While there may not be one best diet for everyone, it helps to understand the patterns that emerge when everyday people try various diets. In these “real world” studies, more and more evidence confirms the benefits of very low-carbohydrate diets for weight loss and treatment of diabetes.
In a recent study published in The International Journal of Endocrinology and Metabolic Disorders, researchers in the Netherlands reviewed the records of 227 patients who were overweight, had type 2 diabetes, and chose to follow one of three diets for 12 months:
- “6 x 6 diet” — a commercial diet that reduces daily carbs to 36 grams for the first stage, and then liberalizes carb intake to less than 75 grams in the second stage, and eventually allows subjects to pick their own carb level in the third phase. It also includes more than 1 gram per kilo of body weight of dietary protein each day. There is no caloric restriction.
- Low-carb diet — a plan with 50-100 grams of carbs each day, 1 gram per kilo of body weight of dietary protein each day, and 35% of calories from fat. There is no caloric restriction, but to meet the criteria specified with a fat limit, this likely ends up being a calorie-reduced diet.
- Energy-restricted diet — a plan with more than 100 grams of carbs each day, 0.8 grams per kilo of body weight of dietary protein each day, and 35% calories from fat, with an energy restriction goal of 600 calories less than “usual intake.”
Since this was not a randomized trial, there were significant differences between the groups at baseline. Interestingly, subjects in the very low-carb, “6 x 6 dieet” arm were more likely to be on insulin and had been diagnosed with diabetes for longer.
After 12 months, those following the very low-carb diet lost significantly more weight — 20.5 pounds (9.3 kilos) versus 14.6 pounds (6.6 kilos) and 12.8 pounds (5.8 kilos) — than the other two groups. The reduction in HbA1c was similar between the very low-carb diet group and the low-carb group, but was better than the energy-restricted diet group at three and six months. This improvement was no longer significant at 12 months; remember that they were allowed to liberalize their carb intake, which may account for the lack of sustained benefit.
Those following the very low-carb diet achieved better glucose control while at the same time reducing medications such as metformin, sulfonylureas and insulin more than the other groups.
All of these improvements were seen despite no restriction on total caloric intake in the very low-carbohydrate group. This once again provides evidence that calorie counting is not necessary as long as someone follows a true low-carb, ketogenic diet.
This study adds more evidence to the effectiveness of very low-carb diets for weight loss and blood sugar control. As we’ve covered recently, it is studies like these that have convinced the American Diabetes Association, as well as a major U.S. health insurance provider, that low-carb diets can be recommended to control type 2 diabetes.
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Thanks for reading,
Bret Scher, MD FACC
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