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The low-carbohydrate diet : short-term metabolic efficacy versus longer-term

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Barber, Thomas M., Hanson, Petra, Kabisch, Stefan, Pfeiffer, Andreas F. H. and Weickert, Martin O. (2021) The low-carbohydrate diet : short-term metabolic efficacy versus longer-term. Nutrients, 13 (4). 1187. doi:10.3390/nu13041187

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Official URL: https://doi.org/10.3390/nu13041187

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Abstract

Background: Diets have been a central component of lifestyle modification for decades. The Low-Carbohydrate Diet (LCD), originally conceived as a treatment strategy for intractable epilepsy (due to its association with ketogenesis), became popular in the 1970s and since then has risen to prominence as a weight loss strategy. Objective: To explore the efficacy, limitations and potential safety concerns of the LCD. Data Sources: We performed a narrative review, based on relevant articles written in English from a Pubmed search, using the terms ‘low carbohydrate diet and metabolic health’. Results: Evidence supports the efficacy of the LCD in the short-term (up to 6-months) for reduction in fat mass and remission of Type 2 Diabetes Mellitus (T2D). However, the longer-term efficacy of the LCD is disappointing, with diminishment of weight loss potential and metabolic benefits of the LCD beyond 6-months of its adoption. Furthermore, practical limitations of the LCD include the associated restriction of food choices that restrict the acceptability of the LCD for the individual, particularly over the longer term. There are also safety concerns of the LCD that stem from nutritional imbalances (with a relative excess of dietary fat and protein intake with associated dyslipidaemia and increased risk of insulin resistance and T2D development) and ketotic effects. Finally, the LCD often results in a reduction in dietary fibre intake, with potentially serious adverse consequences for overall health and the gut microbiota. Conclusions: Although widely adopted, the LCD usually has short-lived metabolic benefits, with limited efficacy and practicality over the longer term. Dietary modification needs tailoring to the individual, with careful a priori assessments of food preferences to ensure acceptability and adherence over the longer term, with avoidance of dietary imbalances and optimization of dietary fibre intake (primarily from plant-based fruit and vegetables), and with a posteriori assessments of the highly individual responses to the LCD. Finally, we need to change our view of diets from simply an excipient for weight loss to an essential component of a healthy lifestyle. View Full-Text

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
R Medicine > RM Therapeutics. Pharmacology
Divisions: Faculty of Medicine > Warwick Medical School > Biomedical Sciences
Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016)
Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Low-carbohydrate diet, Obesity, Non-insulin-dependent diabetes -- Diet therapy, Ketogenic diet, Insulin -- Metabolism -- Regulation
Journal or Publication Title: Nutrients
Publisher: M D P I A G
ISSN: 2072-6643
Official Date: 3 April 2021
Dates:
DateEvent
3 April 2021Published
31 March 2021Accepted
Volume: 13
Number: 4
Article Number: 1187
DOI: 10.3390/nu13041187
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
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