Evidence That Supports the Prescription of Low-Carbohydrate High-Fat Diets

Vince · 2017-03-22T09:42:22+00:00

British Journal of Sports Medicine A Narrative Review Timothy David Noakes; Johann Windt | Disclosures Br J Sports Med. 2017;51(2):133-139. http://www.medscape.com/viewarticle/874707 Abstract and Introduction Abstract Low-carbohydrate high-fat (LCHF) diets are a highly contentious current topic in nutrition. This narrative review aims to provide clinicians with a broad overview of the effects of LCHF diets on body weight, glycaemic control and cardiovascular risk factors while addressing some common concerns and misconceptions. Blood total cholesterol and LDL-cholesterol concentrations show a variable, highly individual response to LCHF diets, and should be monitored in patients adhering to this diet. In contrast, available evidence from clinical and preclinical studies indicates that LCHF diets consistently improve all other markers of cardiovascular risk—lowering elevated blood glucose, insulin, triglyceride, ApoB and saturated fat (especially palmitoleic acid) concentrations, reducing small dense LDL particle numbers, glycated haemoglobin (HbA1c) levels, blood pressure and body weight while increasing low HDL-cholesterol concentrations and reversing non-alcoholic fatty liver disease (NAFLD). This particular combination of favourable modifications to all these risk factors is a benefit unique to LCHF diets. These effects are likely due in part to reduced hunger and decreased ad libitum calorie intake common to low-carbohydrate diets, allied to a reduction in hyperinsulinaemia, and reversal of NAFLD. Although LCHF diets may not be suitable for everyone, available evidence shows this eating plan to be a safe and efficacious dietary option to be considered. LCHF diets may also be particularly beneficial in patients with atherogenic dyslipidaemia, insulin resistance, and the frequently associated NAFLD. Summary and Clinical Considerations One diet does not suit the individual metabolic profiles of everyone. Significant weight loss has been documented in trials comparing a variety of different dietary plans, with all diets performing better than no intervention (controls).[8] In all cases, optimal nutrition should emphasise high nutrient density while properly managing energy balance. As discussed in this review, LCHF diets accomplish these two objectives effectively—controlling energy balance through increased satiety and reduced ad libitum energy intake while encouraging the ingestion of a nutrient-dense diet by replacing refined, nutrient-poor processed foods with nutrient-dense, natural foods. Further, the diet encourages weight loss and unique metabolic changes including marked improvements in glycaemic control and in plasma TG, HDL-C, ApoB and saturated fat concentrations, with reductions in the number of small dense LDL particles that are considered to be especially atherogenic. This unique effect is in part due to the reversal of NAFLD by carbohydrate restriction. While the complex details of individual responses to many different dietary interventions still need to be explored, clinicians can be reassured that LCHF diets are proven to be a safe and efficacious strategy for weight loss and improved health outcomes for many patients, but especially for those with IR, the metabolic syndrome,[40] AD and NAFLD. Thus, LCHF diets may be the ideal choice for patients who have struggled to lose weight on the traditional LFHC diets; for those with IR, including hyperinsulinaemia, T2DM and NAFLD; and for those with AD characterised by high blood TG and low HDL-C concentrations and increased numbers of small dense LDL particles (Pattern B). In practice, beneficial responses to any diet are entirely dependent on the degree of patients' adherence, so an LCHF diet is only appropriate for those patients motivated to comply. In these cases, clinicians can expect positive changes in a number of cardiovascular risk factors, glycaemic control and body composition.[40] Simultaneously, they should monitor individual LDL-C responses, and encourage a continued emphasis on nutrient-rich choices, avoiding ultra-processed foods. Thus, far from being a dietary fad, but not necessarily for everyone, LCHF diets present a sensible dietary option for weight loss and health improvement in certain patients, especially those characterised by IR, AD and NAFLD.

Thread starter Vince
Start date Mar 22, 2017

Vince

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Vince

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Mar 26, 2017

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Cardiac Disease, Carbohydrates and Weight Loss
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Evidence That Supports the Prescription of Low-Carbohydrate High-Fat Diets

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