BMJ: Low and ultra -low carbohydrate diet can alleviate diabetes
The moderate-low definitation evidence of 23 random tests (n = 1357) shows that insisting on low or ultra-low carbohydrates within 6 months can alleviate diabetes without adverse consequences. However, the definition of low carbohydrate diet, the long -term health impact of carbohydrate restrictions on diet, and the definition of diabetes relief are all controversial. It is necessary to further investigate, especially the long -term health results based on the evidence of random test.
Definition of low or ultra -low carbohydrate diet
Carbohydrates are limited to the management of diabetes have a long history. Authoritative institutions have recently emphasized the potential benefits and harm of low carbohydrate diet. However, the definition of such diet may be very different, which may confuse both patients and suppliers. Over the past few decades, the average carbohydrate intake of adults in the United States is estimated to be between 39%and 51%per day (then called califf). Historically, the intake of carbohydrates recommended by authoritative agencies ranges from 45%to 65%of the daily calories. Therefore, the diet of 45%of the daily calorie of carbohydrates is usually considered to be carbohydrate restrictions.
The meaning of low carbohydrate diet depends on the source of reference. For example, in 2015, a formal definition was proposed to define a low -carbohydrate diet. Less than 26%of the daily calories came from carbohydrates (<130 grams/day). The consensus statement of early nutritional therapy describes the "low carbohydrate diet mode, which is about to reduce carbohydrates to 26-45%of the total calories" (225 grams of 225 grams of diet in 2000 calories). The definition of ultra -low carbohydrate diet is also different (for example, the threshold is <10%to <26%) from daily calorie intake. This difference is substantial, because the intake of carbohydrates in the diet is greatly reduced (eg, 10%of the daily calories) has proven to induce nutrients. In this physiological state, ketone body is produced and used as an alternative energy, especially the brain. These diets are usually called ketogenic diets. Instead, the diet of ultra -low carbohydrates is defined as a daily calorie of the perfusion of carbohydrates <26%, and it does not always induce ketogenic ketogenic.
Before reaching a consensus on definition, researchers should clearly define the use of low carbohydrates and ultra -low carbohydrates. In addition, when the interpretation results are explained, evidence of insisting on carbohydrate restrictions, and how to influence the research results.
Why is this very important
Ultra -low carbohydrate diet, especially those diets that induce ketogenic, are controversial. The dispute is mainly related to the five traditional nutrition recommendations. These 5 suggestions are related to the adverse health consequences of high saturated fat diet. The saturated fat diet usually occurs in people with restricted carbohydrate diet. Recently, the most comprehensive review of random trials of diabetes patients who have followed the 6 -month and 12 -month -old low -carbohydrate diet found that there were no statistically significance of total adverse events or serious adverse events, and no clinical importance increased. However, such reports are rare, and the main adverse vascular events may take longer to develop. So far, the random test of the low -carbohydrate diet for patients with diabetes is limited to several tests that last for more than 12 months, and these studies do not exceed 24 months. Long -term observation research on average for 25 years of follow -up shows that there are U -shaped relationships with high intake and low carbohydrate intake, which shows that the risk of death has increased, but mixed factors cannot be ruled out.
In addition to potential harmful health risks, the advocates of plant -based diet also proposed the environment and ethical concerns of restricting the diet of carbohydrates. These diets usually contain a large number of animal products. However, a wide range of carbohydrate restrictions can indeed be realized and personalized. The use of vegetarian or vein, although the vegan ketogenic diet is more challenging and has no calorie restrictions.
Other considerations -define diabetes relief
The relief of diabetes is an important result for patients, clinicians and policy makers. The definition of relief is also different. Generally speaking, in the definition of contemporary diabetes, three factors are considered: glycated hemoglobin (HBA1C) threshold, use of anti -diabetic drugs, and relieving time. Although an international institution composed of diabetes experts in 2009 published a consensus paper, trying to form a regularization definition, these definitions have never been officially adopted. In addition, the scope of definition in 2020 shows that the definition of diabetes relief still has heterogeneity. For example, the most commonly used HBA1C threshold is <42 mmol/mol (6.0%) and <48 mmol/mol (6.5%). As far as drug treatment is concerned, some useful treatment, such as dual -dual -dual -dualty, may be regarded as unsuitable ethics; therefore, there are some resistance to the definition of drug treatment. As for the proposed relief period, according to the source of reference, it can be ranging from 30 days to 5 years.
Before the formal definition of the diabetic research group reached the same definition, the researchers should clearly explain the conditions they defined. Researchers may use several definitions. For example, the Joshu Z Goldenberg research team tried to solve this lack of consensus through the test results of diabetes relief by using four prior definitions in the test of 6 -month and 12 -month results. Carbohydrates restrict the term, evaluation, and application for diabetes to relieve the term. The center of patients, clinicians, and policy makers make decisions based on evidence. Before reaching a consensus, when the carbohydrates restrict the effectiveness and safety of diabetes management for diabetes management, researchers should know that they are defined by the diet of low carbohydrates and ultra -low carbohydrates and diabetes relief. The literature should know the literature. What definitions are used, and at the same time recognize the sub -group analysis of any sensitivity or the results of different definitions.
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Source of the original text
Goldenberg J Z, Johnston B C. Low and Very Low Carbohydrate Diets for Diabetes Remice BMJ 2021; 373: N262 DOI: 10.1136/bmj.n262
