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Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes
This study compared the effects of low-carbohydrate diets and low-fat diets on weight and glycemic control. The results indicated that the difference in weight loss and glycemic control between the two groups was insignificant at the end of one year, but the low-carbohydrate group lost more weight in the initial three months. The low-carbohydrate group also saw a higher increase in HDL cholesterol. The strengths include a large sample size of diabetic (Type 2) and overweight adults (inclusive of all ages 18+). In addition, the time frame for the study was long enough to see marked differences in results at the 6-month point versus the year point. Weaknesses include a lack of measures that ensure that each group was following their assigned diet plans. In addition, the study was funded in part by the Atkins foundation (which was founded by the same founder of the Atkins diet, a popular low-carbohydrate diet plan). This study does not support either side of the controversy, but suggests that the traditionally recommended low-carbohydrate diet for diabetics may bear no different results than a low-fat diet.

Effects of Low-Carbohydrate Diets Versus Low-Fat Diets on Metabolic Risk Factors: A Meta-Analysis of Randomized Controlled Clinical Trials
This meta-analysis looks at 23 randomly controlled clinical trials to assess the effect of low-fat diets versus low-carbohydrate diets on metabolic risk factors. Results show that both diets resulted in weight loss, lower levels of LDL cholesterol, and higher levels of HDL cholesterol. However, the low-carbohydrate diet resulted in a significantly higher increase in HDL cholesterol. Overall, the study suggests that both types of diets can be recommended to prevent and treat metabolic risk factors. A strength is strictly controlled data quality for comparison (the study used a standardized method for taking data from each trial). In addition, the analysis encompasses a heterogeneous sample, as each study used included subjects of different demographics. Weaknesses include high attrition rates among most of the studies used (less than 70% completion) and a statistically significant level of publication bias in the studies on lipids. The results of the study does not support either side of the controversy, but recognizes that there is little difference in metabolic risk factors between low-carbohydrate diets and low-fat diets.

A low-carbohydrate high-fat diet increases weight gain and does not improve glucose tolerance, insulin secretion or β-cell mass in NZO mice
This study looked at the effects of low-carbohydrate diets on pre-diabetic mice. The results showed that insulin secretory function in mice fed a low-carbohydrate and high fat diet did not improve and the diet actually resulted in more weight gain than seen in the control group. Therefore, low-carbohydrate, high-fat diet is not likely to be beneficial in preventing the decline in beta cell function associated with the progression of type 2 diabetes. Strengths of this study include the use of a control group fed standard rodent food and the ability to strictly control the diets of the subjects and the measure energy expenditure. Weaknesses include a lack of generalizability, as the results may not consistent among adults. The results support the contention that a high-fat diet is detrimental to insulin secretion, especially since mice fed the low-carbohydrate diet rapidly developed diabetes after eating a normal diet after the term.

Dietary Fat and the Development of Type 2 Diabetes
This study aims to assess the results of prior clinical trials in order to decide on dietary recommendations for individuals developing type 2 diabetes. The results show that the detrimental effects of diets high in fats (especially saturated fats) are correlated with higher risk of type 2 diabetes. However, when adjusted for BMI, the effect is not significant. Strengths include longitudinal design (measurements were taken both before and after dietary changes, and at regular intervals) and the large size. Weaknesses include measurement error in the studies used in the analysis. The results suggest that a low-fat diet should still be suggested for people developing diabetes, but the effects may be due to the weight gain seen in people consuming high fat diets than the diet itself.

Indigenous nutrition research and the low-carbohydrate diet movement: Explaining obesity and diabetes in Protein Power
This study looks at the strengths and weaknesses of using evidence from indigenous peoples in support of low carbohydrate diets in the prevention of diabetes and heart disease. In particular, the article focuses on contemporary literature on low-carbohydrate diets distributed to the public (particularly Protein Power). The study found that comparations with indigenous peoples presented some false information at times and only looked at indigenous peoples at a frozen point in time (instead of modern times). For example, Protein Power states that the Inuit people do not consume many carbohydrates and see lower rates of both diabetes and heart disease than the US population. In reality, modern day Inuit people actually have higher dead rates from heart disease than does the US population. In addition, there lifespan expectancy is about 10 years lower.

In addition, while making the comparison between the diets of Aboriginal people and westerners, Protein Power fails to acknowledge that the diets that Aboriginal subjects consumed was actually not similar to western diets (westerners consume less fat and more protein than suggested). Therefore, claims that Aboriginal people developed diabetes and heart disease abnormally quickly on a western diet may not be founded (as the cause may not be western diets after all). Therefore, the review suggests that evidence from indigenous peoples in support of low-carbohydrate diets in preventing diabetes is not as strong as suggested. However, in the case of the Inuit, it is true that they have lower instances of diabetes (though this may be caused by a number of other factors as their diet is significantly different from western diets in more ways just carbohydrate consumption). Therefore, the findings overall cast doubt on evidence for low-carbohydrate diets but does not support either side of the controversy.

When Do Nutrient Content and Nutrient Content Claims Matter? Assessing Consumer Tradeoffs Between Carbohydrates and Fat
This study accesses the need for standardized metrics for low-carbohydrate claims on food packaging and their effects on consumer behavior. The study finds that low fat and low carbohydrate labels significantly effect consumer’s perception of potential weight gain (low fat labels lead consumers to believe that the product will lead to lower weight gain to low fat products). The study also showed that consumers did not pay attention to labels that indicate harm to health, such as high levels of added sugar and saturated fat. Therefore the study shows the need for standardized and regulated system for claims on carbohydrate and fat content is necessary for population health. Therefore this study suggests that the effectiveness of any finding on the effects of high fat or high carb diets is compromised by consumer perception (consumer perception often veers away from the findings of scientific studies). The role of policy in population health is therefore evident regardless of the side of nutritional controversy.

Food Insecurity and Glycemic Control Among Low-Income Patients With Type 2 Diabetes
This study finds that food insecurity and type 2 diabetes have a significant relationship. In fact, food insecure patients showed a significantly lower level of glycemic control. Food insecure patients were also more likely to report difficulty affording a diabetic diet. They also reported lower diabetes-specific self-efficacy and higher emotional distress related to diabetes. Difficulty following a healthy diet and emotional distress partially mediated the association between food insecurity and glycemic control. Therefore this article suggests that the claims on the effects of diets on diabetes fails to address the social constructs that put people at risk for diabetes (socio-economic status). The article does not support any side of the controversy but brings attention to the multidimensional nature of illness and recognizes that treatment cannot simply be isolated to fat and carbohydrate content.

Globalization of Diabetes: The role of diet, lifestyle, and genes  [2011]
This article looks at the multitude of outside factors that are linked to the development of diabetes globally. In particular, the article focuses on the obesity epidemic in Asian countries: Asians develop diabetes earlier in life and at lower BMIs than western equivalents. There are several factors that contribute to this, including high consumption of alcohol and smoking, high consumption of refined carbohydrates, genetic disposition, and poor nutrition in utero and in early life combined with overnutrition in later life. These factors bring attention to the number of other factors that contribute to diabetes and questions the validity of studies that only study diabetes in US populations as the differences in lifestyle and genetics cannot be generalized across all people with the illness (a weakness of studies). On the other hand, the study also suggests that high refined carbohydrate consumption contributes to the high rate of diabetes, supporting the notion of low-carbohydrate diets can help prevent and treat the illness.