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Introduction: This case study portrays an unusual case of treatment-induced neuropathy of diabetes (TIND) in a patient with uncontrolled type 2 diabetes (T2D) who achieved rapid improvement in glucose control primarily with dietary intervention. Initial presentation was 50-year-old white male with a long-standing history of obesity and a family history of T2D with a screening glucose level >500mg/dL by glucometer, HbA1c of 14.9%, and initial weight 213 lbs. Methods: The initial intervention included a low-carbohydrate diet, metformin, and a continuous glucose monitor (CGM). Semaglutide was added after seven days. Results: His glycemia was within the target range within three weeks. Four weeks after initiation of therapy, he developed TIND symptoms consisting of burning, tightness, and numbness of bilateral feet along with 10/10 pain. At three months, his HbA1c dropped to 6.9% and his weight to 195 lbs. Treatment of his TIND reduced his pain from 10/10 to 2/10. Conclusion: Whereas TIND is commonly associated with the use of insulin or sulfonylureas, this study adds evidence to the paucity of literature regarding TIND precipitated by dietary intervention.

Extensive research has established the benefits of incorporating low carbohydrate diets (LCDs) for managing obesity, diabetes, and metabolic syndrome (Mets). Recent findings indicate that LCDs could additionally impact cancer development and progression by creating an unfavorable metabolic micro-environment that promotes reprogrammed metabolism in cancer cells. This has led to LCDs being considered as a possible complementary treatment for cancer. Our review specifically examines the association between cancer risk, consumption of dietary carbohydrate, glycemic index (GI), and glycemic load (GL), with a focus on prostate, breast, and colorectal cancer. We also explore relevant mechanism underlying the potential anti-tumor effects of LCD diets, especially in gut microbiota modulation. However, findings in this area remain controversial, and further research is needed to evaluate their application in clinical practice. On the other hand, resistant starch (RS) has gained attention as a healthy and high-quality component of carbohydrate diets. It not only serves as a dietary fiber but also acts as a valuable source of prebiotics due to its ability to influence gut microbial composition, leading to improved metabolic control. This has positioned RS as a potential means for preventing and treating cancer. In this review, we also summarized the RS-gut microbiota-cancer risk axis to enhance our understanding of the health effects of RS consumption. From a clinical perspective, RS supplementation shows promise as a strategy for preventing diseases and managing cancer. It is evident that simply assessing the quantity of dietary carbohydrate intake may not be enough to determine cancer risk; the quality of carbohydrates should also be considered to draw definitive conclusions which will help clinician and nutritionist make a reasonable choice in management cancer.

Mitochondrial quantity and density are associated with increased oxidative metabolism. It has been demonstrated that a hypocaloric high fat/low carbohydrate (HF/LC) diet can up-regulate transcriptional markers of mitochondrial biogenesis; this was yet to be explored in vivo subsequent to a high protein/low carbohydrate (HP/LC) diet. Thus the aims of the study were to explore such diets on transcriptional markers or mitochondrial biogenesis, body composition and resting metabolic rate (RMR). Forty-five healthy male participants were randomly assigned one of four intervention diets: eucaloric high protein low carbohydrate (PRO-EM), hypocaloric high protein low carbohydrate (PRO-ER), eucaloric high carbohydrate (CHO-EM) or hypocaloric high carbohydrate (CHO-ER). The macronutrient ratio of the high protein diet and high carbohydrate diets was 40:30:30% and 10:60:30% (PRO:CHO:FAT) respectively. Energy intake for the hypocaloric diets were calculated to match resting metabolic rate. Participants visited the laboratory on 3 occasions each separated by 7 days. On each visit body composition, resting metabolic rate and a muscle biopsy from the vastus lateralis was collected. Prior to visit 1 and 2 habitual diet was consumed which was used as a control, between visit 2 and 3 the intervention diet was consumed continuously for 7-days. No group × time effect was observed, however in the PRO-ER group a significant increase in AMPK, PGC-1α, SIRT1 and SIRT3 mRNA expression was observed post diet intervention groups (p

Low carbohydrate ketogenic diet (KD) produces several ameliorating effects against metabolic abnormalities found in obese patients. However, mechanisms underlying the effect of KD are poorly understood. We report here that KD increases gangliosides, which were recently identified as a novel modulator involved in the regulation of cellular insulin signalling. We found that the ob/ob mice had low liver ganglioside content, whereas feeding KD increased this to approximately equivalent levels observed in wild-type mice. This result indicates that KD improves the low level expression of gangliosides in ob/ob mouse liver. On the other hand, feeding KD specifically increased only monosialoganglioside GM3 in wild-type mice. This work revealed the potential utility of low carbohydrate diet including KD as a functional food targeting insulin-related metabolic abnormalities.

Background and Aims: Heart failure, insulin resistance and/or type 2 diabetes mellitus coexist in the syndrome that is diabetic cardiomyopathy. Patients with diabetic cardiomyopathy experience high symptom burden and poor quality of life. We tested the hypothesis that a low carbohydrate diet improves heart failure symptoms and quality of life in patients with diabetic cardiomyopathy., Methods and Results: We conducted a 16-week randomised controlled pilot trial comparing the effects of a low carbohydrate diet (LC) to usual care (UC) in 17 adult patients with diabetic cardiomyopathy. New York Heart Association classification, weight, thirst distress and quality of life scores as well as blood pressure and biochemical data were assessed at baseline and at 16 weeks. Thirteen (n = 8 LC; n = 5 UC) patients completed the trial. The low carbohydrate diet induced significant weight loss in completers (p = 0.004). There was a large between-group difference in systolic blood pressure at the end of the study (Hedges's g 0.99[-014,2.08]). There were no significant differences in thirst or quality of life between groups., Conclusion: This is the first clinical trial utilising the low carbohydrate dietary approach in patients with diabetic cardiomyopathy in an outpatient setting. A low carbohydrate diet can lead to significant weight loss in patients with diabetic cardiomyopathy. Future clinical trials with larger samples and that focus on fluid and sodium requirements of patients with diabetic cardiomyopathy who engage in a low carbohydrate diet are warranted., Clinical Trial Registration Number: Australian New Zealand Clinical Trial Registry (ANZCTR): ACTRN12620001278921., Date of Registration: 26th November 2020., Competing Interests: Declaration of competing interest The authors did not use any form of generative artificial intelligence (AI) and/or AI-assisted technologies during the writing process or the preparation of this manuscript., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Diabetes mellitus is globally considered one of the most common chronic diseases, management of which is critically asscociated with an adequate dietary approach. With overweight and obesity being a global epidemic, choosing the appropriate weight loss plan for patients with diabetes seems to be of particular concern for healthcare professionals. Since diabetes and cardiovascular diseases frequently coexist, modern pharmacological therapeutic models aim at addressing both. Therapeutic targets in diabetic population that address glycemic control, adequate lipid and blood pressure control proves to limit the incidence of cardiovascular events, reduce the risk of chronic complications and improve patients quality of life. Similarly, dietary managment in this population should also concentrate on the reduction of reversible cardiovascular risk factors. Nutritional recommendations for diabetic patients should be individualized to meet their expectations and lifestyle in order to ensure compliance and long-term effects. As diabetic population is more vulnerable to further health risks associated with diet induced metabolic changes, inadequate intake of dietary components and increased cardiovascular risk, nutrition plans should be addressed more carefully in this group., (Copyright © 2021 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background: Evidence is limited regarding the association between low-carbohydrate diet (LCD) score and mortality among Asians, a population that consumes a large amount of carbohydrates., Objective: The present study examined the association between low-carbohydrate diet (LCD) score (based on percentage of energy as carbohydrate, fat, and protein) and the risk of total and cause-specific mortality among Asians., Design: This study was a prospective cohort study in Japan with follow-up for a median of 16.9 years involving 43008 men and 50646 women aged 45-75 years. Association of LCD score, LCD score based on animal sources of protein and fat, and LCD score based on plant sources of protein and fat with risk of mortality was assessed using Cox proportional hazards model., Results: A U-shaped association was observed between LCD score and total mortality: the multivariable-adjusted hazard ratios (HRs) (95% CI) of total mortality for lowest through highest scores were 1.00, 0.95 (0.91, 1.01), 0.93 (0.88, 0.98), 0.93 (0.88, 0.98), and 1.01 (0.95, 1.07) (P-non-linearity <0.01). A similar association was found for mortality from cardiovascular disease (CVD) and heart disease. LCD score based on carbohydrate, animal protein, and animal fat also showed a U-shaped association for total mortality (P-non-linearity <0.01). In contrast, LCD score based on carbohydrate, plant protein, and plant fat was linearly associated with lower total (HR, 0.89; 95% CI: 0.83, 0.94 for highest versus lowest quintile), CVD [0.82 (0.73, 0.92)], heart disease [0.83 (0.71, 0.98)], and cerebrovascular disease [0.75 (0.62, 0.91) mortality., Conclusions: Both LCD with high animal protein and fat and high-carbohydrate diet with low animal protein and fat were associated with higher risk of mortality. Meanwhile, LCD high in plant-based sources of protein and fat was associated with a lower risk of total and CVD mortality., Competing Interests: Conflict of interest None reported., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Aims: Studies indicated that the risk of cardiovascular disease (CVD) in association to greater adherence to low-carbohydrate diet (LCD) differs in various populations. In this study, we aimed to assess the association of LCD score with the risk of CVD events in a prospective population-based study., Methods and Results: CVD-free participants (n = 2188) were recruited from the Tehran Lipid and Glucose Study (2006-2008) and followed for a mean of 6.7 years. Using a valid and reliable 168 item semi-quantitative food frequency questionnaire, the LCD score was determined based on the percentage of energy as carbohydrate, protein, and fat, which ranged from 0 to 12. Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate the hazard ratios (HRs) and 95% confidence interval (CI) of CVD across tertiles of LCD score in women and men. Mean ± SD age of participants (44.8% male) was 38.8 ± 13.0 years, and median (25-75, interquartile range) of the LCD score was 6 (4-8) at baseline. During follow-up, 77 (3.5%) new cases of CVD were identified. After adjustment for sex, age, body mass index, physical activity, smoking, energy intake, diabetes, and hypertension, there was no association between the LCD score and risk of CVD outcomes in all participants (HR = 0.93; 95% CI: 0.86-1.02) and women (HR = 1.13; 95% CI: 0.94-1.36); however, the LCD score was associated with an 11% reduced incidence of CVD events in men (HR = 0.89; 95% CI: 0.80-0.98), (P for trend: 0.028)., Conclusion: Findings showed that higher adherence to LCD may be associated with a lower risk of CVD outcomes in men but not in women., (Copyright © 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: Observational studies that investigated the association between adherence to low carbohydrate diet and odds of glioma are sparse. This is particularly relevant in developing countries where dietary carbohydrate intake is very high., Objective: This study was, therefore, conducted to investigate the association between adherence to low carbohydrate dietary pattern and odds of glioma among Iranian adults., Methods: In this hospital-based case-control study, 128 newly diagnosed glioma cases were recruited and 256 age- and sex-matched subjects were enrolled as controls. Dietary intakes were examined by the use of a 126-item validated FFQ. Low carbohydrate diet (LCD) score was computed for each participant based on deciles of percentages of energy from carbohydrates, proteins, and fats. Individuals in the lowest decile of carbohydrate consumption received 10 points. Participants in second decile received 9 points and so on down to participants in the highest decile received 1 points. For fat and protein intakes, the points assigned to deciles were reversed; such that those in the highest decile received 10 points and those in the lowest decile received 1 point. We then summed all points of the three macronutrients to achieve the overall diet score, which ranged from 3 (highest carbohydrate intake and lowest fat and protein intakes) to 30 (lowest carbohydrate intake and highest fat and protein intakes). The higher the score, the greater adherence to the LCD dietary pattern., Results: After adjustment for age and sex, we found that individuals in top tertile of LCD score were 60% less likely to have glioma compared with those in the bottom tertile (OR: 0.40; 95% CI: 0.23, 0.67). Additional controlling for other potential confounders made the association slightly attenuated (OR: 0.49; 95%CI: 0.26, 0.93). Further adjustment for dietary nutrient intakes strengthened the association (OR: 0.32; 95%CI: 0.12, 0.81). After additional controlling for BMI, we found that adherence to LCD was protectively associated with reduced odds of glioma (OR: 0.32; 95%CI: 0.12, 0.81)., Discussion: We found an inverse association between adherence to LCD and odds of glioma among Iranian population. Prospective cohort studies are needed to confirm these findings., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: The traditional Korean diet is relatively high in carbohydrate and low in fat and protein compared with diets of non-Asian populations. In recent decades, the rapid economic growth in Korea has led to lifestyle and dietary changes, with an increase in the prevalence of dyslipidemia, a risk factor for chronic diseases., Objective: To examine the association between a low carbohydrate diet (LCD) score and dyslipidemia in Korean adults., Design: The Korea National Health and Nutrition Examination Survey is an ongoing nationally representative population-based cross-sectional survey that is conducted annually., Participants/setting: A total of 12,199 Korea National Health and Nutrition Examination Survey participants aged ≥20 years from 2010 to 2016 were included in this study., Main Outcome Measures: Individual components of dyslipidemia, such as hypercholesterolemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol levels, were defined based on fasting blood test results., Statistical Analyses: Participants were classified by sex into quintiles of LCD scores calculated using 1-day 24-hour dietary recall data. A multivariable logistic regression model was used to examine the association between LCD score and each dyslipidemia component after adjusting for potential confounders., Results: A higher LCD score was significantly associated with higher odds of hypercholesterolemia (odds ratio 1.36, 95% CI, 1.05 to 1.78; P for trend=0.031) and lower odds of low high-density lipoprotein cholesterol levels (odds ratio 0.72, 95% CI 0.55 to 0.94; P for trend=0.002) in women. However, in men, higher LCD scores were significantly associated with lower odds of hypertriglyceridemia (odds ratio 0.70, 95% CI 0.52 to 0.95; P for trend=0.012). More specifically, animal-based LCD scores were negatively associated with the odds of hypertriglyceridemia (odds ratio 0.65, 95% CI 0.48 to 0.87; P for trend=0.010) in men., Conclusions: These results suggest that the complicated and integrated effects of macronutrient composition on individual lipid components should be considered for preventing dyslipidemia in Korean adults., (Copyright © 2019 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Weight loss by lifestyle modification is the cornerstone therapy of Non Alcoholic Fatty Liver Disease. Low carbohydrate diet has showed favorable effects for body weight as well as hepatic fat content in several reports. In this meta-analysis, we review clinical studies article to date regarding the composition of the diet and analyzed the impact of low carbohydrate diet comparing to low calorie diet on hepatic fat change, AST and ALT using Forest plot. We aimed to investigate the efficacy of low carbohydrate diet on NAFLD., Methods: We collected studies that were conducted with various amounts of carbohydrate and different methods for changing the hepatic fat and fibrosis., Results: Eleven clinical studies (seven randomized controlled trials) were selected on the efficacy and safety of low carbohydrate diet on NAFLD patients. Four studies evaluated hepatic fat by magnetic resonance imaging and two evaluated hepatic fat using computed tomography. However, the pools of subjects were small, the criterion for low carbohydrate was variable, and there is yet an established standard method of evaluation of liver. In meta-analysis, there was no significant difference between low carbohydrate diet group and low fat diet group on the improvement of hepatic fat content and transaminases in NAFLD., Conclusion: So far there's little evidence that low-carbohydrate diet has more beneficial effect on NAFLD than low calorie diet in similar calorie intake., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Postprandial hypoglycemia is a risk after Roux-en-Y gastric bypass (RYGB)., Objectives: We speculated that a carbohydrate-reduced, high-protein (CRHP) diet might reduce the risk of hypoglycemia and therefore compared the acute effects of a conventionally recommended (CR) diet and CRHP diet [55/30 energy percent (E%) carbohydrate and 15/30 E% protein, respectively] in RYGB patients., Methods: Ten individuals (2 males, 8 females, mean ± SD age 47 ± 7 y; stable body mass index 31 ± 6 kg/m2; 6 ± 3 y post-RYGB) with recurrent postprandial hypoglycemia documented by plasma glucose (PG) ≤3.4 mmol/L were examined on 2 d with isoenergetic CRHP or CR diets comprising a breakfast and subsequent lunch meal., Results: Peak PG was significantly reduced on the CRHP diet after breakfast and lunch by 11% and 31% compared with the CR diet. Nadir PG increased significantly on CRHP (by 13% and 9%). Insulin secretion was reduced, and glucagon secretion increased on the CRHP diet after both meals. Glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide secretion were lower after lunch but unaltered after breakfast on CRHP; β-cell function and insulin clearance were unchanged., Conclusions: The CRHP diet lowered glucose excursions and reduced insulin secretion and incretin hormone responses, but enhanced glucagon responses compared with the CR diet. Taken together, the results may explain the decreased glucose variability and lower risk of postprandial hypoglycemia. This study was registered at clinicaltrials.gov as NCT02665715., (© 2019 American Society for Nutrition.)

Aims: Obesity is an important public health issue because of its high prevalence and concomitant increase in risk of cardiovascular diseases. Low carbohydrate diets are popular for weight loss and weight management but are not recommended in leading guidelines due to the perception that increases in dietary fat intake may lead to an adverse cardiovascular risk profile. To clarify the effects of a low-carbohydrate diet for weight loss on cardiovascular disease risk factors as compared to a low fat diet for weight loss, we systematically reviewed data from randomized controlled clinical trials and large observational studies., Data Synthesis: We searched the MEDLINE database (Jan 1966-Nov 2013) to identify studies that examined a low-carbohydrate diet as compared to a low-fat diet for weight loss or the improvement of cardiovascular disease risk factors., Conclusions: Recent randomized controlled trials document that low-carbohydrate diets not only decrease body weight but also improve cardiovascular risk factors. In light of this evidence from randomized controlled trials, dietary guidelines should be re-visited advocating a healthy low carbohydrate dietary pattern as an alternative dietary strategy for the prevention of obesity and cardiovascular disease risk factors., (Copyright © 2014. Published by Elsevier B.V.)