High glucose appears to trigger the activation of innate immune cells, suggesting that hyperglycemia itself drives a vicious cycle of inflammation and insulin resistance in T2D.
17
2018
1
"High glucose appears to trigger the activation of innate immune cells, suggesting that hyperglycemia itself drives a vicious cycle of inflammation and insulin resistance in T2D. Lowering carbohydrate consumption effectively lowers glucose, but impacts on inflammation are unclear. Aims: 1) to determine whether reducing hyperglycemia by following a low-carbohydrate, high-fat (LC) diet could lower markers of innate immune cell activation in T2D, and 2) to examine if the combination of a LC diet with strategically timed postmeal walking was superior to a LC diet alone. "
N
11
"Targets 1) LC alone E: ~1700 kcal Carb: ~10%E Protein: ~25%E Fat: ~65%E 2) LC + Ex: same as above + ~210 kcal added to compensate for postmeal walks"
"Guidelines (GL) diet Based on current dietary guidelines for adults with T2D (low glycemic index, low-fat, whole foods) Targets E: 1700 kcal Carb: ~55%E (low GI and high-fiber mainly) Protein: ~25%E (mainly from lean meats) Fat: ~20%E (saturated fat <7%) Intake: NR"
"Primary: glucose control assessed by continuous glucose monitoring (CGM)* Secondary: 13 markers of inflammation in plasma and peripheral blood mononuclear cells (PBMCs); metabolic control. *Mean glucose CONGA - continuous overall net glycemic action MAGE - mean amplitude of glycemic excursion "
"Glucose control: CGM most improved with LC diet + Ex; LC diet alone also SS effective, compared to GL diet. Both LC diet and LC diet + Ex resulted in SS improvement in proinsulin. Inflammation: No consistent effects, many NSS. All 3 diets improved peripheral blood mononuclear cells phosphorylated c-Jun N-terminal kinase. GL diet most improved monocyte microparticles. "
"FBG, pre→post, mmol/l LC diet: 8.4→7.6 WG SS LC diet + Ex: 7.8→7.0 WG SS GL diet: 8.3→8.1 WG NSS 4-day CGM Mean glucose LC diet: 6.5mmol/l LC diet + Ex: 6.2 GL diet: 7.4 LC + Ex superior to LC and GL diets BG SS LC alone superior to GL diet BG SS MAGE LC diet: 2.0mmol/l LC diet + Ex: 1.7 GL diet: 4.3 LC + Ex superior to GL diet BG SS LC alone superior to GL diet BG SS CONGA LC diet: 6.2mmol/l LC diet + Ex: 5.9 GL diet: 6.6 LC + Ex superior to GL and LC diets BG SS LC alone superior to GL diet BG SS "
1
*
NR
*
*
NR
*
*
NR
*
*
NR
*
*
"WG: N BG: N WG NSS for all diet groups. BG NSS"
0
0
*
*
~2kg weight loss occurred with all 3 diets, despite efforts to maintain baseline weight
*
*
NR
*
*
NR
*
*
NSS for all 3 diets
0
0
"Proinsulin SS decreased with both the LC diet and LC + Ex. GL diet NSS. Proinsulin-C-peptide ratio SS decreased with both the LC diet and LC + Ex. GL diet NSS. "
*
*
"Markers: leukocyte-derived microparticles (LMP); monocyte-derived microparticles (MMP); phosphorylated c-Jun NH2-terminal kinase (p-JNK); toll-like receptors 2 and 4 (TLR 2, TLR 4); tumor necrosis factor (TNF); granulocytes, lymphocytes, monocytes; monocyte chemoattractant protein-1 (MCP-1); interleukin 6, 10, 18. SS effects: SS overall time effects for MCP-1, p-JNK, and MMPs (decrease in MMPs greatest with GL diet) In pre/post comparisons: LC + Ex decreased MCP-1 All 3 diets decreased p-JNK (overall lowest with LC + Ex) TLR4 overall lowest with GL "
*
*
NR
NR
"Longer-term studies using LCHF diets and exercise looking at cardiometabolic and inflammatory markers are necessary to confirm the beneficial effects of such diets in individuals with T2D."
Abbreviations:
AHA - American Heart Association;
ALT - alanine aminotransferase;
AMDR - acceptable macronutrient distribution range;
AST - aspartate aminotransferase;
BG - between study groups;
BHOB - beta-hydroxybutyrate;
DBP - diastolic blood pressure;
E- energy, caloric intake;
eGFR - estimated glomerular filtration rate;
FBG - fasting blood glucose;
GGT - gamma-glutamyl transferase;
HDL-C - high-density lipoprotein cholesterol;
iGFR - isotope glomerurar filtration rate;
LDL-C - low-density lipoprotein cholesterol;
NAFLD - non-alcoholic fatty liver disease;
NR - not reported (or data needed for calculation not available);
N - no;
NA - not applicable;
NS - not specified;
NSS - not statistically significant;
SBP - systolic blood pressure;
SS - statistically significant;
TG - triglyceride;
total C - total cholesterol;
V - varied, mixed;
WG - within a study group;
WMD - weighted mean difference;
Y - yes
Number of People in Studies:
3,296 Enrolled in randomized controlled trials on 25% or less carbohydrates
2,626 Completed randomized controlled trials on 25% or less carbohydrates
79.67% 82% completion of studies
Duration of Trial
<6 Months
6-9 Months
1 -2 years
>2 years
# of Trials
36
6
9s
1