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Review

The Low-Carbohydrate Diet: Short-Term Metabolic Efficacy Versus Longer-Term Limitations

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Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
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Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry CV2 2DX, UK
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NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
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Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité University Medicine, Hindenburgdamm 30, 12203 Berlin, Germany
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Deutsches Zentrum für Diabetesforschung e.V., Geschäftsstelle am Helmholtz-Zentrum München, Ingolstädter Landstraße, 85764 Neuherberg, Germany
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Centre for Sport, Exercise and Life Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry CV2 2DX, UK
*
Author to whom correspondence should be addressed.
Academic Editor: Yasuyuki Nakamura
Nutrients 2021, 13(4), 1187; https://doi.org/10.3390/nu13041187
Received: 16 March 2021 / Revised: 28 March 2021 / Accepted: 31 March 2021 / Published: 3 April 2021
(This article belongs to the Special Issue Low-Carbohydrate Diets and Health Outcomes)
Background: Diets have been a central component of lifestyle modification for decades. The Low-Carbohydrate Diet (LCD), originally conceived as a treatment strategy for intractable epilepsy (due to its association with ketogenesis), became popular in the 1970s and since then has risen to prominence as a weight loss strategy. Objective: To explore the efficacy, limitations and potential safety concerns of the LCD. Data Sources: We performed a narrative review, based on relevant articles written in English from a Pubmed search, using the terms ‘low carbohydrate diet and metabolic health’. Results: Evidence supports the efficacy of the LCD in the short-term (up to 6-months) for reduction in fat mass and remission of Type 2 Diabetes Mellitus (T2D). However, the longer-term efficacy of the LCD is disappointing, with diminishment of weight loss potential and metabolic benefits of the LCD beyond 6-months of its adoption. Furthermore, practical limitations of the LCD include the associated restriction of food choices that restrict the acceptability of the LCD for the individual, particularly over the longer term. There are also safety concerns of the LCD that stem from nutritional imbalances (with a relative excess of dietary fat and protein intake with associated dyslipidaemia and increased risk of insulin resistance and T2D development) and ketotic effects. Finally, the LCD often results in a reduction in dietary fibre intake, with potentially serious adverse consequences for overall health and the gut microbiota. Conclusions: Although widely adopted, the LCD usually has short-lived metabolic benefits, with limited efficacy and practicality over the longer term. Dietary modification needs tailoring to the individual, with careful a priori assessments of food preferences to ensure acceptability and adherence over the longer term, with avoidance of dietary imbalances and optimization of dietary fibre intake (primarily from plant-based fruit and vegetables), and with a posteriori assessments of the highly individual responses to the LCD. Finally, we need to change our view of diets from simply an excipient for weight loss to an essential component of a healthy lifestyle. View Full-Text
Keywords: Low-Carbohydrate Diet; Type 2 Diabetes Mellitus; fat mass; ketogenesis Low-Carbohydrate Diet; Type 2 Diabetes Mellitus; fat mass; ketogenesis
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MDPI and ACS Style

Barber, T.M.; Hanson, P.; Kabisch, S.; Pfeiffer, A.F.H.; Weickert, M.O. The Low-Carbohydrate Diet: Short-Term Metabolic Efficacy Versus Longer-Term Limitations. Nutrients 2021, 13, 1187. https://doi.org/10.3390/nu13041187

AMA Style

Barber TM, Hanson P, Kabisch S, Pfeiffer AFH, Weickert MO. The Low-Carbohydrate Diet: Short-Term Metabolic Efficacy Versus Longer-Term Limitations. Nutrients. 2021; 13(4):1187. https://doi.org/10.3390/nu13041187

Chicago/Turabian Style

Barber, Thomas M.; Hanson, Petra; Kabisch, Stefan; Pfeiffer, Andreas F.H.; Weickert, Martin O. 2021. "The Low-Carbohydrate Diet: Short-Term Metabolic Efficacy Versus Longer-Term Limitations" Nutrients 13, no. 4: 1187. https://doi.org/10.3390/nu13041187

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