Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes
Publication: Annals of Internal Medicine
Volume 142, Number 6
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Abstract
Background:
It is not known how a low-carbohydrate, high-protein, high-fat diet causes weight loss or how it affects blood glucose levels in patients with type 2 diabetes.
Objective:
To determine effects of a strict low-carbohydrate diet on body weight, body water, energy intake and expenditure, glycemic control, insulin sensitivity, and lipid levels in obese patients with type 2 diabetes.
Design:
Inpatient comparison of 2 diets.
Setting:
General clinical research center of a university hospital.
Patients:
10 obese patients with type 2 diabetes.
Intervention:
Usual diets for 7 days followed by a low-carbohydrate diet for 14 days.
Measurements:
Body weight, water, and composition; energy intake and expenditure; diet satisfaction; hemoglobin A1c; insulin sensitivity; 24-hour urinary ketone excretion; and plasma profiles of glucose, insulin, leptin, and ghrelin.
Results:
On the low-carbohydrate diet, mean energy intake decreased from 3111 kcal/d to 2164 kcal/d. The mean energy deficit of 1027 kcal/d (median, 737 kcal/d) completely accounted for the weight loss of 1.65 kg in 14 days (median, 1.34 kg in 14 days). Mean 24-hour plasma profiles of glucose levels normalized, mean hemoglobin A1c decreased from 7.3% to 6.8%, and insulin sensitivity improved by approximately 75%. Mean plasma triglyceride and cholesterol levels decreased (change, −35% and −10%, respectively).
Limitations:
The study was limited by the short duration, small number of participants, and lack of a strict control group.
Conclusion:
In a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in spontaneous reduction in energy intake to a level appropriate to their height; weight loss that was completely accounted for by reduced caloric intake; much improved 24-hour blood glucose profiles, insulin sensitivity, and hemoglobin A1c; and decreased plasma triglyceride and cholesterol levels. The long-term effects of this diet, however, remain uncertain.
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References
1.
Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288:1723-7. [PMID: 12365955]
2.
Atkins RC. Dr. Atkins' Diet Revolution. New York: Bantam; 1972.
3.
Freedman MR, King J, Kennedy E. Popular diets: a scientific review. Obes Res. 2001;9 Suppl 1 1S-40S. [PMID: 11374180]
4.
Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082-90. [PMID: 12761365]
5.
Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med. 2003;348:2074-81. [PMID: 12761364]
6.
Yancy WS Jr, Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med. 2004;140:769-77. [PMID: 15148063]
7.
Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140:778-85. [PMID: 15148064]
8.
Atkins RC. Dr. Atkins' New Diet Revolution. New York: Avon Books; 1992.
9.
Greene P, Willett W, Devecis J, Skaf A. Pilot 12-week feeding weight-loss comparison: low-fat vs. low-carbohydrate (ketogenic) diets [Abstract]. Obes Res. 2003;11:A23.
10.
Hill AJ, Blundell JE. Nutrients and behaviour: research strategies for the investigation of taste characteristics, food preferences, hunger sensations and eating patterns in man. J Psychiatr Res. 1982;17:203-12. [PMID: 6764938]
11.
Lukaski HC. Methods for the assessment of human body composition: traditional and new. Am J Clin Nutr. 1987;46:537-56. [PMID: 3310598]
12.
Schoeller DA, Ravussin E, Schutz Y, Acheson KJ, Baertschi P, Jéquier E. Energy expenditure by doubly labeled water: validation in humans and proposed calculation. Am J Physiol. 1986;250:R823-30. [PMID: 3085521]
13.
Homko CJ, Cheung P, Boden G. Effects of free fatty acids on glucose uptake and utilization in healthy women. Diabetes. 2003;52:487-91. [PMID: 12540625]
14.
Boden G, Cheung P, Homko C. Effects of acute insulin excess and deficiency on gluconeogenesis and glycogenolysis in type 1 diabetes. Diabetes. 2003;52:133-7. [PMID: 12502503]
15.
Molina JM, Baron AD, Edelman SV, Brechtel G, Wallace P, Olefsky JM. Use of a variable tracer infusion method to determine glucose turnover in humans. Am J Physiol. 1990;258:16-23. [PMID: 2405697]
16.
Altszuler N, De Bodo RC, Steele R, Wall JS. Measurement of size and turnover rate of body glucose pool by the isotope dilution method. Am J Physiol. 1956;187:15-24. [PMID: 13362583]
17.
Owen OE, Trapp VE, Reichard GA Jr, Mozzoli MA, Smith R, Boden G. Effects of therapy on the nature and quantity of fuels oxidized during diabetic ketoacidosis. Diabetes. 1980;29:365-72. [PMID: 6769726]
18.
Tappy L, Owen OE, Boden G. Effect of hyperinsulinemia on urea pool size and substrate oxidation rates. Diabetes. 1988;37:1212-6. [PMID: 3044886]
19.
Hawk PB. The Kjeldahl method. In: Hawk PB, Oser BL, and Summerson WH, eds. Practical Physiological Chemistry. 12th ed. Toronto: Blakiston; 1947:814-22.
20.
Van Itallie TB, Yang MU. Diet and weight loss. N Engl J Med. 1977;297:1158-61. [PMID: 917044]
21.
Lewis SB, Wallin JD, Kane JP, Gerich JE. Effect of diet composition on metabolic adaptations to hypocaloric nutrition: comparison of high carbohydrate and high fat isocaloric diets. Am J Clin Nutr. 1977;30:160-70. [PMID: 835502]
22.
Owen OE, Kavle E, Owen RS, Polansky M, Caprio S, Mozzoli MA, et al. A reappraisal of caloric requirements in healthy women. Am J Clin Nutr. 1986;44:1-19. [PMID: 3728346]
23.
Owen OE, Holup JL, D'Alessio DA, Craig ES, Polansky M, Smalley KJ, et al. A reappraisal of the caloric requirements of men. Am J Clin Nutr. 1987;46:875-85. [PMID: 3687821]
24.
Rich AJ, Chambers P, Johnston IDA. Are ketones an appetite suppressant? [Abstract]. JPEN J Parenter Enteral Nutr. 1988;13:7S.
25.
Rodin J, Wack J, Ferrannini E, DeFronzo RA. Effect of insulin and glucose on feeding behavior. Metabolism. 1985;34:826-31. [PMID: 3897769]
26.
Holt SH, Miller JB. Increased insulin responses to ingested foods are associated with lessened satiety. Appetite. 1995;24:43-54. [PMID: 7741535]
27.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:977-86. [PMID: 8366922]
28.
Considine RV, Sinha MK, Heiman ML, Kriauciunas A, Stephens TW, Nyce MR, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med. 1996;334:292-5. [PMID: 8532024]
29.
Boden G, Chen X, Mozzoli M, Ryan I. Effect of fasting on serum leptin in normal human subjects. J Clin Endocrinol Metab. 1996;81:3419-23. [PMID: 8784108]
30.
Boden G, Chen X, Kolaczynski JW, Polansky M. Effects of prolonged hyperinsulinemia on serum leptin in normal human subjects. J Clin Invest. 1997;100:1107-13. [PMID: 9276727]
31.
Campfield LA, Smith JF. Central integration of peripheral signals in the regulation of food intake and energy balance: role of leptin and insulin. In: Bray GA, Bouchard C, eds. Handbook of Obesity. 2nd ed. New York: Marcel Dekker; 2003:461-79.
32.
Jenkins DJ, Wolever TM, Jenkins AL, Josse RG, Wong GS. The glycaemic response to carbohydrate foods. Lancet. 1984;2:388-91. [PMID: 6147465]
33.
Garg A, Bantle JP, Henry RR, Coulston AM, Griver KA, Raatz SK, et al. Effects of varying carbohydrate content of diet in patients with non–insulin-dependent diabetes mellitus. JAMA. 1994;271:1421-8. [PMID: 7848401]
Information & Authors
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Published In
Annals of Internal Medicine
Volume 142 • Number 6 • 15 March 2005
Pages: 403 - 411
History
Published online: 15 March 2005
Published in issue: 15 March 2005
Keywords
Copyright
© 2005 American College of Physicians.
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Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes. Ann Intern Med.2005;142:403-411. [Epub 15 March 2005]. doi:10.7326/0003-4819-142-6-200503150-00006
Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes. Ann Intern Med.2005;142:403-411. [Epub 15 March 2005]. doi:10.7326/0003-4819-142-6-200503150-00006
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