanda

    Google Scholar 

  17. Beck AT, Steer RA, Brown GK (1996) Beck depression inventory manual, 2nd edn. The Psychological Corporation, San Antonio

    Google Scholar 

  18. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA (1983) Manual for the state-trait anxiety inventory. Consulting Psychologists Press Inc, Palo Alto

    Google Scholar 

  19. Boyer JG, Earp JA (1997) The development of an instrument for assessing the quality of life of people with diabetes. Diabetes-39. Med Care 35(5):440–453

    Article  CAS  Google Scholar 

  20. Polonsky WH, Anderson BJ, Lohrer PA, Welch G, Jacobson AM, Aponte JE, Schwartz CE (1995) Assessment of diabetes-related distress. Diabetes Care 18(6):754–760

    Article  CAS  Google Scholar 

  21. Welch G, Weinger K, Anderson B, Polonsky WH (2003) Responsiveness of the problem areas in diabetes (PAID) questionnaire. Diabetic Med 20(1):69–72

    Article  CAS  Google Scholar 

  22. Polonsky WH, Welch G (1996) Listening to our patients’ concerns: understanding and addressing diabetes-specific emotional distress. Diabetes Spectr 9:8–11

    Google Scholar 

  23. Danthiir V, Burns NR, Nettelbeck T, Wilson C, Wittert G (2011) The older people, omega-3, and cognitive health (EPOCH) trial design and methodology: a randomised, double-blind, controlled trial investigating the effect of long-chain omega-3 fatty acids on cognitive ageing and wellbeing in cognitively healthy older adults. Nutr J 10:117

    Article  CAS  Google Scholar 

  24. Danthiir V, Hosking D, Burns NR, Wilson C, Nettelbeck T, Calvaresi E, Clifton P, Wittert GA (2014) Cognitive performance in older adults is inversely associated with fish consumption but not erythrocyte membrane n-3 fatty acids. J Nutr 144(3):311–320. https://doi.org/10.3945/jn.113.175695

    Article  PubMed  CAS  Google Scholar 

  25. van den Berg E, Kloppenborg RP, Kessels RP, Kappelle LJ, Biessels GJ (2009) Type 2 diabetes mellitus, hypertension, dyslipidemia and obesity: a systematic comparison of their impact on cognition. Biochem Biophys Acta 1792(5):470–481. https://doi.org/10.1016/j.bbadis.2008.09.004

    Article  PubMed  CAS  Google Scholar 

  26. Cohen J (1969) Statistical power analysis for the behavioural sciences. Academic Press, London

    Google Scholar 

  27. Freedman M, King J, Kennedy E (2001) Popular diets: a scientific review. Obes Res 9(1):1S-40S

    Article  CAS  Google Scholar 

  28. El Ghoch M, Calugi S, Dalle Grave R (2016) The effects of low-carbohydrate diets on psychosocial outcomes in obesity/overweight: a systematic review of randomized, controlled studies. Nutrients. https://doi.org/10.3390/nu8070402

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sumlin LL, Garcia TJ, Brown SA, Winter MA, Garcia AA, Brown A, Cuevas HE (2014) Depression and adherence to lifestyle changes in type 2 diabetes: a systematic review. Diabetes Educ 40(6):731–744

    Article  Google Scholar 

  30. Ciechanowski PS, Katon WJ, Russo JE (2000) Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 160(21):3278–3285

    Article  CAS  Google Scholar 

  31. Lin EH, Rutter CM, Katon W, Heckbert SR, Ciechanowski P, Oliver MM, Ludman EJ, Young BA, Williams LH, McCulloch DK, Von Korff M (2010) Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care 33(2):264–269. https://doi.org/10.2337/dc09-1068

    Article  PubMed  Google Scholar 

  32. van Dooren FE, Nefs G, Schram MT, Verhey FR, Denollet J, Pouwer F (2013) Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis. PLoS ONE 8(3):e57058. https://doi.org/10.1371/journal.pone.0057058

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Miller-Kovach K, Hermann M, Winick M (1999) The psychological ramifications of weight management. J Womens Health Gend Based Med 8(4):477–482

    Article  CAS  Google Scholar 

  34. Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B (2010) Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 33(12):e147-167. https://doi.org/10.2337/dc10-9990

    Article  PubMed  PubMed Central  Google Scholar 

  35. Vallis M (2016) Quality of life and psychological well-being in obesity management: improving the odds of success by managing distress. Int J Clin Pract 70(3):196–205. https://doi.org/10.1111/ijcp.12765

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Ravona-Springer R, Heymann A, Schmeidler J, Moshier E, Guerrero-Berroa E, Soleimani L, Sano M, Leroith D, Preiss R, Tzukran R, Silverman JM, Beeri MS (2017) Hemoglobin A1c variability predicts symptoms of depression in elderly individuals with type 2 diabetes. Diabetes Care 40(9):1187–1193. https://doi.org/10.2337/dc16-2754

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Gummesson A, Nyman E, Knutsson M, Karpefors M (2017) Effect of weight reduction on glycated haemoglobin in weight loss trials in patients with type 2 diabetes. Diabetes Obes Metab 19(9):1295–1305. https://doi.org/10.1111/dom.12971

    Article  PubMed  CAS  Google Scholar 

  38. Makris A, Darcey VL, Rosenbaum DL, Komaroff E, Vander Veur SS, Collins BN, Klein S, Wyatt HR, Foster GD (2013) Similar effects on cognitive performance during high- and low-carbohydrate obesity treatment. Nutr Diabetes 3:e89. https://doi.org/10.1038/nutd.2013.29

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Brinkworth GD, Buckley JD, Noakes M, Clifton PM, Wilson CJ (2009) Long-term effects of a very low-carbohydrate diet and a low-fat diet on mood and cognitive function. Arch Intern Med 169(20):1873–1880. https://doi.org/10.1001/archinternmed.2009.329169/20/1873[pii]

    Article  PubMed  CAS  Google Scholar 

  40. Cheatham RA, Roberts SB, Das SK, Gilhooly CH, Golden JK, Hyatt R, Lerner D, Saltzman E, Lieberman HR (2009) Long-term effects of provided low and high glycemic load low energy diets on mood and cognition. Physiol Behav 98(3):374–379. https://doi.org/10.1016/j.physbeh.2009.06.015

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. Zhang J, McKeown RE, Muldoon MF, Tang S (2006) Cognitive performance is associated with macronutrient intake in healthy young and middle-aged adults. Nutr Neurosci 9(3–4):179–187. https://doi.org/10.1080/10284150600955172

    Article  PubMed  CAS  Google Scholar 

  42. Okereke OI, Rosner BA, Kim DH, Kang JH, Cook NR, Manson JE, Buring JE, Willett WC, Grodstein F (2012) Dietary fat types and 4-year cognitive change in community-dwelling older women. Ann Neurol 72(1):124–134. https://doi.org/10.1002/ana.23593

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Sanchez-Villegas A, Verberne L, De Irala J, Ruiz-Canela M, Toledo E, Serra-Majem L, Martinez-Gonzalez MA (2011) Dietary fat intake and the risk of depression: the SUN Project. PLoS ONE 6(1):e16268. https://doi.org/10.1371/journal.pone.0016268

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Solfrizzi V, Colacicco AM, D’Introno A, Capurso C, Torres F, Rizzo C, Capurso A, Panza F (2006) Dietary intake of unsaturated fatty acids and age-related cognitive decline: a 8.5-year follow-up of the Italian Longitudinal Study on Aging. Neurobiol Aging 27(11):1694–1704. https://doi.org/10.1016/j.neurobiolaging.2005.09.026

    Article  PubMed  CAS  Google Scholar 

  45. Naqvi AZ, Harty B, Mukamal KJ, Stoddard AM, Vitolins M, Dunn JE (2011) Monounsaturated, trans, and saturated Fatty acids and cognitive decline in women. J Am Geriatr Soc 59(5):837–843. https://doi.org/10.1111/j.1532-5415.2011.03402.x

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kien CL, Bunn JY, Tompkins CL, Dumas JA, Crain KI, Ebenstein DB, Koves TR, Muoio DM (2013) Substituting dietary monounsaturated fat for saturated fat is associated with increased daily physical activity and resting energy expenditure and with changes in mood. Am J Clin Nutr 97(4):689–697. https://doi.org/10.3945/ajcn.112.051730

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  47. Witte AV, Fobker M, Gellner R, Knecht S, Floel A (2009) Caloric restriction improves memory in elderly humans. Proc Natl Acad Sci USA 106(4):1255–1260

    Article  Google Scholar 

  48. Louie JC, Jones M, Barclay AW, Brand-Miller JC (2017) Dietary glycaemic index and glycaemic load among Australian adults—results from the 2011–2012 Australian Health Survey. Sci Rep 7:43882. https://doi.org/10.1038/srep43882

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, Cavan D, Shaw JE, Makaroff LE (2017) IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 128:40–50. https://doi.org/10.1016/j.diabres.2017.03.024

    Article  PubMed  CAS  Google Scholar 

  50. Bakker LE, van Schinkel LD, Guigas B, Streefland TC, Jonker JT, van Klinken JB, van der Zon GC, Lamb HJ, Smit JW, Pijl H, Meinders AE, Jazet IM (2014) A 5-day high-fat, high-calorie diet impairs insulin sensitivity in healthy, young South Asian men but not in Caucasian men. Diabetes 63(1):248–258. https://doi.org/10.2337/db13-0696

    Article  PubMed  CAS  Google Scholar 

  51. Alathari BE, Bodhini D, Jayashri R, Lakshmipriya N, Shanthi Rani CS, Sudha V, Lovegrove JA, Anjana RM, Mohan V, Radha V, Pradeepa R, Vimaleswaran KS (2020) A nutrigenetic approach to investigate the relationship between metabolic traits and vitamin d status in an asian indian population. Nutrients. https://doi.org/10.3390/nu12051357

    Article  PubMed  PubMed Central  Google Scholar 

  52. Clarke C, Best T (2017) Low-carbohydrate, high-fat dieters: characteristic food choice motivations, health perceptions and behaviours. Food Qual Prefer 62:162–171

    Article  Google Scholar 

  53. Iacovides S, Goble D, Paterson B, Meiring RM (2019) Three consecutive weeks of nutritional ketosis has no effect on cognitive function, sleep, and mood compared with a high-carbohydrate, low-fat diet in healthy individuals: a randomized, crossover, controlled trial. Am J Clin Nutr 110(2):349–357. https://doi.org/10.1093/ajcn/nqz073

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank the volunteers for their participation. We gratefully acknowledge the work of the Clinical Research Team at the Commonwealth Scientific and Industrial Research Organisation (CSIRO)—Food and Nutrition, Adelaide, South Australia: Ann McGuffin, Julia Weaver and Vanessa Courage for coordinating the trial; Pennie Taylor, Janna Lutze, Paul Foster, Gemma Williams, Hannah Gilbert and Fiona Barr for assisting in designing and implementing the dietary intervention; Lindy Lawson, Theresa Mckinnon for nursing expertise and administering the questionnaires; Vanessa Danthiier for developing the cognitive test battery; Heidi Long and Laura Edney for administering the cognitive tests; Julie Syrette for performing the data scoring and data management; Luke Johnston and Annie Hastwell (Fit for Success, SA), Kelly French, Jason Delfos, Kristi Lacey-Powell, Marilyn Woods, John Perrin, Simon Pane, Annette Beckette (SA Aquatic Centre & Leisure Centre), and Angie Mondello and Josh Gniadek (Boot Camp Plus, SA), for conducting the exercise sessions.

Funding

This study was supported by a National Health and Medical Research Council of Australia Project Grant (APP103415).

Author information

Authors and Affiliations

  1. Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Adelaide, SA, Australia

    Naomi Kakoschke, Ian T. Zajac, Natalie D. Luscombe-Marsh & Manny Noakes

  2. A-Star Singapore-Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore

    Jeannie Tay

  3. Freemasons Foundation Centre for Men’s Health, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia

    Campbell H. Thompson & Gary Wittert

  4. Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia

    Jonathan D. Buckley & Grant D. Brinkworth

  5. Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Riverside Corporate Park, 11 Julius Avenue, North Ryde, NSW, 2113, Australia

    Grant D. Brinkworth

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  1. Naomi Kakoschke
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  2. Ian T. Zajac
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  3. Jeannie Tay
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  9. Grant D. Brinkworth
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Contributions

GDB had full access to all the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: All authors. Data analysis and interpretation of data: All authors. Drafting of the manuscript: NK, IZ, GDB. Critical revision the manuscript for intellectual content: All authors. Read and approved the final manuscript: All authors. Obtained funding: GDB, NLM, CHT, MN, JDB. Study supervision: GDB, JT, NLM, CHT, MN, JDB.

Corresponding author

Correspondence to Grant D. Brinkworth.

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The sponsor has no role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript.

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Kakoschke, N., Zajac, I.T., Tay, J. et al. Effects of very low-carbohydrate vs. high-carbohydrate weight loss diets on psychological health in adults with obesity and type 2 diabetes: a 2-year randomized controlled trial. Eur J Nutr 60, 4251–4262 (2021). https://doi.org/10.1007/s00394-021-02587-z

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