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Do Low-Carbohydrate, High-Protein Diets Offer an Advantage? (ADA 2021) – Diabetes Daily

We already know that low-carb diets can be great for glucose control and diabetes management. The evidence is clear: patients with both type 2 diabetes and type 1 diabetes can benefit from the low-carbohydrate approach.

But as the diet has gained acceptance, some specialists have begun to look more carefully at the details and other consequences of the low-carb approach. Does the amount of protein matter? Can carbohydrate restriction have negative effects on lipid profiles, cognition, or mental health parameters?

Here we describe three new study reports just released at the American Diabetes Association (ADA) 81st virtual Scientific Sessions that address some of these topics.

Higher-Protein Diet, Inflammation and Type 2 Diabetes Remission

Many studies have shown that weight loss and improved blood glucose levels can be achieved with a variety of dietary approaches, but does increasing the protein and lowering carbs offer even more advantages for those with diabetes?

Frankie Stenz, MS, PhD, and Associate Professor of Medicine Endocrinology, and her team at the University of Tennessee evaluated the effects of a high-carb (55% CHO and 15% protein) vs. a high-protein (30% protein and 40% CHO) diet in adults with type 2 diabetes for 6 months. They report that the higher-protein approach significantly reduced inflammatory markers (several important cytokines measured in the blood), as compared to the higher-carb group. Inflammation markers are important parameters, especially for those with diabetes, as inflammation is closely linked to insulin resistance. Also, while weight loss was similar between the two groups, those adhering to the higher-protein diet had a significant increase in lean body mass as well as a decrease in fat mass as compared to the higher-carb group.

Moreover, while improved glucose tolerance and and insulin sensitivity occurred in both groups to some degree, diabetes remission occurred in only 16% in the high-carb group, as compared to a striking 100% in the higher-protein group. Remission was defined by the study authors as a lowering of A1c to <6.5%, along with fasting glucose levels of <126 mg/dL and not exceeding 140 mg/dL at two hours post-meal. The researchers conclude,

The HP [High Protein] diet demonstrated improvement in glucose tolerance and insulin sensitivity with 100% remission… and a significant decrease in inflammatory cytokines.

Photo credit: iStock

Lower-Carb, Higher-Protein Diets and Lipid Levels

Effects on blood lipid levels when eating lower-carb (and by extension higher protein and fat) are often a point of controversy, especially when it comes to people with diabetes, who are already at higher risk for heart disease. Heart disease is complex and multifactorial; however, many researchers agree that both blood glucose parameters and lipid profiles can play a significant role. Previous research has produced some mixed results regarding how different diets can affect lipid profiles, with many studies showing improvements in lipid parameters when eating lower-carb.

Most recently, an international team of experts from Denmark and Texas released the results of a new study that evaluated how lower-carb, higher-protein diets affect weight loss and blood lipid profiles in adults with type 2 diabetes. Over a period of six weeks, 72 patients were assigned to a lower-carb, higher-protein diet (30% CHO and 30% protein) vs. a “conventional” eating approach (50% CHO and 17% protein). When weight loss and blood lipid profiles were examined between the groups, the findings demonstrated that while both groups achieved similar levels of weight loss, those in the lower-carb, higher-protein group achieved more of a decrease in their triglyceride and LDL-cholesterol levels, along with a greater increase in HDL-cholesterol levels. Also, they determined that the triglyceride levels in the liver were significantly reduced in this group, as compared to those eating higher-carb. The team concluded that,

Carbohydrate restriction adds to the positive effect of weight loss in T2D patients by inducing greater improvements in atherogenic lipid profile, maybe facilitated by a reduction in intrahepatic fat.

Carbohydrate Restriction, Quality of Life and Cognitive Performance

Do low-carbohydrate eating patterns have effects on cognitive function and mental health?

Nicole J. Jensen and a team from Copenhagen University in Denmark just announced the results of a randomized trial that examined quality of life parameters and cognitive function among “72 adults with type 2 diabetes and overweight and obesity” as a function of diet. One group was assigned to a lower-carb, higher-protein diet (30% CHO and 30% protein) and another to a higher-carb diet (50% CHO and 17% protein) for six weeks. Next, the team looked at weight loss along with mental health parameters and cognitive performance scores between the two groups. While both groups achieved similar weight loss, the study authors reported additional mental health and cognitive benefits in the lower-carb, higher-protein group. They conclude,

Weight loss improves physical health independently of diet composition, and carbohydrate restriction may further benefit mental health, without adversely affecting overall cognition.

Summary

Altogether, these new studies highlight that while weight loss and improvement of blood glucose levels is achievable using various dietary approaches, lower-carb and higher-protein diets appear to confer additional benefits. Namely, lowering carbs and increasing protein consumption can lower inflammation, improve lipid parameters, increase lean muscle mass and fat loss, and further improve glucose levels in adults with type 2 diabetes, as opposed to a more conventional dietary approach. Moreover, a lower-carb, higher protein diet may confer additional mental health benefits and does not negatively affect cognitive performance.



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