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Effectiveness of Low-Carbohydrate Diets in Treating Type II Diabetes

Food for thought

David Stockton

on 4 October 2012

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Transcript of Effectiveness of Low-Carbohydrate Diets in Treating Type II Diabetes

Effectiveness of Low-Carbohydrate Diets
in Treating Type II Diabetes David Stockton
U of T Medical School Class of 2014 Accurso et. al. 2008.
Dietary carbohydrate restriction
in T2DM and MetS: time for a
critical appraisal. Nutr & Met. Low-Carb is Dangerous Low-Carb Works Theory 3) Limit the messenger that leads to resistance to and/or underproduction of insulin. Westman et. al. 2008. The effect of a
low-carbohydrate, ketogenic diet versus a
low-glycemic index diet on glycemic control in T2DM Design: Prospective, randomized, unblinded, cohort study. 24 week follow-up. N=49
Primary Outcome: HbA1C Bravata et. al. 2003.
Efficacy and safety of low-carbohydrate
diets: A systematic review. JAMA. 1) Insufficient evidence to make recommendations for or against the
use of low-carbohydrate diets Counter-theory 1) The proportional increase in protein and fats, especially animal fats, may result in: impaired renal function, increased risk of colon cancer, and increased risk of heart disease. Foo et. al. 2009. Vascular
effects of a low-carbohydrate
high-protein diet. PNAS. 1) Low-carb increased atherosclerosis and decreased ischemia-induced neovascularization in mice models
2) Raised concern that low-carb diets could have adverse vascular effects Doc, do these
low-carb diets really work? 1. Lack of control over what subjects ultimately eat Literature Disclaimers: Results:
1) The lowest carb diet was most effective for improving glycemic control (-1.5% vs. -0.5%) 2) HDL increased greatly in the lowest carb diet 3) Diabetes medications reduced/ eliminated in 95.2% of participants on the lowest carb diet 2) Confounders: calorie-restriction, lack of adequate follow-up, exercise, lack of intention-to-treat analysis "Our results demonstrated the marked discordance between the knowledge needed to guide dietary choices and the information that is available in the medical literature." 1) Low-carb diets have been effective for certain people with Type II Diabetes.

2) If you are considering an extreme low-carb diet and are taking insulin, medical supervision is advised.

3) The long-term safety and side-effects have not been elucidated.

4) The quality of food may be important. i.e. locally grown vegetables & fruit in season, grass-fed meat.

5) Stick to the perimeter of the grocery store &
avoid the centre isles! What we can tell patients 2. Small N and/or short duration 3. Both intervention and control diets are hypocaloric 4. Significant confounders & conflicts of interest

Source: Nutrition Science Initiative www.nusi.org 1) Type II Diabetes is an insulin problem 2) Carbohydrate is the macronutrient that raises postprandial serum glucose and insulin most potently. Low-carb diets:


glycemic control


caloric intake More research needed
to support their
efficacy and safety. 2) Any weight lost is quickly re-gained. 3) The long-term vascular effects are not established.
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