title: A low-carbohydrate as compared with a low-fat diet in severe obesity. Euglycemia and normolipidemia after anti-obesity gastric bypass. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes--a randomized controlled trial. Clinical Efficacy of Two Hypocaloric Diets That Vary in Overweight Patients With Type 2 Diabetes Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes. A brief report. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects.
abstract: BACKGROUND The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed . METHODS We r and omly assigned 132 severely obese subjects ( including 77 blacks and 23 women ) with a mean body-mass index of 43 and a high prevalence of diabetes ( 39 percent ) or the metabolic syndrome ( 43 percent ) to a carbohydrate-restricted ( low-carbohydrate ) diet or  a calorie- and fat-restricted ( low-fat ) diet . RESULTS Seventy-nine subjects completed the six-month study . An analysis including all subjects , with the last observation carried forward for those who dropped out , showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet ( mean [ + /-SD ] , -5.8+/-8.6 kg vs. -1.9+/-4.2 kg ; P=0.002 ) and had greater decreases in triglyceride levels ( mean , -20+/-43 percent vs. -4+/-31 percent ; P=0.001 ) , irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications . Insulin sensitivity , measured only in subjects without diabetes , also improved more among subjects on the low-carbohydrate diet ( 6+/-9 percent vs. -3+/-8 percent , P=0.01 ) . The amount of weight lost ( P<0.001 ) and assignment to the low-carbohydrate diet ( P=0.01 ) were independent predictors of improvement in triglyceride levels and insulin sensitivity . CONCLUSIONS Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet , with a relative improvement in insulin sensitivity and triglyceride levels , even after adjustment for the amount of weight lost . This finding should be interpreted with caution , given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study . Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed UNLABELLED Weight loss and resolution of comorbidities is well established after modern bariatric procedures , however chronology of glyco-lipidic biochemical response is still debated . OBJECTIVE Aim ing to analyze this variable as well as its correlation with food amount and composition , a prospect i ve study was design ed . METHODOLOGY Eighty consecutive patients undergoing Roux-en-Y gastric bypass were investigated every three months until one year after surgery . Females only were accepted and variables included general and nutritional course as well as glucose and lipid measurements . Energy intake was documented including percentage of macronutrients in the diet . RESULTS Surgery was successful with about 71 % excess body weight loss at the end of the first year . Mean energy intake on the 4 postoperative quarters was respectively 519.6 + /- 306.6 , 836.0 + /- 407.9 , 702.1 + /- 313.1 and 868.8 + /- 342.8 kcal/day ( mean + /- SD ) . Fat intake was initially low but reached 34.1 + /- 7.9 % of total calories at final measurement . Blood glucose and lipid fractions tended to be borderline or abnormal preoperatively , and favorably changed by 12 months . Consumption of glucose- and lipid-lowering medication  significantly diminished , but each of these was still necessary in 6.3 % of the group . Correlation between body mass index and also calorie intake versus glucose and lipid measurements was highly significant ( P = 0.000 ) . CONCLUSIONS 1 ) Energy intake after operation was very low ; 2 ) Weight loss proceeded rapidly and correlated with meal pattern ; 3 ) Improvement of glucose and lipid tests was adequate but took several quarters to normalize ; 4 ) Decreased requirements for glucose- and lipid-lowering medication was significant but not absolute ; 4 ) Fat percentage of total calories exceeded 30 % at the end of the observation period , despite recommendations to the contrary Objective Dietary carbohydrate is the major determinant of postpr and ial glucose levels , and several clinical studies have shown that low-carbohydrate diets improve glycemic control . In this study , we tested the hypothesis that a diet lower in carbohydrate would lead to greater improvement in glycemic control over a 24-week period in patients with obesity and type 2 diabetes mellitus . Research design and methods Eighty-four community volunteers with obesity and type 2 diabetes were r and omized to either a low-carbohydrate , ketogenic diet ( < 20 g of carbohydrate daily ; LCKD ) or a low-glycemic , reduced-calorie diet ( 500 kcal/day deficit from weight maintenance diet ; LGID ) . Both groups received group meetings , nutritional supplementation , and an exercise recommendation . The main outcome was glycemic control , measured by hemoglobin A1c . Results Forty-nine ( 58.3 % ) participants completed the study . Both interventions led to improvements in hemoglobin A1c , fasting glucose , fasting insulin , and weight loss . The LCKD group had greater improvements in hemoglobin A1c ( -1.5 % vs. -0.5 % , p = 0.03 ) , body weight ( -11.1 kg vs. -6.9 kg , p = 0.008 ) , and high density lipoprotein cholesterol ( + 5.6 mg/dL vs. 0 mg/dL , p < 0.001 ) compared to the LGID group . Diabetes medications were reduced or eliminated in 95.2 % of LCKD vs. 62 % of LGID participants ( p < 0.01 ) . Conclusion Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes . The diet lower in carbohydrate led to greater improvements in glycemic control , and more frequent medication reduction/elimination than the low glycemic index diet . Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes OBJECTIVE To compare the effects of a 1-year intervention with a low-carbohydrate and a low-fat diet on weight loss and glycemic control in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS This study is a r and omized clinical trial of 105 overweight adults with type 2 diabetes . Primary outcomes were weight and A1C . Secondary outcomes included blood pressure and lipids . Outcome measures were obtained at 3 , 6 , and 12 months . RESULTS The greatest reduction in weight and A1C occurred within the first 3 months . Weight loss occurred faster in the low-carbohydrate group than in the low-fat group ( P = 0.005 ) , but at 1 year a similar 3.4 % weight reduction was seen in both dietary groups . There was no significant change in A1C in either group at 1 year . There was no change in blood pressure , but a greater increase in HDL was observed in the low-carbohydrate group ( P = 0.002 ) . CONCLUSIONS Among patients with type 2 diabetes , after 1 year a low-carbohydrate diet had effects on weight and A1C similar to those seen with a low-fat diet . There was no significant effect on blood pressure , but the low-carbohydrate diet produced a greater increase in HDL cholesterol OBJECTIVE This study sought to examine the effects of a 3-month programme of dietary advice to restrict carbohydrate intake compared with reduced-portion , low-fat advice in obese subjects with poorly controlled Type 2 diabetes . RESEARCH DESIGN AND METHODS One hundred and two patients with Type 2 diabetes were recruited across three centres and r and omly allocated to receive group education and individual dietary advice .  Weight , glycaemic control , lipids and blood pressure were assessed at baseline and 3 months . Dietary quality was assessed at the end of study . RESULTS Weight loss was greater in the low-carbohydrate ( LC ) group ( -3.55 + /- 0.63 , mean + /- sem ) vs. -0.92 + /- 0.40 kg , P = 0.001 ) and cholesterol : high-density lipoprotein ( HDL ) ratio improved ( -0.48 + /- 0.11 vs. -0.10 + /- 0.10 , P = 0.01 ) . However , relative saturated fat intake was greater ( 13.9 + /- 0.71 vs. 11.0 + /- 0.47 % of dietary intake , P < 0.001 ) , although absolute intakes were moderate . CONCLUSIONS Carbohydrate restriction was an effective method of achieving short-term weight loss compared with st and ard advice , but this was at the expense of an increase in relative saturated fat intake Approximately 80 % of patients with type 2 diabetes are overweight/obese ( 1 ) , and weight loss is the mainstay of treatment for these individuals . However , there is growing controversy as to whether reduced-fat or reduced-carbohydrate diets are best suited for this purpose , and results ( 2–8 ) in nondiabetic subjects suggest that lower carbohydrate diets are similarly or more efficacious in improving weight , triglycerides , and HDL cholesterol . There are no published r and omized studies evaluating the role of dietary macronutrients with respect to weight loss and cardiovascular risk improvement in patients with type 2 diabetes . Thus , we r and omized diet-treated patients with type 2 diabetes to hypocaloric diets , moderately restricted in either carbohydrate or fat , to determine whether weight loss or metabolic improvement differed as a function of macronutrient composition . A total of 29 patients with diet-treated type 2 diabetes were recruited from the San Francisco Bay area . All subjects gave written informed consent . Inclusion criteria included BMI 27–36 kg/m2 , fasting plasma glucose concentration 7.2–8.3 mmol/l , no use of antihyperglycemic medications , and stable weight for 3 months . Subjects on anti-hypertensive or cholesterol-lowering drugs or aspirin were allowed to continue their medications . Insulin-mediated glucose uptake was quantified by a modification ( 9 ) of the insulin suppression test as originally described ( 10 ) and vali date d ( 11 ) . In this test , a 180-min infusion of somatostatin ( 0.27 μg/m2 per min ) , insulin ( 25 mU/m2 per min ) , In two groups of obese patients with type 2 diabetes the effects of 2 different diet compositions were tested with regard to glycaemic control and bodyweight . A group of 16 obese patients with type 2 diabetes was advised on a low-carbohydrate diet , 1800 kcal for men and 1600 kcal for women , distributed as 20 % carbohydrates , 30 % protein and 50 % fat .  Fifteen obese diabetes patients on a high-carbohydrate diet were control group .  Their diet , 1600 - 1800 kcal for men and 1400 - 1600 kcal for women , consisted of approximately 60 % carbohydrates , 15 % protein and 25 % fat . Positive effects on the glucose levels were seen very soon . After 6 months a marked reduction in bodyweight of patients in the low-carbohydrate diet group was observed , and this remained one year later . After 6 months the mean changes in the low-carbohydrate group and the control group respectively were ( + /-SD ) : fasting blood glucose ( f-BG ) : -3.4 + /- 2.9 and -0.6 + /- 2.9 mmol/l ; HBA1c : -1.4 + /- 1.1 % and -0.6 + /- 1.4 % ; Body Weight : -11.4 + /- 4 kg and -1.8 + /- 3.8 kg ; BMI : -4.1 + /- 1.3 kg/m _ and -0.7 + /- 1.3 kg/m_. Large changes in blood glucose levels were seen immediately . A low-carbohydrate diet is an effective tool in the treatment of obese patients with type 2 diabetes BACKGROUND Low-carbohydrate diets are effective for weight reduction in people without diabetes , but there is limited evidence for people with Type 2 diabetes . Aims To assess the impact of a low-carbohydrate diet on body weight , glycated haemoglobin ( HbA(1c ) ) , ketone and lipid levels in diabetic and non-diabetic subjects . METHODS Thirteen Type 2 diabetic subjects ( on diet or metformin ) and 13 non-diabetic subjects were r and omly allocated to either a low-carbohydrate diet ( < or = 40 g carbohydrate/day ) or a healthy-eating diet following Diabetes UK nutritional recommendations and were seen monthly for 3 months . Subjects ( 25 % male ) were ( mean + /- sd ) age 52 + /- 9 years , weight 96.3 + /- 16.6 kg , body mass index 35.1 kg/m(2 ) , HbA(1c ) 6.6 + /- 1.1 % , total cholesterol 5.1 + /- 1.1 mmol/l , high-density lipoprotein cholesterol 1.3 + /- 0.4 mmol/l , low-density lipoprotein cholesterol 3.1 + /- 0.9 mmol/l , triglycerides ( geometric mean ) 1.55 ( 1.10 , 2.35 ) mmol/l and ketones range 0.0 - 0.2 mmol/l . RESULTS Analysis was by intention to treat with last observation carried forward . Twenty-two of the participants ( 85 % ) completed the study .  Weight loss was greater ( 6.9 vs. 2.1 kg , P = 0.003 ) in the low-carbohydrate group , with no difference in changes in HbA(1c ) , ketone or lipid levels . CONCLUSIONS The diet was equally effective in those with and without diabetes
target: The longest trial intervention studies did not show a difference in weight change .
  This review shows that there are no consistent differences in weight and A1C changes over the long-term treatment with LCD and LFD , UCD or LGID
background: INTRODUCTION Low carbohydrate diets ( LCD ) have shown beneficial effects on short-term weight reduction programs for obese individuals without diabetes , but the long-term evidence of efficacy on individuals with type 2 diabetes is not conclusive .
  OBJECTIVE To evaluate , the effectiveness of 12 or more weeks of LCD compared to Low Fat Diet ( LFD ) , Usual Care Diet ( UCD ) or Low Glycemic Index Diet ( LGID ) on weight reduction and AIC on type 2 diabetes individuals .