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The Merits and the Pitfalls of Low Carbohydrate Diet: A Concise Review

Abstract

Low carbohydrate diets (LCD) may help body weight loss and glycemic control in diabetes but their long-term consequences are not known. The aim of this review is to highlight the contrast between the potential benefits of short term LCD and the adverse health effects of long-term consumption of LCD. LCD can enhance weight loss in the short term although its effect is small and not sustainable. In people with diabetes and insulin resistance, LCD is helpful in achieving glycemic control. However, there are untoward side effects especially when carbohydrates are severely restricted (< 50 gm a day) to induce ketosis. The latter curbs appetite but also may cause nausea, fatigue water and electrolyte losses and limits exercise capacity. In addition, observational studies suggest that low carbohydrate diets (< 40% energy form carbohydrates) as well as very high carbohydrate diets (> 70% energy from carbohydrate) are associated with increased mortality. The available scientific evidence supports the current dietary recommendations to replace highly processed carbohydrates with unprocessed carbohydrates as well as limiting added sugars in the diet.

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References

  1. Alexandraki I, Palacio C, Mooradian AD. The relative merits of low carbohydrate diets in managing obesity: a meta-analysis of low carbohydrate versus low fat diets. Southern medical Journal 2015;108:401–416.

    CAS  Article  Google Scholar 

  2. Franz, MJ, Bantle JP, Beebe CA, Brunzell JD, Jean-Louis Chiasson J-L, Garg A, Holzmeister LA, Hoogwerf B, Mayer-Davis E, Mooradian AD, Purnell JQ, Wheeler M. Technical Review: Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002;25:148–198.

    Article  Google Scholar 

  3. Retterstøl K, Svendsen M, Narverud I, Holven KB. Effect of low carbohydrate high fat diet on LDL cholesterol and gene expression in normal-weight, young adults: A randomized controlled study. Atherosclerosis. 2018 Dec;279:52–61

    Article  Google Scholar 

  4. Carr PR, Walter V, Brenner H, Hoffmeister M. Meat subtypes and their association with colorectal cancer: Systematic review and meta-analysis. Int J Cancer. 2016 Jan 15;138(2):293–302

    CAS  Article  Google Scholar 

  5. Ding B, Xiao R, Ma W, Zhao L, Bi Y, Zhang Y. The association between macronutrient intake and cognition in individuals aged under 65 in china: a cross-sectional study. BMJ Open 2018;8(1):e018573.

    Article  Google Scholar 

  6. 2015–2020 Dietary Guidelines for Americans, https://health.gov/dietaryguidelines/2015/ Accessed December 2019.

  7. Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: A Consensus Report. Diabetes Care 2019; 42: 731–754

    Article  Google Scholar 

  8. Brouns F. Overweight and diabetes prevention: is a low-carbohydrate-high-fat diet recommendable? Eur J Nutr. 2018; 57: 1301–1312.

    CAS  Article  Google Scholar 

  9. Kang HC, Chung DE, Kim DW, Kim HD. Early- and late-onset complications of the ketogenic diet for intractable epilepsy. Epilepsia. 2004 Sep;45(9): 1116–23

    Article  Google Scholar 

  10. Bergqvist AG, Schall JI, Stallings VA, Zemel BS. Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. Am J Clin Nutr. 2008 Dec;88 (6): 1678–84

    CAS  Article  Google Scholar 

  11. Nuttall FQ, Mooradian AD, Gannon MC, Billington C, Krezowski P. Effect of protein ingestion on the glucose and insulin response to a standardized oral glucose load. Diabetes Care. 1984 Sep-Oct;7(5):465–70

    CAS  Article  Google Scholar 

  12. Davies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2018; 61:2461–2498

    Article  Google Scholar 

  13. Sieri S et al Dietary glycemic load and index and risk of coronary heart disease in a large Italian cohort The EPICOR Study. Arch Intern Med. 2010;170:640–647.

    CAS  Article  Google Scholar 

  14. Barclay AW, Petocz P, McMillan-Price J, Flood VM, Prvan T, Mitchell P, Brand-Miller JC. Glycemic index, glycemic load, and chronic disease risk—a meta-analysis of observational studies. Am J Clin Nutr 2008;87:627–637.

    CAS  Article  Google Scholar 

  15. Solon-Biet SM, McMahon AC, Ballard JW et al. The ratio of macronutrients, not caloric intake, dictates cardiometabolic health, aging, and longevity in ad libitum-fed mice. Cell Metab. 2014;19:418–430.

    CAS  Article  Google Scholar 

  16. Levine ME, Suarez JA, Brandhorst S, et al. Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population. Cell Metab. 2014;19:407–417.

    CAS  Article  Google Scholar 

  17. Mazidi M, Katsiki N, Mikhailidis DP, Sattar N, Banach M. Lower carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling of prospective studies. Eur Heart J. 2019;40:2870–2879.

    Article  Google Scholar 

  18. Seidelmann SB, Claggett B, Cheng S et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health 2018; 3: e419–e428.

    Article  Google Scholar 

  19. Dehghan M, Mente A, Zhang X et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017;390:2050–2062.

    CAS  Article  Google Scholar 

  20. Howard, BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 2006;295:655–666.

    CAS  Article  Google Scholar 

  21. Chlebowski RT et al. Low-fat dietary pattern and breast cancer mortality in the Women’s Health Initiative Randomized Controlled Trial. J Clin Oncol. 2017; 35: 2919–2926.

    CAS  Article  Google Scholar 

  22. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 2018;378:e34.

    CAS  Article  Google Scholar 

  23. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008;359:229–241.

    CAS  Article  Google Scholar 

  24. Wang DD, Li Y, Chiuve SE, et al. Association of specific dietary fats with total and cause-specific mortality. JAMA Intern Med 2016; 176: 1134–1145.

    Article  Google Scholar 

  25. Satija A, Bhupathiraju SN, Rimm EB, Spiegelman D, Chiuve SE, Borgi L, Willett WC, Manson JE, Sun Q, Hu FB. Plant based dietary patterns and incidence of type 2 diabetes in US men and women: results from three prospective cohort studies. PLoS Med 2016;13(6):e1002039

    Article  Google Scholar 

  26. Huang R-Y, Huang C-C, Hu FB, Chavarro JE. Vegetarian diets and weight reduction: a meta-analysis of randomized controlled trials. J Gen Intern Med 2016;31:109–116

    Article  Google Scholar 

  27. de la Fuente-Arrillaga, C, Martinez-Gonzalez MA, I Zazpe I, Z Vazquez-Ruiz Z, Benito-Corchon S, Bes-Rastrollo M., Glycemic load, glycemic index, bread and incidence of overweight/obesity in a Mediterranean cohort: the SUN project. BMC Public Health 2014; 14: 1091.

    Article  Google Scholar 

  28. Sun Q, Spiegelman D, van Dam RM, Holmes MD, Malik VS, Willett WC, Hu FB. White rice, brown rice, and risk of type 2 diabetes in US men and women. Archives of Internal Medicine 2010;170:961–969.

    Article  Google Scholar 

  29. Mooradian AD, Smith M, Tokuda M. The role of artificial and natural sweeteners in reducing the consumption of table sugar: A Narrative review. Clinical Nutrition ESPEN 2017;18:1–8.

    Article  Google Scholar 

  30. World Health Organization. (2015). Guideline: sugars intake for adults and children. World Health Organization, https://apps.who.int/iris/handle/10665/149782. Accessed December 2019.

  31. Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, Accurso A, Frassetto L, Gower BA, McFarlane SI. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition 2015;31:1–13.

    CAS  Article  Google Scholar 

  32. Jagadish S, Payne ET, Wong-Kisiel L, Nickels KC, Eckert S, Wirrell EC. The ketogenic and modified atkins diet therapy for children with refractory epilepsy of genetic etiology. Pediat. Neurol. 2019;94:32–37.

    Article  Google Scholar 

  33. Di Francesco A, Di Germanio C, Bernier M, de Cabo R. A time to fast. Science 2018;362:770–775.

    CAS  Article  Google Scholar 

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There was no funding for this manuscript. The author does not have any conflicts of interest to report.

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Correspondence to Arshag D. Mooradian.

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Mooradian, A.D. The Merits and the Pitfalls of Low Carbohydrate Diet: A Concise Review. J Nutr Health Aging 24, 805–808 (2020). https://doi.org/10.1007/s12603-020-1417-1

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Key words

  • Low carbohydrate
  • ketosis
  • weight loss
  • high protein