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ARTICLE

Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes

Guenther Boden, MD; Karin Sargrad, MS, RD, CDE; Carol Homko, PhD, RN, CDE; Maria Mozzoli, BS; and T. Peter Stein, PhD

15 March 2005 | Volume 142 Issue 6 | Pages 403-411

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 A_1c; 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 A_1c 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 A_1c; and decreased plasma triglyceride and cholesterol levels. The long-term effects of this diet, however, remain uncertain.

Editors' Notes Context Despite the popularity of low-carbohydrate diets for weight loss, we know little about how low-carbohydrate diets cause weight loss or how they affect glycemic control. Contribution In a study that observed 10 obese patients with type 2 diabetes during 7 days of usual diet and 14 days of a low-carbohydrate diet (21 g of carbohydrates per day), participants lost weight and had improvement in glycemic control while eating the low-carbohydrate diet. Reduced calorie intake, not reductions in body water, accounted for the observed weight loss. Cautions This study compared low-carbohydrate diet with usual diet rather than a conventional weight loss diet. –The Editors

 

Author and Article Information

From Temple University School of Medicine, Philadelphia, Pennsylvania, and University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, Stratford, New Jersey.

Acknowledgments: The authors thank the nurses of the General Clinical Research Center for help with the studies and for excellent patient care, Karen Kresge for technical assistance, and Constance Harris Crews for typing the manuscript.

Grant Support: By National Institutes of Health grants R01-AG15353, R01-DK58895, R01-HL0733267, R01-DK066003, and M01-RR-00349 (General Clinical Research Center branch of the National Center for Research Resources) and a Mentor-Based Training Grant from the American Diabetes Association (Dr. Boden).

Potential Financial Conflicts of Interest: None disclosed.

Corresponding Author: Guenther Boden, MD, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140.

Current Author Addresses: Drs. Boden and Homko and Ms. Mozzoli: Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140.

Ms. Sargrad: Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104.

Dr. Stein: University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, 1 Medical Center Drive, Stratford, NJ 08084.

Author Contributions: Conception and design: G. Boden, K. Sargrad.

Analysis and interpretation of the data: G. Boden, K. Sargrad, C. Homko, M. Mozzoli, T.P. Stein.

Drafting of the article: G. Boden.

Critical revision of the article for important intellectual content: G. Boden.

Final approval of the article: G. Boden.

Provision of study materials or patients: C. Homko, T.P. Stein.

Obtaining of funding: G. Boden.

Administrative, technical, or logistic support: C. Homko, M. Mozzoli.

Collection and assembly of data: K. Sargrad, C. Homko, M. Mozzoli.

Related articles in Annals:

Editorials
Is There Something Special about Low-Carbohydrate Diets?
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Annals 2005 142: 469-470. [Full Text]  

Summaries for Patients
Short-Term Effects of Low-Carbohydrate Diet Compared with Usual Diet in Obese Patients with Type 2 Diabetes

Annals 2005 142: I-44. [Full Text]  

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