Ebbeling CB, Bielak L, Lakin PR, et al. Energy Requirement Is Higher During Weight-Loss Maintenance in Adults Consuming a Low- Compared with High-Carbohydrate Diet. J Nutr. 2020;150(8):2009-2015. doi:10.1093/jn/nxaa150
There have now been a number of reviews on this topic. A recent (07/2021) narrative review paper from Wheatley et al is an excellent overview of the literature, the remaining areas of controversy, and practical recommendations. In addition, this paper from Brown et al focuses on options for remission (08/2021).
Systematic Reviews, Meta-Analyses and other reviews
Yancy WS, Westman EC, McDuffie JR, et al. A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss. Arch Intern Med. 2010;170(2):136. doi:10.1001/archinternmed.2009.492
Chiu S, Bergeron N, Williams PT, Bray GA, Sutherland B, Krauss RM. Comparison of the DASH (Dietary Approaches to Stop Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial1–3. The American Journal of Clinical Nutrition. 2016;103(2):341-347. doi:10.3945/ajcn.115.123281Unwin DJ, T
Unwin DJ, Tobin SD, Murray SW, Delon C, Brady AJ. Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care. International Journal of Environmental Research and Public Health. 2019;16(15):2680. doi:10.3390/ijerph16152680
Caution – there are several reports of lactation ketoacidosis occuring in the literature (see Possible Complications). For a prudent interpretation of the literature regarding breastfeeding, the link below to Dr. Andreas Eenfeldt – Diet Doctor, may be helpful – Breastfeeding on a low-carb diet – is it dangerous? Diet Doctor.
As oestrogen/progesterone are insulin sensitizing hormones, a reduction in these hormones can increase insulin resistance which may contribute to the metabolic dysregulation and symptoms of menopause. This section includes studies that support potential benefits of a TCR approach to help manage areas of common concern during menopause, primarily as a means of reducing glycaemic variability and insulin resistance.
Insulin resistance, weight gain and cardiovascular disease
Therapeutic carbohydrate reduction is one way to combat insulin resistance, weight gain, and inflammation – risk factors for CVD. Insulin resistance also contributes to platelet dysfunction and clotting risk.
Glycaemic variability, insulin resistance and hot flashes
Sleep has a bidirectional effect on metabolic health. Poor sleep patterns, such as shift work, can increase insulin resistance and increase the risk of developing metabolic syndrome. Increasing insulin resistance via other mechanisms, like changes in hormones, can reduce melatonin (inverse relationship) and affect sleep.
For more on this, see section on sleep.
Brain glucose hypometabolism and cognitive decline
‘The peri-menopausal transition is a tipping point for female brain aging. From the metabolic perspective, the process begins with decline in glucose metabolism and increase in insulin resistance, followed by a compensatory mechanism to use fatty acids and ketone bodies as an auxiliary fuel source’ Wang et al
TCR reduces brain insulin resistance and inflammation. If carbohydrate intake is sufficiently reduced ketone bodies can provide an alternative fuel source for the brain, further supporting cognitive function.
For more on this, see section on Neurodegeneration.
Insulin resistance and mental health
This is an emerging area. See the section on Mental Health for the full collection.
Insulin resistance and bone turnover
Diet quality affects bone markers and metabolic syndrome is associated with reduced bone mineral density therefore addressing metabolic health through diet may have a valid role in protection from osteoporosis.
For more on this, see section on bone health.
Breast Cancer and Insulin Resistance
Multiple factors contribute to increased risk of breast cancer – the presence of insulin resistance/metabolic syndrome is known to impact risk and prognosis. For more on this, see section on cancer.
Updated 01 January 2022
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Latest Update: 01 December 2021