Low Carb Diet for heart and kidneys, what is the evidence?

10.04.231http://twitter.com/pronutritionist

Reijo Laatikainen, Authorized Nutritionist, MBA http://twitter.com/pronutritionist

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Effect of Low Carb and Low Fat diets on cardiovascular risk factors (RCT trials)

Better* Comment

LDL cholesterol Low Fat Hession et al. Δ 0,2-0,4 mmol/l

HDL cholesterol Low Carb Hession et al. Δ 0,05 mmol/l

Triglycerides Low Carb Hession et al. Δ 0,2 mmol/l

f-glucose Equal Kodama et al. + Hession et al.

2 h glucose Low Carb Kodama et al. 10 % lower

f-insulin Low Carb Kodama et al. 8 % lower

2 h insulin Low Carb Kodama et al. 13 % lower

Blood pressure Low Carb Hession et al. Δ in systolic 2 mmHg

Insulin sensitivity ? Shai et al. +Samaha et al: Low Carb better

Endothelial function ? In favour of Low Fat (2 vs 1 study) (Phillips et al. & Wyscherley vs Volek)

10/04/23

References on the last page

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Effect of Low Carb and Low Fat diets on mortality and morbidity (cohort studies)

Better* Comment

All cause mortality Low Fat Trichopoulou, Lagiou and Fung et al.

Cardiovascular mortality Low Fat Lagiou & Trichopoulou et al.

Coronary Heart Disease Equal or Low Carb

Halton et al. (Low Carb better if plant-based)

CV event (any) Low Fat Sjögren et al.

Strokes Equal No difference or N/A

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Additional points • Fung et al. showed in line with Halton et al. that plant-based Low Carb Diet is linked to reduced risk of cardiac death.

References on the last page

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Effect of Low Carb and Low Fat diets on renal function (RCT trials)

Better Comment

Progression to ESRD* ? No studies

Microalbuminuria Equal Brinkworth et al

GFR Equal Brinkworth et al

S-Creatinine Equal Brinkworth et al

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Additional points • In addition, Skov et al. & Noakes et al. have shown in short term trials (<6 months) equal effects of high & low protein diets on key parameters of renal function (normal kidney function at baseline)• Some cohort studies have linked the high intake of saturated fat to impaired renal function (Lin et al. 2010)• In renal failure, low protein diets delay progression to dialysis (Robertson et al. 2007)

*) End Stage Renal Disease

References on the last page

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References

Cardiovascular risk factors

Mortality & CV morbidity

Kidney function

Hession E et al. Systematic review of randomized controlled trials of  low-carbohydrate vs. low-fat/low-calorie diets in the  management of obesity and its comorbidities. Obesity reviews (2009) 10, 36–50

Fung T et al. Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality Two Cohort Studies. Ann Intern Med 2010;153:289-298

Brinkworth et la. Renal function following long-term weight loss in individuals with abdominal obesity on a very low carbohydrate diet vs. high carbohydrate diet. Journal of the American Dietetic Association 110:633-638, 2010.

Kodama S et al. Influence of Fat and Carbohydrate Proportions on the Metabolic Profile in Patients With Type 2 Diabetes: A Meta-Analysis. Diabetes Care. 2009 May; 32(5): 959–965

Halton TL et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-200

Skov et al. Changes in renal function during weight loss induced by high vs low-protein low-fat diets in overweight subjects. Int J Obes Relat Metab Disord. 1999 Nov;23(11):1170-7.Smaha

Samaha et al. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe ObesityN Engl J Med 2003;348:2074-81

Lagiou P et al. Low carbohydrate-high protein diet and mortality in a cohort of Swedish women. J Intern Med. 2007;261:366-74

Noakes et al. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Am J Clin Nutr June 2005vol. 81 no. 6 1298-1306

Shai et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. NEJM 2008: 359(3); 229-41

Sjögren P et al. Mediterranean and carbohydrate-restricted diets and mortality among elderly men: a cohort study in Sweden. Am J Clin Nutr 2010; Sept 8,E-pub ahead of print

Lin J et al. Associations of dietary fat with albuminuria and kidney dysfunction. Am J Clin Nutr. 2010 Oct;92(4):897-904. Epub 2010 Aug 11.

Phillips et al. Benefit of low-fat over low-carbohydrate diet on endothelial health in obesity.Hypertension. 2008 Feb;51(2):376-82

Trichopoulou A et al. Low-carbohydrate-high-protein diet and long-term survival in a general population cohort. Eur J Clin Nutr. 2007;61:575-81

Lin J et al.  Associations of diet with albuminuria and kidney function decline. Clin J Am Soc Nephrol. 2010 May;5(5):836-43. Epub 2010 Mar 18.

Volet E et al.Effects of dietary carbohydrate restriction versus low-fat diet on flow-mediated dilation.Metabolism. 2009 Dec;58(12):1769-77.

Robertson et al. Protein restriction for diabetic renal disease. Cochrane Database of Systematic Reviews. 2007, Issue 4. Art. No.: CD002181. DOI: 10.1002/14651858.CD002181.pub2

Wycherley TP et al. Long-term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients.J Intern Med. 2010 May;267(5):452-61. Epub 2009 Oct 6.

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