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<\/a><\/p>\nLow-carbohydrate diets<\/b>\u00a0restrict\u00a0carbohydrate<\/a>\u00a0consumption relative to the average diet. Foods high in carbohydrates (e.g.,\u00a0sugar<\/a>,\u00a0bread<\/a>,\u00a0pasta<\/a>) are limited and replaced with foods containing a higher percentage of fat<\/a>\u00a0and\u00a0protein<\/a>\u00a0(e.g.,\u00a0meat<\/a>,\u00a0poultry,\u00a0fish<\/a>,\u00a0shellfish<\/a>,\u00a0eggs<\/a>,\u00a0cheese<\/a>,\u00a0nuts<\/a>, and\u00a0seeds<\/a>), as well as low carbohydrate foods (e.g., spinach<\/a>,\u00a0kale<\/a>,\u00a0chard<\/a>,\u00a0collards<\/a>, and other fibrous\u00a0vegetables).<\/p>\n There is a lack of standardization of how many carbohydrates, low-carbohydrate diets must have. This has complicated research. o<\/sup>ne definition from the American Academy of Family Physicians\u00a0specifies low-carbohydrate diets as having less than 20% carbohydrate content.<\/sup><\/p>\n There is no good evidence that low-carbohydrate dieting confers any particular health benefits apart from\u00a0weight loss<\/a>, where low-carbohydrate diets achieve outcomes similar to<\/p>\n , weight loss is mainly determined by calorie restriction and adherence.<\/p>\n An extreme form of low-carbohydrate diet called the\u00a0ketogenic diet\u00a0was first established as a medical diet for treating\u00a0epilepsy.\u00a0It became a popular\u00a0fad diet\u00a0for weight loss through\u00a0celebrity endorsement. Still, there is no evidence of any distinctive benefit for this purpose. The diet carries a risk of adverse effects, <\/sup>\u00a0with the\u00a0British Dietetic Association naming it one of the “top five worst celeb diets to avoid” in 2018.<\/p>\n Related:25 Different Types of Carrots<\/a><\/strong><\/p>\n The macronutrient ratios of low-carbohydrate diets are not standardized. As of 2018, the conflicting definitions of “low-carbohydrate” diets have complicated research into the subject<\/a>.<\/sup><\/p>\n The National Lipid Association and Lifestyle Taskforce define low-carbohydrate diets and those containing less than 25% of calories from carbohydrates. Deficient carbohydrate diets contain less than 10% carbohydrates<\/a>. <\/sup>A 2016\u00a0review<\/a> of low-carbohydrate diets classified diets with 50g of carbohydrate per day (less than 10% of total calories) as “deficient” and diets with 40% of calories from carbohydrates as “mild” low-carbohydrate diets.<\/sup>\u00a0The UK\u00a0National Health Service<\/a> recommends that “carbohydrates should be the body’s main source of energy in a healthy, balanced diet.”<\/sup><\/p>\n Like other leafy vegetables,\u00a0curly kale\u00a0is a food that is low in carbohydrates.<\/p>\n<\/div>\n<\/div>\n<\/div>\n There is evidence that the quality, rather than the quantity, of carbohydrates in a diet is important for health. High-fiber, slow-digesting carbohydrate-rich foods are healthful, while highly refined and sugary foods are less so. People choosing a diet for health conditions should have their diet tailored to their requirements.<\/sup>\u00a0For people with metabolic conditions, a diet with approximately 40-50% carbohydrate is recommended.<\/sup><\/p>\n Most vegetables are low- or moderate-carbohydrate foods (in some low-carbohydrate diets,\u00a0fiber\u00a0is excluded because it is not a nutritive carbohydrate). Some vegetables, such as\u00a0potatoes,\u00a0carrots,\u00a0maize (corn), and rice, are high in starch. Most low-carbohydrate diet plans accommodate broccoli,\u00a0spinach,\u00a0kale,\u00a0lettuce,\u00a0cucumbers,\u00a0cauliflower,\u00a0peppers, and most green leafy vegetables.<\/p>\n The\u00a0National Academy of Medicine\u00a0recommends a daily average of 130\u00a0g of carbohydrates per day. The\u00a0FAO\u00a0and\u00a0WHO similarly recommend that the majority of dietary energy comes from carbohydrates. Low-carbohydrate diets are not recommended in the 2015\u20132020 edition of Dietary Guidelines for Americans, which instead recommends a low-fat diet.<\/p>\n Carbohydrate has been wrongly accused of being a uniquely “fattening” macronutrient, misleading many dieters into compromising the nutritiousness of their diet by eliminating carbohydrate-rich food. Low-carbohydrate diet proponents emphasize research saying that low-carbohydrate diets can initially cause slightly greater weight loss than a balanced diet, but any such advantage does not persist. In the long-term successful weight maintenance is determined by calorie intake and not by macronutrient ratios.<\/sup><\/sup><\/p>\n The public has become confused by how some diets, such as the Zone diet<\/a>\u00a0and the\u00a0South Beach diet<\/a>, are promoted as “low-carbohydrate” when they would more properly be termed “medium-carbohydrate”<\/a> diets.<\/p>\n Low-carbohydrate diet advocates including\u00a0Gary Taubes\u00a0and\u00a0David Ludwig\u00a0have proposed a “carbohydrate-insulin hypothesis” in which carbohydrates are said to be uniquely fattening because they raise insulin levels and cause fat to accumulate unduly. The hypothesis appears to run counter to known human biology, whereby there is no good evidence of any such association between the actions of insulin, fat accumulation, and obesity.<\/sup> The hypothesis predicted that low-carbohydrate dieting would offer a “metabolic advantage” of increased energy expenditure equivalent to 400-600\u2009kcal(kilocalorie)\/day, in accord with the promise of the Atkins diet: a “high-calorie way to stay thin forever.”<\/sup><\/p>\n With funding from the\u00a0Laura and John Arnold Foundation, in 2012, Taubes co-founded the Nutrition Science Initiative (NuSI) to raise over $200 million to undertake a “Manhattan Project\u00a0For Nutrition” and validate the hypothesis. \u00a0Intermediate results, published in the\u00a0American Journal of Clinical Nutrition,<\/i> did not provide convincing evidence of any advantage to a low-carbohydrate diet compared to diets of other compositions. This study revealed a marginal (\u223c100 kcal\/d) but statistically significant effect of the ketogenic diet to increase 24-hour energy expenditure measured in a respiratory chamber, but the effect waned over time. Ultimately a very low-calorie, ketogenic diet (of 5% carbohydrate) “was not associated with significant loss of fat mass” compared to a non-specialized diet with the same calories; there was no useful “metabolic advantage.”]<\/sup> In 2017 Kevin Hall, an\u00a0NIH\u00a0(National Institutes of Health) researcher hired to assist with the project, wrote that the carbohydrate-insulin hypothesis had been\u00a0falsified by experiment. Hall wrote, “the rise in obesity prevalence may be primarily due to increased consumption of refined carbohydrates, but the mechanisms are likely to be quite different from those proposed by the carbohydrate-insulin model.”<\/sup><\/p>\n It has been repeatedly found that in the long-term, all diets with the same calorific value perform the same for weight loss, except for the one differentiating factor of how well people can faithfully follow the dietary program.<\/sup> A study comparing groups taking low-fat, low-carbohydrate, and\u00a0Mediterranean diets found at six months, the low-carbohydrate diet still had most people adhering to it. Still, the situation reversed: at two years, the low-carbohydrate group had the highest incidence of lapses and dropouts. <\/sup>This may be due to the comparatively limited food choice of low-carbohydrate diets<\/a>.<\/sup><\/p>\n People taking a low-carbohydrate diet can experience more weight loss in the short and medium term than people taking a low-fat diet<\/a>. <\/sup>\u00a0Such people have slightly more weight loss initially, equivalent to approximately 100kcal\/day, but the advantage diminishes over time and is ultimately insignificant.<\/sup>\u00a0The\u00a0Endocrine Society\u00a0stated that “when calorie intake is held constant […] body-fat accumulation does not appear to be affected by even very pronounced changes in the amount of fat vs. carbohydrate in the diet.”<\/sup><\/p>\n Much of the research comparing low-fat vs. low-carbohydrate dieting has been of poor quality, and studies that reported large effects have garnered disproportionate attention compared to those that are methodologically sound. A 2018 review said, “higher-quality meta-analyses reported little or no difference in weight loss between the two diets.”<\/sup>\u00a0Low-quality\u00a0meta-analyses have tended to report favorably on the effect of low-carbohydrate diets: a\u00a0systematic review\u00a0reported that 8 out of 10 meta-analyses assessed whether weight loss outcomes could have been affected by\u00a0publication bias, and 7 of them concluded positively.<\/sup> A 2017 review concluded that various diets, including low-carbohydrate diets, achieve similar weight loss outcomes, which are mainly determined by\u00a0calorie restriction\u00a0and adherence rather than the type of diet. Low-carbohydrate dieting tends to raise LDL cholesterol levels, but it is unclear how this might affect c<\/a>ardiovascular health. <\/sup><\/sup>Potential favorable changes in triglyceride and\u00a0HDL cholesterol\u00a0values should be weighed against potential unfavorable changes in LDL and total cholesterol values.<\/sup><\/p>\n Some\u00a0randomized control trials\u00a0have shown that low-carbohydrate diets, especially very low-carbohydrate diets, perform better than low-fat diets in improving cardiometabolic risk factors in the long term, suggesting that low-carbohydrate diets are a viable option alongside low-fat diets for people at risk of cardiovascular disease.<\/sup><\/p>\n There is only poor-quality evidence of the effect of different diets on reducing or preventing\u00a0high blood pressure. Still, it\u00a0suggests the low-carbohydrate diet is among the better-performing ones, while the\u00a0DASH diet\u00a0(Dietary Approaches to Stop Hypertension) performs best. There is limited evidence for the effectiveness of low-carbohydrate diets for people with\u00a0type 1 diabetes. <\/sup>For certain individuals, it may be feasible to follow a low-carbohydrate regime combined with carefully managed\u00a0insulin dosing. This can be hard to maintain, and there are concerns about potential adverse health effects caused by the diet.<\/sup>\u00a0In general, people with type 1 diabetes are advised to follow an individualized eating plan.<\/sup><\/p>\n The proportion of carbohydrates in a diet is not linked to the risk of type 2 diabetes. However, some evidence suggests that diets containing certain high-carbohydrate items \u2013 such as sugar-sweetened drinks or white rice \u2013 are associated with an increased risk.<\/sup>\u00a0Some evidence indicates that consuming fewer carbohydrate foods may reduce\u00a0biomarkers\u00a0of type 2 diabetes.<\/sup><\/sup><\/p>\n An in 2019 consensus report on nutrition therapy for adults with diabetes and prediabetes the American Diabetes Association (ADA) states, “Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia (blood sugar) and may be applied in a variety of eating patterns that meet individual needs and preferences.<\/i>“, it also states that reducing overall carbohydrate intake with low- or very low- carbohydrate eating plans is a viable approach.<\/sup> While other sources state that there is no good evidence that low-carbohydrate diets are better than a conventional\u00a0healthy diet\u00a0in which carbohydrates typically account for more than 40% of calories consumed. <\/sup>\u00a0Low-carbohydrate dieting does not affect the kidney function\u00a0of people who have type 2 diabetes.<\/sup><\/p>\n Limiting carbohydrate consumption generally results in improved glucose control, although without long-term weight loss.<\/sup>\u00a0Low-carbohydrate diets can be useful to help people with type 2 diabetes lose weight, but “no single approach has been proven to be consistently superior<\/a>.”<\/sup> According to the ADA, people with diabetes should be “developing healthy eating patterns rather than focusing on individual macronutrients, micronutrients, or single foods.” They recommended that the carbohydrates in a diet should come from “vegetables, legumes, fruits, dairy (milk and yogurt), and whole grains,” while highly refined foods and sugary drinks should be avoided.\u00a0<\/sup> The ADA also wrote that “reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.” For individuals with type 2 diabetes who can’t meet the glycemic targets or where reducing anti-glycemic medications is a priority, the ADA says that low or very-low-carbohydrate diets are a viable approach.<\/p>\n A low-carbohydrate diet has been found to reduce endurance capacity for intense exercise efforts. Depleted muscle glycogen<\/a> following such efforts is only slowly replenished if a low-carbohydrate diet is taken. Inadequate carbohydrate intake during athletic training causes metabolic acidosis, which may be responsible for the impaired performance that has been observed.<\/sup><\/p>\n The\u00a0ketogenic diet<\/a>\u00a0is a high-fat, low-carbohydrate diet used to treat drug-resistant childhood\u00a0epilepsy<\/a>.<\/sup>\u00a0The premise of the ketogenic diet for weight loss is that if the body is deprived of\u00a0glucose<\/a> obtained from carbohydrate foods, it will produce energy from stored fat. In the 2010s, the ketogenic diet became a\u00a0fad diet\u00a0for people wanting to lose weight.<\/sup>\u00a0The keto diet became popular through\u00a0celebrity endorsement. Still, there is no evidence of any distinctive benefit for this purpose. The diet carries a risk of\u00a0adverse effects,\u00a0with the\u00a0British Dietetic Association naming it one of the “top five worst celeb diets to avoid” in 2018.<\/p>\n According to dietitian Keri Gans, the “keto diet” was the most popularly searched diet on Google in 2018.\u00a0In 2021, it was ranked by\u00a0U.S. News & World Report<\/i> 37th (tie) out of 39 best diets overall and 4th in best fast weight-loss diets.<\/sup><\/p>\n The ketogenic diet may not achieve sustainable weight loss, as this requires strict carbohydrate abstinence, and maintaining the diet is difficult.<\/sup><\/sup>\u00a0Side effects may include\u00a0constipation,\u00a0high cholesterol, growth slowing,\u00a0acidosis, and\u00a0kidney stones.<\/sup><\/p>\n It has been hypothesized that some people have an atypical metabolism and would therefore benefit metabolically from adopting a ketogenic diet. Still, as of 2020, there had been no long-term research<\/a> into this.<\/p>\n High and low-carbohydrate diets that are rich in animal-derived proteins and fats may be associated with increased mortality. On the contrary, with plant-derived proteins and fats, there may be a decrease in mortality.<\/sup><\/p>\n As of 2018, research has paid insufficient attention to the potential\u00a0adverse effects of carbohydrate-restricted dieting, particularly for\u00a0micronutrient\u00a0sufficiency,\u00a0bone health,\u00a0and\u00a0cancer\u00a0risk. <\/sup>\u00a0One low-quality meta-analysis reported that adverse effects could include “constipation,\u00a0headache,\u00a0halitosis,\u00a0muscle cramps,\u00a0and general weakness.”<\/sup><\/p>\n Ketosis\u00a0induced by a low-carbohydrate diet has led to reported cases of\u00a0ketoacidosis, a life-threatening condition. This has led to the suggestion that ketoacidosis should be considered a potential hazard of low-carbohydrate dieting.<\/sup><\/p>\n In a comprehensive\u00a0systematic review\u00a0of 2018, Churuangsuk and colleagues reported that other\u00a0case reports give rise to concerns of other potential risks of low-carbohydrate dieting, including\u00a0hyperosmolar coma,\u00a0Wernicke’s encephalopathy,\u00a0optic neuropathy\u00a0from\u00a0thiamine deficiency,\u00a0acute coronary syndrome,\u00a0and\u00a0anxiety disorder.<\/sup><\/p>\n Significantly restricting the proportion of carbohydrates in the diet risks causing malnutrition<\/a>, and can make it difficult to get enough dietary fiber<\/a>\u00a0to stay healthy<\/a>.<\/sup><\/p>\n As of 2014, it appeared that concerning the risk of death for people with cardiovascular disease, the kind of carbohydrates consumed is important; diets relatively higher in fiber and whole grains lead to reduced risk of death from cardiovascular disease compared to diets high in refined grains<\/a>.<\/p>\n<\/a>Definition and classification<\/span><\/h2>\n
Macronutrient ratios<\/span><\/h3>\n
<\/a>Foodstuffs<\/span><\/h2>\n
<\/a><\/p>\nAdoption and advocacy<\/span><\/h2>\n
Carbohydrate-insulin hypothesis<\/span><\/h2>\n
<\/a>Health aspects<\/span><\/h2>\n
Adherence<\/span><\/h3>\n
Bodyweight<\/span><\/h3>\n
<\/a><\/sup><\/p>\nCardiovascular health<\/span><\/h3>\n
<\/sup><\/p>\nDiabetes<\/span><\/h3>\n
Exercise and fatigue<\/span><\/h3>\n
Ketogenic diet<\/span><\/h3>\n
<\/p>\nSafety<\/span><\/h3>\n
History<\/span><\/h2>\n