J Korean Med Assoc.  2017 Jan;60(1):40-46. 10.5124/jkma.2017.60.1.40.

Effectiveness and safety of low-carbohydrate diets

• Cho YG
• Kang JH

• KMID: 2367728
• DOI: http://doi.org/10.5124/jkma.2017.60.1.40

Abstract

With the recent assertions made by certain Korean media that low-carbohydrate, high-fat diets are panaceas for weight reduction and health improvement, such diets have been in the public spotlight. Medical and nutrition professionals have claimed that the inordinate popularity of low-carbohydrate, high-fat diets may pose a significant threat to public health. The aim of this review was to explore the latest evidence on the effectiveness and safety of low-carbohydrate diets. Recent clinical trials have shown that low-carbohydrate diets result in favorable changes in body weight and biochemical cardiovascular risk factors. However, the safety of low-carbohydrate diets remains inconclusive in the long term. Although the latest guidelines for the management of obesity recommend obese adults to use low-carbohydrate diets as an alternative dietary approach to achieve weight loss depending on each patient's dietary habits and medical status, such diets cannot currently be recommended as a strategy for health promotion among the general population due to long-term safety concerns. The results of cohort studies in Japan that have shown moderate diets lower in carbohydrates to be associated with decreased risks of cardiovascular mortality, total mortality, and type 2 diabetes in Japanese women, suggest that a low-glycemic load diet might be an optimal dietary approach for Korean obese adults with insulin resistance.

Keyword

Diet, carbohydrate-restricted; Diet, high-fat; Obesity; Weight loss; Safety

MeSH Terms

Adult
Asian Continental Ancestry Group
Body Weight
Carbohydrates
Cohort Studies
Diet*
Diet, Carbohydrate-Restricted
Diet, High-Fat
Female
Food Habits
Health Promotion
Humans
Insulin Resistance
Japan
Mortality
Obesity
Public Health
Risk Factors
Weight Loss
Carbohydrates

Reference

1. Committee of Clinical Practice Guidelines, Korean Society for the Study of Obesity. 2014 Clinical practice guidelines for obesity. Seoul: Cheongun;2014.

2. Korean Society for the Study of Obesity. Clinical obesity. 3rd ed. Seoul: Korea Medical Book Publishing Company;2008.

3. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med. 1998; 158:1855–1867.

4. Heini AF, Weinsier RL. Divergent trends in obesity and fat intake patterns: the American paradox. Am J Med. 1997; 102:259–264.

5. Willett WC, Leibel RL. Dietary fat is not a major determinant of body fat. Am J Med. 2002; 113:Suppl 9B. 47S–59S.

6. Gross LS, Li L, Ford ES, Liu S. Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment. Am J Clin Nutr. 2004; 79:774–779.

7. Kim SJ, Park HS. Relationship between dietary carbohydrate and body weight. J Korean Soc Study Obes. 2003; 12:235–244.

8. Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemie-niuk RA, Ball GD, Busse JW, Thorlund K, Guyatt G, Jansen JP, Mills EJ. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014; 312:923–933.

9. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005; 293:43–53.

10. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, Hu FB, Hubbard VS, Jakicic JM, Kushner RF, Loria CM, Millen BE, Nonas CA, Pi-Sunyer FX, Stevens J, Stevens VJ, Wadden TA, Wolfe BM, Yanovski SZ, Jordan HS, Kendall KA, Lux LJ, Mentor-Marcel R, Morgan LC, Trisolini MG, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC Jr, Tomaselli GF. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014; 129:25 Suppl 2. S102–S138.

11. Korean Endocrine Society. Korean Diabetes Association. Korean Society for the Study of Obesity. Korean Nutrition Society. Korean Society of Lipidology and Atherosclerosis. Joint statement by five associations of medical and nutrition professionals on the popularity of the low-carbohydrate, high-fat diets [Internet]. Seoul: Korean Nutrition Society;2016. cited 2016 Nov 17. Available from: http://www.kns.or.kr/common/download.asp?file_name=20161026133924022402.pdf&FileDir=Notice.

12. Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, Accurso A, Frassetto L, Gower BA, McFarlane SI, Nielsen JV, Krarup T, Saslow L, Roth KS, Vernon MC, Volek JS, Wilshire GB, Dahlqvist A, Sundberg R, Childers A, Morrison K, Manninen AH, Dashti HM, Wood RJ, Wortman J, Worm N. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015; 31:1–13.

13. Adam-Perrot A, Clifton P, Brouns F. Low-carbohydrate diets: nutritional and physiological aspects. Obes Rev. 2006; 7:49–58.

14. Malik VS, Hu FB. Popular weight-loss diets: from evidence to practice. Nat Clin Pract Cardiovasc Med. 2007; 4:34–41.

15. Kim EM, Lee JH. Dietary protein and obesity. Korean J Obes. 2008; 17:101–109.

16. Halton TL, Hu FB. The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. J Am Coll Nutr. 2004; 23:373–385.

17. Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013; 110:1178–1187.

18. Foster GD, Wyatt HR, Hill JO, Makris AP, Rosenbaum DL, Brill C, Stein RI, Mohammed BS, Miller B, Rader DJ, Zemel B, Wadden TA, Tenhave T, Newcomb CW, Klein S. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med. 2010; 153:147–157.

19. Santos FL, Esteves SS, da Costa Pereira A, Yancy WS Jr, Nunes JP. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev. 2012; 13:1048–1066.

20. Hu T, Mills KT, Yao L, Demanelis K, Eloustaz M, Yancy WS Jr, Kelly TN, He J, Bazzano LA. Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol. 2012; 176:Suppl 7. S44–S54.

21. Krauss RM, Blanche PJ, Rawlings RS, Fernstrom HS, Williams PT. Separate effects of reduced carbohydrate intake and weight loss on atherogenic dyslipidemia. Am J Clin Nutr. 2006; 83:1025–1031.

22. Crowe TC. Safety of low-carbohydrate diets. Obes Rev. 2005; 6:235–245.

23. Wycherley TP, Brinkworth GD, Keogh JB, Noakes M, Buckley JD, Clifton PM. Long-term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients. J Intern Med. 2010; 267:452–461.

24. Halton TL, Willett WC, Liu S, Manson JE, Albert CM, Rexrode K, Hu FB. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006; 355:1991–2002.

25. Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS One. 2013; 8:e55030.

26. Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, Hu FB. Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. Ann Intern Med. 2010; 153:289–298.

27. Nakamura Y, Okuda N, Okamura T, Kadota A, Miyagawa N, Hayakawa T, Kita Y, Fujiyoshi A, Nagai M, Takashima N, Ohkubo T, Miura K, Okayama A, Ueshima H. NIPPON DATA Research Group. Low-carbohydrate diets and cardiovascular and total mortality in Japanese: a 29-year follow-up of NIPPON DATA80. Br J Nutr. 2014; 112:916–924.

28. Noto H, Goto A, Tsujimoto T, Noda M. Long-term low-carbohydrate diets and type 2 diabetes risk: a systematic review and meta-analysis of observational studies. J Gen Fam Med. 2016; 17:60–70.

29. Halton TL, Liu S, Manson JE, Hu FB. Low-carbohydrate-diet score and risk of type 2 diabetes in women. Am J Clin Nutr. 2008; 87:339–346.

30. de Koning L, Fung TT, Liao X, Chiuve SE, Rimm EB, Willett WC, Spiegelman D, Hu FB. Low-carbohydrate diet scores and risk of type 2 diabetes in men. Am J Clin Nutr. 2011; 93:844–850.

31. Frigolet ME, Ramos Barragan VE, Tamez Gonzalez M. Low-carbohydrate diets: a matter of love or hate. Ann Nutr Metab. 2011; 58:320–334.

32. Nanri A, Mizoue T, Kurotani K, Goto A, Oba S, Noda M, Sawada N, Tsugane S. Japan Public Health Center-Based Prospective Study Group. Low-carbohydrate diet and type 2 diabetes risk in Japanese men and women: the Japan Public Health Center-Based Prospective Study. PLoS One. 2015; 10:e0118377.

33. Ezaki O. The optimal dietary fat to carbohydrate ratio to prevent obesity in the Japanese population: a review of the epidemiological, physiological and molecular evidence. J Nutr Sci Vitaminol (Tokyo). 2011; 57:383–393.