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The effects of a low-carbohydrate, high fat diet on diabetes related physiological mechanisms

Written by: Candice Spence 27 May 2019 Researcher:

Institution: University of Cape Town

Researchers: Emeritus Professor Tim Noakes, Dr James Smith, Dr Chris Webster, Dr Kate Larmuth

Background: Low carbohydrate high fat (LCHF) diets are an effective means for people with type 2 diabetes (T2D) to improve glucose control and reduce medication use, however there are still many unanswered questions about the diet. For example, there is much confusion as to what actually constitutes an effective LCHF diet in practice and little is known about the perceptions and experiences of T2D patients who follow an LCHF diet. The physiological mechanisms of how the diet improves glucose control and affects health are not clearly understood. Understanding these mechanisms is important if LCHF diets are to be widely accepted for managing T2D because there are still concerns that the high fat component of the diet will negatively impact other aspects of diabetes pathology.

Aim: To understand the nuances of an LCHF diet and its effect on diabetes related physiological mechanisms and cardiovascular disease risk

  • Study 1 is a multi-method study of patients with T2D who claimed to have followed a LCHF diet for longer than six months. The composition of the diet, diabetes medication use, and diabetes status was assessed (quantitative research) and participants were interviewed about their experiences with the diet and its effect on their health (qualitative research).
  • Study 2 will be used to develop and optimize our testing procedures to study advanced physiological mechanisms, including liver glucose production, muscle metabolism (mitochondrial function), and cardiovascular disease. These assessments will be piloted on twelve volunteers with a range of health and dietary characteristics to ensure that we can detect predictable differences amongst participants.
  • Study 3 will investigate the effect of an LCHF diet on diabetes related physiological mechanisms using the assessment methods from Study 2.

Summary of Study 1 (completed):

Study 1 had consisted of both  quantitative and qualitative research.  The objective of the qualitative research was to investigate the experiences and perceptions of individuals with T2D who had self-selected and followed an LCHF diet for at least 6 months. This was done through in-depth one-on-one interviews with 28 participants who had been previously diagnosed with T2D and who claimed to follow an LCHF diet. Results indicated that participants associated carbohydrate rich foods, as well as sweet-tasting, packaged, and/or highly-processed foods, with hunger, cravings, and binging. They believed that by avoiding these foods, they had reduced their hunger and addictive eating behaviours, which gave them control over their eating, and in turn, gave them control of their health, weight and T2D.

The objective of the quantitative research was to characterise the diet, eating patterns, T2D status, and medication use of individuals with confirmed T2D, who claimed to have followed an LCHF diet for at least. This was an observational study with a 15-month follow-up assessment. This also included detailed medications history, mixed-method dietary assessment, and blood samples. Past laboratory results were obtained corresponding to T2D diagnosis and immediately prior to starting an LCHF diet. Results showed a preference for whole foods was a key component of participants’ LCHF diets. Participants achieved and sustained excellent glucose control whilst following the diet. These observational data suggest that an LCHF diet can be sustainable and effective for managing T2D amongst certain individuals in real-world settings.

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