Carbohydrate-controlled Diets Research Articles

The Effect of Metformin and Carbohydrate-Controlled Diet on DNA Methylation and Gene Expression in the Endometrium of Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is an endocrine disease associated with infertility and metabolic disorders in reproductive-aged women. In this study, we evaluated the expression of eight genes related to endometrial function and their DNA methylation levels in the endometrium of PCOS patients and women without the disease (control group). In addition, eight of the PCOS patients underwent intervention with metformin (1500 mg/day) and a carbohydrate-controlled diet (type and quantity) for three months. Clinical and metabolic parameters were determined, and RT-qPCR and MeDIP-qPCR were used to evaluate gene expression and DNA methylation levels, respectively. Decreased expression levels of HOXA10, GAB1, and SLC2A4 genes and increased DNA methylation levels of the HOXA10 promoter were found in the endometrium of PCOS patients compared to controls. After metformin and nutritional intervention, some metabolic and clinical variables improved in PCOS patients. This intervention was associated with increased expression of HOXA10, ESR1, GAB1, and SLC2A4 genes and reduced DNA methylation levels of the HOXA10 promoter in the endometrium of PCOS women. Our preliminary findings suggest that metformin and a carbohydrate-controlled diet improve endometrial function in PCOS patients, partly by modulating DNA methylation of the HOXA10 gene promoter and the expression of genes implicated in endometrial receptivity and insulin signaling.

Anchoring Bias – A Barrier to the Art of Healing

“Patient A” is a 25-year-old male with a history of type 1 diabetes mellitus complicated by presumed diabetic gastroparesis, who presents to the hospital with intractable nausea and vomiting. Upon first impression, the patient is agitated and hostile. “Patient A” is a poor historian, exhibiting limited medical insight and providing a contradictory history. A quick review of his chart details a longstanding history of drug abuse with multiple hospital visits in the last 2 years for similar presenting complaints of refractory vomiting totaling 15-20 episodes per day. “Patient A” is requesting medications to help with the burning discomfort associated with his nausea and vomiting; however, clinicians cautiously treat his pain due to his extensive history of substance abuse. The current provider forgoes another comprehensive work-up, as his symptoms were previously investigated at prior presentations for the same complaints. A repeat hemoglobin A1C is deemed unnecessary because of known poorly-controlled diabetes. Additionally, further inquiry into the patient’s medical compliance is disregarded, given his chart previously classified him as a “non-compliant patient.” During hospitalization, “Patient A” is managed with strict glucose control, carbohydrate-controlled diet, antiemetics with gradual resolution of presenting symptoms, and repeated conversations emphasizing diabetic medical compliance which were poorly received by the patient.

Stability of stevioside in food processing conditions: unexpected recombination of stevioside hydrolysis products in ESI source.

Stevioside is the main and the sweetest glycoside of stevia plant. It is attractive as a natural sweetener to diabetics and others on carbohydrate-controlled diets. This paper discusses the stability of stevioside under food processing conditions. It was found that stevioside was transformed not only to rubusoside, steviolbioside, steviol monoside and steviol but also to previously unknown stevioside α-anomer and rubusoside α-anomer. Those two identified stevioside transformation products are formed not only during the heating of acidic, neutral and alkaline stevioside standard solutions and stevia leaves suspensions in water and ethanol/water solvents but also during the processing of foods containing stevia. Apart from presenting the new compounds, the paper additionally shows that the recombination of sugar moiety with steviolbioside molecule in MS/ESI source can occur. The effect of molecule recombination in the MS source is known from the literature; however, it has not been reported previously in relation to stevioside derivatives.

Awareness and Perception of Carbohydrate-Controlled Diets for Management of PCOS: A Benchmark Study

Abstract Objectives Infertility affects 6.1 million women in the United States. There is currently no recognized Medical Nutrition Therapy to optimize fertility. Despite a lack of research evidence of safety and efficacy, carbohydrate restriction (CR) and carbohydrate-controlled diets (CCD) are utilized by individuals and practitioners as a treatment for subfertility. An aim of this study was to assess awareness and perception of CR as a treatment for subfertility by Registered Dietitian Nutritionists (RDN). In addition, a secondary aim was to compare similar questions gathered from individuals who followed a CCD for fertility enhancement. Methods This study was a combination of two surveys open for respondents July 2019 to January 2020 via REDCap. The survey for the first aim had a restricted population of RDNs consisting of 20 questions investigating perception of CR therapy and experience with patients with subfertility. The survey was emailed via listserv through the Academy of Nutrition and Dietetics. The second survey targeted individuals who implemented CR as a fertility therapy. It consisted of 45 questions and was distributed to CCD related social media groups. Results The first survey had 240 RDN respondents with an average of 12 years of experience. The second survey had 203 CCD respondents of which 49% had followed a CCD for less than one year. While the remaining 51% followed a CCD for an average of 3.6 years. There was a statistically significant difference between how the two groups defined carbohydrate restriction χ,2 (3, 410) = 265.4, P < 0.01. Among RDNs, 49.8% selected “Below 45% kcal from carbohydrate/day” and 32.2% selected “Below 100 g carbohydrate/day”. In contrast, 75.4% of followers of a CCD selected “Below 20 g carbohydrate/day”. A total of 41% of RDNs were familiar with research regarding the effect of carbohydrate reduction on female subfertility markers, such as PCOS and anovulation, of which 67% believe the body of evidence demonstrates “generally positive outcomes” on markers of fertility. Conclusions The results of this study highlight the lack of a consistent definition of CCD between providers and the public. There may be a need for educating providers that research regarding CCD and fertility exists, but effectiveness of CR as a treatment cannot be properly assessed without an agreed upon definition. Funding Sources N/A.

Dietary Intervention for Inpatient Glycemic Control

While recommendations for inpatient glycemic control suggest a conservative target of 140-180mg/dL, many struggle to achieve this goal. Glycemic control begins with a carbohydrate-controlled diet, but many inpatient diets continue to be suboptimal and can contribute to hyperglycemia. At our institution, the carbohydrate-controlled breakfast diet was changed to better reflect carbohydrate goals (e.g., replacing french toast on the “bad diet” with vegetable frittatas on the “good diet”). Pre- and post-prandial glucose values for patients with types I and II diabetes receiving a carbohydrate-controlled diet were collected by retrospective chart review during the weeks before and after these changes took effect. Patients on steroids were analyzed separately. Individual post-prandial glucose values were recorded in a binary fashion as meeting or exceeding predefined glucose targets (<180 mg/dL, <250mg/dL, and <350mg/dL). During this period, 369 patients not receiving steroids and 39 patients receiving steroids had at least one relevant glucose value. In the non-steroid group, there was no difference in proportion of patients who exceeded any of the predefined thresholds. However, in the steroid group, there was a trend toward reduction in proportion of patients exceeding blood glucose of 180mg/dL (absolute risk reduction 19%, 95% confidence interval -4% to 42%, p = 0.12) and 250mg/dL (absolute risk reduction 17%, 95% confidence interval -2% to 35%, p = 0.08) on the days after the dietary change. Although all patients with diabetes may experience hyperglycemia proportionate to their carbohydrate intake, those on steroids experience induced insulin resistance leading to especially diet-sensitive glucose excursions. Our data suggests that patients receiving steroids can likely achieve improved inpatient glucose control through dietary modification. Physician and administration attention to carbohydrate-controlled menus represents an opportunity for improved quality of care for inpatients with diabetes. Disclosure S. Cromer: None. M.M. Bogun: Other Relationship; Self; Mytonomy.

Effect of different plant beds and fertilizers on Stevia (Stevia rebaudiana Bertoni) production

Stevia rebaudiana Bertoni is well-known for its high content of steviol glycoside, a diterpene compound (about 4-20%) in dryleaf matter that is responsible for providing the non-caloric value sweet taste. Steviol glycosides are natural sugar substitutes for diabetics and other people on carbohydrate-controlled diets. Studies revealed that the glycosides yield, especially stevioside, greatly depends on the total biomass yield, which in turn depends on agricultural practices for cultivation of stevia. In this study, the effect of five various combinations of soil, cocopeat, perlite, and vermicompost plant beds mixed with four different fertilizers of tea compost, vermiwash, Hoagland and water, on four different physiological (leaf area, stem length, fresh weight and dry weight) and six different biochemical (chlorophyll content, carotenoid, protein, glucose, phenols and rebaudiosides) characteristics of plant were evaluated. To gain the highest content of biochemical compounds, especially all types of rebaudiosides, a combination of vermicompost, perlite and cocopeat with vermiwash or any other fertilizers can be useful

A Multi-Center Assessment of Nutrient Levels and Foods Provided by Hospital Patient Menus.

Diets of high nutritional quality can aid in the prevention and management of malnutrition in hospitalized patients. This study evaluated the nutritional quality of hospital patient menus. At three large acute care hospitals in Ontario, Canada, 84 standard menus were evaluated, which included regular and carbohydrate-controlled diets and 3000 mg and 2000 mg sodium diets. Mean levels of calories, macronutrients and vitamins and minerals provided were calculated. Comparisons were made with the Dietary Reference Intakes (DRI) and Canada’s Food Guide (CFG) recommendations. Calorie levels ranged from 1281 to 3007 kcal, with 45% of menus below 1600 kcal. Protein ranged from 49 to 159 g (0.9–1.1 g/kg/day). Energy and protein levels were highest in carbohydrate-controlled menus. All regular and carbohydrate-controlled menus provided macronutrients within the Acceptable Macronutrient Distribution Ranges. The proportion of regular diet menus meeting the DRIs: 0% for fiber; 7% for calcium; 57% for vitamin C; and 100% for iron. Compared to CFG recommended servings, 35% met vegetables and fruit and milk and alternatives, 11% met grain products and 8% met meat and alternatives. These data support the need for frequent monitoring and evaluation of menus, food procurement and menu planning policies and for sufficient resources to ensure menu quality.

The integration of diet and nutrition lifestyle management strategies into the dental office visit for diabetes risk reduction and management

The incidence of diabetes and prediabetes in the United States continues to increase. Oral health care professionals (OHCPs) play a role in diabetes screening and education. The author presents and explores diet and lifestyle management strategies OHCPs can provide to patients who have prediabetes and type 2 diabetes mellitus (T2DM). Modest weight loss (7 percent of body weight) and regular physical activity (150 minutes per week) are important in the prevention and treatment of prediabetes and T2DM. Following a carbohydrate-controlled diet that is limited in fat and cholesterol will help patients with T2DM achieve normoglycemia and reduce their risk of developing diabetes complications. The importance of using these strategies can be reinforced by OHCPs during office visits. OHCPs can collaborate with registered dietitians to improve the outcome of oral health through diabetes prevention, education and management. Being familiar with risk factors for T2DM and recommendations for lifestyle modification strategies to prevent T2DM may help OHCPs educate patients and refer them for appropriate treatment and therapy.

Diabetes in Pregnancy

Diabetes is one of the most common medical complications affecting pregnancy. Diabetes in pregnancy is classified into two categories: pregestational diabetes and gestational diabetes (GDM). Pregestational diabetes comprises both type 1 and type 2 diabetes. GDM refers to those individuals diagnosed with carbohydrate intolerance during pregnancy. Regardless of the type of diabetes, pregnancies complicated by diabetes require specialized care and management to ensure the best outcomes for both the mother and the fetus. The management of diabetes is aimed at controlling fasting and postprandial blood glucose concentrations to decrease the known maternal and neonatal sequelae of GDM, including stillbirth, macrosomia, and neonatal metabolic derangements. In general, a carbohydrate-controlled diet, vigilant monitoring of glucose values, and in many individuals, insulin therapy form the mainstay of therapy. In addition to glucose control, increased fetal surveillance is necessary to ensure proper development, appropriate growth, and fetal well-being. Although diabetes requires a multidisciplinary approach that includes physicians and nurses who have specialized training in diabetes, pediatricians, and nutritionists, good outcomes can be observed.

Carbohydrate‐ vs Fat‐Controlled Diet Effect on Weight Loss and Coronary Artery Disease Risk

This pilot study compared weight loss and serum indicators of coronary artery disease (CAD) risk between 2 weight loss (energy-deficit) diets, one controlled for carbohydrate as a percentage of total calories and the other controlled for fat as percentage of total calories. Participants were randomized to 1 of 2 diets and fed on an outpatient basis for 70 days, after which they followed their diets using their own resources for an additional 70 days. Energy deficit for the diets was determined by indirect calorimetry with a 500- to 750-calorie per day adjustment. Weight and CAD risk indicators and serum lipid and C-reactive protein levels were measured at baseline, day 70, and day 140. The study was completed by 16 of 20 participants who were able to comply with the feeding portion of the study as well as with follow-up appointments during the second (self-management) period of the study. Participants lost weight in both diet groups (24.4 lbs, carbohydrate controlled; 18.5 lbs, fat controlled), and serum CAD risk factors decreased in both groups. There were no significant differences in CAD risk factors between diet groups, although there was a trend toward lighter low-density lipoprotein (LDL) size in the carbohydrate-controlled group. During the self-management portion of the study, weight loss stalled or regained from loss during the previous feeding period. The results, although underpowered, are consistent with recent studies in which macronutrient ratio of total calories in diet did not affect degree of weight loss and in which carbohydrate-controlled diets produced a predominance of lighter LDLs.

Stevioside inhibits atherosclerosis by improving insulin signaling and antioxidant defense in obese insulin-resistant mice

Stevioside is a non-caloric natural sweetener that does not induce a glycemic response, making it attractive as sweetener to diabetics and others on carbohydrate-controlled diets. Obesity is frequently associated with insulin resistance and increased inflammation and oxidative stress. Therefore, we investigated its effects on insulin resistance, inflammation and oxidative stress related to atherosclerosis in obese insulin-resistant mice. Twelve-week-old mice were treated with stevioside (10 mg kg(-1), n=14) or placebo (n=20) for 12 weeks. Stevioside had no effect on weight and triglycerides, but lowered glucose and insulin. Stevioside treatment improved adipose tissue maturation, and increased glucose transport, insulin signaling and antioxidant defense in white visceral adipose tissues. Together, these increases were associated with a twofold increase of adiponectin. In addition, stevioside reduced plaque volume in the aortic arch by decreasing the macrophage, lipid and oxidized low-density lipoprotein (ox-LDL) content of the plaque. The higher smooth muscle cell-to-macrophage ratio was indicative for a more stable plaque phenotype. The decrease in ox-LDL in the plaque was likely due to an increase in the antioxidant defense in the vascular wall, as evidenced by increased Sod1, Sod2 and Sod3. Circulating adiponectin was associated with improved insulin signaling and antioxidant defense in both the adipose tissue and the aorta of stevioside-treated mice. Stevioside treatment was associated with improved insulin signaling and antioxidant defense in both the adipose tissue and the vascular wall, leading to inhibition of atherosclerotic plaque development and inducing plaque stabilization.

Optimal Nutrition for Improved Twin Pregnancy Outcome

Twin pregnancies contribute a disproportionate degree to perinatal morbidity, partly because of increased risks of low birth weight and prematurity. Although the cause of the morbidity is multifactorial, attention to twin-specific maternal nutrition may be beneficial in achieving optimal fetal growth and birth weight. Achievement of body mass index (BMI)-specific weight gain goals, micronutrient and macronutrient supplementation specific to the physiology of twin gestations, and carbohydrate-controlled diets are recommended for optimal twin growth and pregnancy outcomes. The daily recommended caloric intake for normal-BMI women with twins is 40-45 kcal/kg each day, and iron, folate, calcium, magnesium, and zinc supplementation is recommended beyond a usual prenatal vitamin. Daily supplementation of docosahexaenoic acid and vitamin D should also be considered. Multiple gestation-specific prenatal care settings with a focus on nutritional interventions improve birth weight and length of gestation and should be considered for the care of women carrying multiples. Antepartum lactation consultation can also improve the rate of postpartum breastfeeding in twin pregnancies. Twin gestation-specific nutritional interventions seem effective in improving the outcome of these pregnancies and should be emphasized in the antepartum care of multiple gestations. This review examines the available evidence and offers recommendations for twin pregnancy-specific nutritional interventions.

Hypertriglyceridemia

Hypertriglyceridemia is a commonly encountered lipid abnormality frequently associated with other lipid and metabolic derangements. The National Cholesterol Education Program recommends obtaining a fasting lipid panel in adults over the age of 20. The discovery of hypertriglyceridemia should prompt an investigation for secondary causes such as high fat diet, excessive alcohol intake, certain medications, and medical conditions (eg, diabetes mellitus, hypothyroidism). In addition, patients should be evaluated for other components of the metabolic syndrome. These include abdominal obesity, insulin resistance, low high-density lipoprotein (HDL), high triglyceride, and hypertension. Hypertriglyceridemia is classified as primary hypertriglyceridemia when there are no secondary causes identified. Primary hypertriglyceridemia is the result of various genetic defects leading to disordered triglyceride metabolism. It is important to treat hypertriglyceridemia to prevent pancreatitis by reducing triglyceride levels to <500 mg/dL. Furthermore, lowering triglycerides while treating other dyslipidemias and components of the metabolic syndrome will reduce coronary events. However, it is controversial how much isolated hypertriglyceridemia correlates directly with coronary artery disease and further studies are needed to clarify whether treatment for this condition leads to meaningful clinical outcomes. Therapeutic lifestyle changes (TLC) are the first line of treatment for hypertriglyceridemia. These changes include a low saturated fat, carbohydrate-controlled diet, combined with alcohol reduction, smoking cessation, and regular aerobic exercise. High doses of omega-3 fatty acids from fish and fish oil supplements will lower triglyceride levels significantly. When patients do not reach their goals by TLC, drug therapy should be started. In cases of isolated hypertriglyceridemia, fibrates are initially considered. When elevated low-density lipoprotein levels accompany hypertriglyceridemia, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors are preferred. In patients with low HDL levels and hypertriglyceridemia, extended release niacin can be considered. A combination of the medicines may be necessary in recalcitrant cases.

Diet and the diabetic: the fallacy of a controlled carbohydrate intake.

The dietary intake of 16 well-established diabetics was recorded over six-week periods on two different diets--a conventional, carbohydrate-controlled diet and an unrestricted, carbohydrate diet which allowed free choice as to quantity of food eaten and time of meals. In all patients the carbohydrate intake varied considerably from day to day and the variation was as great on the supposedly controlled carbohydrate diet as on the unrestricted diet. In agreement with other studies, carbohydrate intake was often considerably higher on the usual diabetic diet than had been recommended or than the patient believed they were taking. It is suggested that present methods for controlling the carbohydrate intake of diabetics are ineffective and, in particular, do not ensure a regular intake from day to day.