But Andrew has Type 1 diabetes, and six years ago, in order to control his blood sugar levels, his parents put him on a low-carbohydrate, high-protein diet. Dietary amylose-amylopectin starch content affects glucose and lipid metabolism in adipocytes of normal and diabetic rats. Even in studies in the general population where a higher CHO intake was associated with worse outcomes, healthier macronutrients consumption was associated with decreased cardiovascular and non-cardiovascular mortality. Nutrition and Metabolism Has carbohydrate-restriction been forgotten as a treatment for diabetes mellitus? Once insulin was introduced, carb restriction fell out of practice. However, some people with type 1 diabetes have confirmed that counting at least a portion of fiber in foods works best when calculating insulin dosages. Some studies indicate that both type and levels of nutrients can influence the generation, survival and function of lymphocytes and therefore can affect certain autoimmune diseases to some extent [ 82 ]. We know that, for example, a Mediterranean diet is safe, can be maintained for a life-time and has durable effects on glycemic control when compared to a standard diet [ 59, 60 ], in addition to reducing post-prandial lipemia [ 61 ]. A clinical audit performed to assess the long-term adherence to LCD in people with T1D showed that after two years about half of the people ceased adhering, the other half adhered for at least four years, with the adherent patients experiencing a sustained reduction in HbA1c levels [ 98 ].
Low-carb and ketogenic diets are popular among clinicians and patients, but the appropriateness of reducing carbohydrates intake in obese patients and in patients with diabetes is still debated. Studies in the literature are indeed controversial, possibly because these diets are generally poorly defined; this, together with the intrinsic complexity of dietary interventions, makes it difficult to compare results from different studies. Despite the evidence that reducing carbohydrates intake lowers body weight and, in patients with type 2 diabetes, improves glucose control, few data are available about sustainability, safety and efficacy in the long-term. In this review we explored the possible role of low-carb and ketogenic diets in the pathogenesis and management of type 2 diabetes and obesity. Furthermore, we also reviewed evidence of carbohydrates restriction in both pathogenesis of type 1 diabetes, through gut microbiota modification, and treatment of type 1 diabetes, addressing the legitimate concerns about the use of such diets in patients who are ketosis-prone and often have not completed their growth. According to the International Diabetes Federation 8th Diabetes Atlas, about million people worldwide have diabetes and, if the current trends continue, million of people aged 20—79 will have diabetes by [ 1 ]. Nutrition is key for preventing type 2 diabetes T2D and obesity, but there are no evidence-based data defining the best dietary approach to prevent and treat these conditions. In the last decades, low carbohydrate diets LCD and ketogenic diets KD have become widely known and popular ways to lose weight, not only within the scientific community, but also among the general public, with best-selling dedicated books or intense discussion on social media networks staying at the top of the diet trend list for years. These dietary approaches are effective for losing weight, but there is growing evidence suggesting that caution is needed, especially when these diets are followed for long periods of time, or by individuals of a very young age or with certain diseases [ 2, 3 ].
Although episodes of hypoglycemia can be minimized with a low-carb approach, occasional lows are inevitable for people with type 1 diabetes. Dehghan M. However, some people with type 1 diabetes have confirmed that counting at least a portion of fiber in foods works best when calculating insulin dosages. An obesity-associated gut microbiome with increased capacity for energy harvest. Protein provides essential amino acids, helps build and maintain muscle, and is involved in creating hormones, among other functions. Veggiotti P. This surprised and impressed him: he had never seen any patient with type 1 diabetes able to completely normalize their hemoglobin A1cs. Moschen A. Effect of low-fat vs low-carbohydrate diet on month weight loss in overweight adults and the association with genotype pattern or insulin secretion: The DIETFITS randomized clinical trial. IJC Metab. Diabetes Obes.