Scientific review of low carb diet

[col101]

Can across this review paper of LC/KD. It's the first I've read that seems to explore the metabolic and physiological effects of such a diet. I'm rooting with moving from a moderate carb intake to low 50g down to 20g but as a T1D dear DKA this paper supports the theory that DKA is not result of ketogenic diet. Thoughts and experiences very welcome.
http://www.jpgmonline.com/article.a...e=63;issue=4;spage=242;epage=251;aulast=Gupta

 

[ringi]

Get yourself a copy of "The Art and Science of Low Carbohydrate Living" it explains the sciance and has references to lots of reserach paper.

Also remember you can use "google scholar" to find what paper cites the paper you are reading, so as to find if someone has built on the research.

 

[Grateful]

Can across this review paper of LC/KD. It's the first I've read that seems to explore the metabolic and physiological effects of such a diet.

This appears to be a meta-study, i.e. a summary of what other researchers have discovered. It is summarized in a table embedded in the study: http://www.jpgmonline.com/viewimage.asp?img=jpgm_2017_63_4_242_216437_t3.jpg.

One problem with many existing studies, including the ones summarized in the table above, is that they are short-term. For instance, one of them involved 21 overweight T2 subjects in a 16-week trial. The average drop in A1C at the end of the study was 16 percent (that's a percentage decrease, not a fall in NGSP percentage points!).

That is a much smaller decrease than you will see achived by numerous members of this forum. Unfortunately though, it is much more scientifically respectable than the anecdotal experience of forum members. On a low-carb diet, my A1C dropped by 33 percent, from 8.3% (67) to 5.5% (37), in the space of just 11 weeks. And, of course, there are plenty of people who won't be helped, or won't be helped enough, by the low-carb diet (and they will be rolled in to the study's statistics, which of course is essential in order to get truthful results).

The paper you cited is a study of "fully ketogenic" diets, an extreme form of low-carb. I was probably ketogenic for the first couple of months of my diet, but then relaxed the carbs. Some of us on this forum stay "keto" for the long term, but probably not the majority, even amongst the low-carb crowd.

Edited to add: @col101 I see that you are a Type 1. How does a T1 manage on a keto diet? Does that make insulin management tricky because of the small doses, I wonder? (I am T2 and know nothing about this.)

 

[Oldvatr]

Can across this review paper of LC/KD. It's the first I've read that seems to explore the metabolic and physiological effects of such a diet. I'm rooting with moving from a moderate carb intake to low 50g down to 20g but as a T1D dear DKA this paper supports the theory that DKA is not result of ketogenic diet. Thoughts and experiences very welcome.
http://www.jpgmonline.com/article.a...e=63;issue=4;spage=242;epage=251;aulast=Gupta

As a supporter of LCHF I will read this paper in full, but a quick read has rung warning bells in my head already. The way they have written their Introduction shows they may well have been fully behind LCHF when they started their study, and thus their findings may be just a tick box to confirm their beliefs, There is a danger this paper may contain bias toward keto diet, and may not be fully independent. They may be bending their science to fit the results, if you see what I mean,

Certainly other studies I have read do indicate that a keto diet does not in itself lead or cause DKA, but anyone taking a hypoglycemic med such as insulin or a sulphonurea needs to beware that it can still occur due to the meds having less glucose to work on, so leading to overload all the same. Keto is generally safe, but there can be circumstances that can trip you up. e,g excessive alcohol consumption or the use of some supplements.

 

[Oldvatr]

OK I have now digested a bigger part (but not all) of this report, and most of the technical descriptions of the endocrine processes seem to tie in with reports I have read elsewhere, and I think the authors here have done a good job in collating that info. It holds water in my view.

I am not so sure about the section where they make claims for how KD benefits various diseases and associated health conditions such as cancer and Parkinsons., I was relatively comfortable with it, but cannot say I am able to take these claims onboard yet.

I like their description of how best to organise a keto diet, and the advice they give about multivitamin supplements and the nutrients to add when in KD. I found their dietary advice to be very Indian flavoured, and also significantly high fat. Interesting recipes

Their descriptions on warnings, contraindictions etc needs further study on my part, but their warning about not recommending KD for those using SGLT-2 inhibitor meds is one we should definitely take note of.

Their projections for long term effects of KD will need time to prove (obviously) so the jury must remain out on this info for a while. I need to revisit this part again when my my eyes get back into focus (LOL)

I now see my initial read was correct. These guys are very clued up on KD and will be bissed, but I found no evidence that the info they discussed has been massaged - it is info that is in archived studies which they correctly reference at the end (79 of them)

So I commend this report to the House.

Thank you @col101 for finding and sharing it with us. I have bookmarked it as a good reference.

 

[ringi]

I expect the issue (if any) with SGLT-2 inhibitors will turn out to be the risk of dehydration and low salt on a LCHF diet, along with SGLT-2 inhibitors incorrectly being given to people who produce little or none of their own insulin. (They are only licensed for Type2.) The combination of SGLT-2 inhibitor and low carb needs more research, but I can’t think of anyone with a vested interest to fund it…. (I have not seen any salid evidance that there is an issue, just people saying there is, as other people have said there is.)

For large scale, long term studies on Type2 control with Low Carb we will have to weight until Virthealth publishes more of their data, it will be well audicted, as they are working with large US health insurnce compnaeis on a "payment by results" bases.

 

[Oldvatr]

I expect the issue (if any) with SGLT-2 inhibitors will turn out to be the risk of dehydration and low salt on a LCHF diet, along with SGLT-2 inhibitors incorrectly being given to people who produce little or none of their own insulin. (They are only licensed for Type2.) The combination of SGLT-2 inhibitor and low carb needs more research, but I can’t think of anyone with a vested interest to fund it…. (I have not seen any salid evidance that there is an issue, just people saying there is, as other people have said there is.)

For large scale, long term studies on Type2 control with Low Carb we will have to weight until Virthealth publishes more of their data, it will be well audicted, as they are working with large US health insurnce compnaeis on a "payment by results" bases.

You may be right, but then again you could be wrong, The cause of the DKA with SGLT-2 is not currently understood, but there are warnings on the FDA website, and there was an advisory sent out by NICE that GP's should provide warnings when prescribing SGLT-2 meds. But from feed back on this forum, that advice is not always given,
Until they establish a causal link, then we should be aware and careful not to advise LC to users on SGLT-2 without adding a warning ourselves. If course this does not cover the case of people already using LC who get switched to SGLT-2 later on.

 

[ringi]

The big issue with DKA and SGLT-2 is that most doctors assumes that someone can't be in DKA unless their BG is very high - this is not the case when SGLT-2 are in use. (Anyone with true Type2 producing much of their own insulin, can't get DKA.) As as keytones are expected to be detectable on low carb, thats another way to rule out DKA that can't be used....

 

[Oldvatr]

The big issue with DKA and SGLT-2 is that most doctors assumes that someone can't be in DKA unless their BG is very high - this is not the case when SGLT-2 are in use. (Anyone with true Type2 producing much of their own insulin, can't get DKA.) As as keytones are expected to be detectable on low carb, thats another way to rule out DKA that can't be used....

Some T2 may be producing oodles of insulin, but may not be able to use it due to IR. Or they may be overdosing on glucose lowering meds and not adjusting it to follow the diet. Infection may also come into play especially an inflamed pancreas or pancreatitis, As I said earlier, alcohol may be involved. There may be other medical reasons why DKA could occur, and it seems SGLT-2 meds amplify the risk at low glucose levels

The levels of blood ketones due to dietary means alone is significantly lower than any level associated with DKA by at least an order of magnitude. Certainly doctors are not yet fully trained to recognise DKA resulting from to those meds.