Low-carb Research Articles

The use of bio-efficient plant materials to optimize the fatty acid composition of poultry terrins

The development of functional products characterized by high biological efficiency is an urgent task. The article presents the results of the development of balanced-fatty acid terrins from poultry meat. To increase the biological effectiveness of chopped products, raw materials containing omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) were selected. Based on the analysis of the chemical composition of the raw material kit, the intervals for the Introduction of ingredients containing biologically effective components are calculated. Their optimum amount has been experimentally established. The resulting innovative products are characterized by a balanced composition in terms of content and ratio of omega-3 and omega-6 PUFAs. In addition, the value of the indicator of biological value has increased. Developed poultry terrins can be recommended both for a wide range of consumers, and for use in diet (including low-carb diets), baby food. The developed terrines will expand the range of chopped poultry products of functional orientation.

A Case Study: Low-carb, High-fat (LCHF) Diet Combined with Fried Food in Patient with Type 2 Diabetes and Central Obesity Reduces Need for Exogenous Insulin Injection

Eating is not a simple act of feeding our body. Diet plays a pivotal role in health promotion and chronic disease prevention. According to DGA [1] more than 117 million of American adults have one or more preventable chronic diseases, many of which are related to poor quality eating patterns and physical inactivity. These include cardiovascular disease, high blood pressure, type 2 diabetes, some cancers, and poor bone health. The importance of diet mostly as prevention for all the disorders correlated with metabolism should be strongly highlighted in this day: in fact, this clinical case shows how it’s possible to decrease glycemia with diet in type 2 diabetes (T2D). Fat foods and fried foods play an unsuspected important role in Diabesity.

Research on Marketing Strategy for A Ketogenic Food Start Up Business in Bandung

Many people feel it is necessary to have a slender body and pursuing it through various ways, including diet. The ketogenic diet is a low-carb and high-fat diet and has been proven to be one of the effective diets to lose weight. The preliminary research shows the lack of choices of pure keto-friendly food on the market is the main problem of keto dieters. This is seen as a good opportunity from a business perspective and further research was conducted. The research was done using a qualitative method in-depth interviews to gain perspective on how to market a ketogenic food provider. The respondents are those who have dieted and have had a problem in body weight. There are 7 out of 8 respondents said they would consider doing the keto diet in the future. This research results that the suitable target consumers are people with age of 22-35 years old, have monthly income >Rp3.000.000,00, currently in college and college graduate, student, and employee, in upper middle social class, have interests in weight loss and delicious food, and body goals oriented. The personas for this target market are lazy dieters, weight loss achievers, and experimental dieters. The result for marketing strategy is a 4P marketing mix. The products are keto-friendly heavy meals and desserts. The price per item is between Rp50.000,00-Rp75.000,00. The consumers can make the purchase online. The promotions are educational and informative contents, endorsement, paid promote, discount, and cheaper price for weekly meal plan purchase.

The effect of Ketogenic diet on vitamin D3 and testosterone hormone in patients with diabetes mellitus type 2

Abstract A keto diet is well-known for being a low carb diet in which the body produces ketones in the liver to be used as energy. When something high in carbs is eaten, the body will produce glucose and insulin. Glucose is the easiest molecule for the body to convert and use as energy, so it will be chosen over any other energy source. The aim of this study is to examine the effect of a ketogenic diet on type 2 diabetic patients and the effect it has on testosterone, vitamin D3, HDL, LDL levels, in comparison to non-ketogenic diet subjects. In the study, Type 2 diabetic patients undergoing a keto diet were selected and serum D3 levels and testosterone levels were examined and compared with control subjects. The result show a significant increase in testosterone hormone in patients with diabetes mellitus type 2 following a Ketogenic diet (mean± Std. Error 427.4±2.52) as compared with the control group (mean ± Std. Error 422.2±0.24) and as compared with patients with diabetes mellitus type 2 who are not following a Ketogenic diet (mean± Std. Error 151.4±1.41). The results show no significant level in LDL level in patients with diabetes mellitus type 2 following a Ketogenic diet (mean ± Std. Error 78.53±0.17), as compared to a control group (mean ± Std. Error 75.0.3±0.14) and no significant level in HDL level in patients with diabetes mellitus type 2 following a Ketogenic diet (mean± Std. Error 46.3±1.55), as compared with a control group (mean ± Std. Error 46.2±2.43), and with patients with diabetes mellitus type 2 who are not following a Ketogenic diet (mean ± Std. Error 45.1±1.55). The results show a significant increase in vitamin D3 level in patient with diabetes mellitus type 2 who are following a Ketogenic diet (mean ± Std. Error 53.5±0.32), as compared with a control group (mean± Std. Error 57±0.24), and with patients with diabetes mellitus type 2 who are not following a Ketogenic diet (mean ± Std. Error 25.1±1.55). Herein, normal vitamin D3 levels in patients corresponds to normal testosterone hormone levels. In conclusion, this study shows that in patients with diabetes mellitus type 2, following a ketogenic diet has a positive effect on the patients’ health.

Effects of a Low Carb Diet and Whey Proteins on Anthropometric, Hematochemical, and Cardiovascular Parameters in Subjects with Obesity.

BackgroundThe best way to lose body weight, without using drugs and/or suffering hunger and stress, has not yet been defined. The present study tested a low carbohydrate diet, enriched with proteins, in subjects with overweight and obesity.MethodsThe study enrolled 22 uncomplicated overweight and obese subjects. Several parameters were examined before and after 6 weeks of a low-carbohydrate diet, enriched with 18 g of whey proteins. Anthropometric (body mass index, waist circumference) variables, fasting hormones (insulin, TSH, FT3, FT4), and metabolic (glucose, prealbumin, and lipid levels) parameters were measured. 25-OH-vitamin D (25 (OH) D), parathyroid hormone (PTH) and osteocalcin, were also quantified. Body composition parameters (fat mass, fat-free mass, body cell mass, total body water) were measured by electrical bioimpedance analysis. As cardiovascular parameters, blood pressure, endothelium flow-mediated dilation (FMD), and common carotid artery intima-media thickness were also measured.ResultsThe low-carbohydrate diet integrated with proteins induced a significant decrease in body weight (P < 0.001), waist circumference (P < 0.001), fat mass (P < 0.001), diastolic blood pressure (P < 0.01), triglycerides (P < 0.001), total cholesterol (P < 0.001), pre-albumin (P < 0.001), insulin (P < 0.001), HOMAIR (P < 0.001), FT3 (P < 0.05), and c-IMT (P < 0.001), and a significant increase in FMD (P < 0.001) and 25 (OH) D (P < 0.001) was also observed.ConclusionAll these results suggest that a short-term non-prescriptive low carbohydrate diet, enriched with whey proteins, may be a good way to start losing fat mass and increase health.

GH.p-Modulus Study of Linear Elastic Glucose Theory Based on Data From 159 Liquid Egg Meals, 126 Solid Egg Meals, and 2,843 Total Meals Using GH-Method: Math-Physical Medicine, Part 12 (No. 364)

This article is Part 12 of the author’s linear elastic glucose behavior study. It focuses on a deeper investigation of GH.p-modulus through the comparison of the results from his neuroscience study of egg meals against his 2,843 total meals during the period of 5/5/2018 to 11/17/2020. In the comparison study, he can explore the potential range (variance) of GH.p-modulus values with special cases of 285 egg meals and general case of 2,843 total meals. As a result, it extends to connect the study of his eight hypothetical standard cases presented in paper No. 361 (Reference 17). Here is the step-by-step explanation of the predicted postprandial plasma glucose (PPG) equation using linear elastic glucose theory as described in References 9 through 19: (1) Baseline PPG equals to 97% of FPG value, or 97% * (weight * GH.f-Modulus). (2) Baseline PPG plus increased amount of PPG due to food, i.e. plus (carbs/sugar intake amount * GH.p-Modulus). (3) Baseline PPG plus increased PPG due to food, and then subtracts reduction amount of PPG due to exercise, i.e. minus (post-meal walking k-steps * 5). (4) The Predicted PPG equals to Baseline PPG plus the food influences, and then subtracts the exercise influences. The linear elastic glucose equation is: Predicted PPG = (0.97 * GH.f-modulus * Weight) +(GH.p-modulus * Carbs&amp;sugar) - (post-meal walking k-steps * 5) Where (1) Incremental PPG = Predicted PPG - Baseline PPG + Exercise impact (2) GH.f-modulus = FPG / Weight (3) GH.p-modulus = Incremental PPG / Carbs intake It is quite interesting to put the author’s 285 special egg meals experimental data side by side with his 2,843 total meals data together. The differences of the carb amount and GH.p-modulus values between the egg meals and total meals are vast and obvious. The neuroscience egg meals are offered as extreme cases for the GH.p-modulus boundary situations by having an extremely low carb intake amount per meal with an associated much higher GH.p-modulus value. However, the conclusions from the case of 2,843 total meals could offer general guidelines for type 2 diabetes patients who want to control their diabetic conditions via lifestyle management program. The author thinks that a general GH.p-modulus range of 1.0 to 5.0 is probably suitable for the majority of clinical cases (the author’s own range is 2.1 to 3.4). From a practical angle, a patient can use this GH.p-modulus value as a multiplier of his carbs/sugar amount and use a number of 5 as his multiplier to the post-meal walking k-steps and then plug them into the following “quick but not so dirty” formula in order to obtain the predicted PPG. Predicted PPG =FPG + (GH.p * Carbs) - (k-steps *5) Where the patient can attempt to use different numbers between 1 through 5 as the GH.p input value to determine the suitable GH.p-modulus. By using the above estimated PPG formula, diabetes patients can find their PPG level very quickly and accurately without delving into the details of the linear elastic glucose theory.

Randomized Controlled Lifestyle Intervention (LION) Study for Weight Loss and Maintenance in Adults With Obesity—Design and Methods

Introduction: Due to the increasing prevalence of obesity, approaches for a more effective treatment especially in the long-term perspective are needed. However, studies on weight loss and maintenance show heterogeneous results with large inter-individual variations. Therefore, it is of interest to identify factors that contribute to inter-individual differences and predict the success of long-term weight management.Methods and Analysis: The primary outcome of the Lifestyle Intervention (LION) Study is to evaluate the effect of two diets (low carb vs. low fat) and two digital counseling tools (newsletter vs. mobile application) on weight maintenance 12 months after weight loss. The identification of predictive factors (e.g., genetic, epigenetic, physiological, psychological) for the success of weight loss and maintenance is a secondary outcome. Men and women with a body mass index (BMI) between 30.0 and 39.9 kg/m2, aged 18–65 years, and without severe diseases are considered eligible. After phenotyping (e.g., anthropometry, resting metabolic rate, meal challenges, blood parameters) participants will follow a formula-based, low-calorie diet (LCD) for 8 weeks. In addition, the intake of 200 g raw or cooked non-starchy vegetables are allowed per day. Subsequently, 252 participants will be randomized into one of the four intervention groups (low carb/app, low carb/newsletter, low fat/app, low fat/newsletter) for the 12-month weight maintenance step. The study will be concluded after another 12 months of follow-up. Results should provide indications for successful weight management and give insights into the personalized treatment of obesity.Ethics and Dissemination: This study has been granted ethical approval by the local Ethics Review Committee of the School of Medicine, Technical University of Munich (vote: 69/19 S).Trial Registration Number: This study has been registered within ClinicalTrials.gov (NCT04023942) and the German Clinical Trials Register (DRKS00017819).

Dietary Patterns, Diabetes, and Aging

Several studies have suggested that eating patterns are associated with healthy aging and lower risk of diseases such as diabetes. The purpose of this paper is to review recent publications about dietary patterns, diabetes, and aging. The most robust research available on dietary patterns to reduce the risk of diabetes mainly indicates Mediterranean-style, DASH diet, vegetarian or vegan, and low-carb diet plans. An optimal dietary pattern for healthy aging and the treatment of diabetes should emphasize plant-based food (vegetables, beans, nuts and seeds, fruits, and whole intact grains), fish and other seafood, olive oil as the principal source of dietary fat; low-fat dairy products (mainly yoghurt and cheese) in low to moderate amounts; minimized consumption of refined grains; and preference of whole foods over highly processed foods. Further research on this topic is needed.

Aralıklı Açlık Diyetleri ve Düşük Karbonhidratlı Diyetlerin Obezite Tedavisindeki Etkisi

Obezite, prevalansı giderek artan küresel bir sağlık sorunudur. Fazla kilolu ve obez bireyleri tedavi etmek için yeni diyet stratejileri oluşturulmuştur ve bu diyet stratejileri popüler ve yaygın hale gelmiştir. Bu diyetler arasında “aralıklı açlık diyetleri” ve “düşük karbonhidratlı diyetler (DKD)” bulunmaktadır. Birçok aralıklı açlık diyeti varyasyonu açlık döngülerinin uzunluğu ve sıklığı bakımından farklılık gösterir. Alternatif gün açlık diyetleri (dönüşümlü açlık), zaman kısıtlı beslenme, dini oruç olarak sınıflandırılabilir. Düşük karbonhidratlı diyetlerin ortak bir tanımı bulunmamaktadır. Bazı DKD’lerde enerji alımına bağlı, bazılarında ise enerji alımından bağımsız olarak karbonhidrat alım miktarı kısıtlanmaktadır. Alternatif gün açlık diyetlerinin ve zaman sınırlı beslenmenin vücut ağırlığı kaybında olumlu etkileri olduğu öne sürülmektedir, ancak, açlık süresinin uzaması diyete uyumu azaltabilir. Ramazan orucunda ise genellikle bir aylık süreçte kaybedilen vücut ağırlığı geri kazanılmaktadır. Düşük karbonhidratlı diyetlerin vücut ağırlığı kaybı üzerine olumlu etkileri olsa da düşük yağlı diyetlerin etkileri konusunda çelişkili veriler bulunmaktadır. Her iki beslenme modeli de obezitede vücut ağırlık kontrolü için uygulanabilecek yaklaşımlar olabilir; ancak uzun dönemli etkilerinin ortaya konulması için uzun süreli takip çalışmalarına ihtiyaç duyulmaktadır.

Remission of Type 2 Diabetes from a Reduced Carbohydrate Diet with Digital Behavior Change Support: 15-month Case Study

Type 2 diabetes is a global burden affecting over 400 million people across the world. The prevalence of type 2 diabetes is growing, driven by a sedentary lifestyle and unhealthy eating habits. In community settings, less than 1 in 1,000 people achieves type 2 diabetes remission. In the UK, adults eat 300% the recommended intake of added sugar in the diet. People diagnosed with type 2 diabetes are treated with diet and exercise before progressing to medications including metformin and insulin. Studies have highlighted the therapeutic benefits of carbohydrate restriction on health conditions including obesity, type 2 diabetes and epilepsy. The goal of this study is to assess the effects of a behavioral change intervention on primary markers of HbA1c and weight. This paper presents the case of a 72-year-old adult living in England diagnosed with type 2 diabetes in 2015 and referred to a digital behaviour change app (Low Carb Program) in 2018. The results of this study suggest lifestyle and behavior changes can be maintained with the assistance of a digital health app. This case study may lay groundwork for future research on technological and lifestyle approaches to manage type 2 diabetes.

Participant characteristics and self-reported weight status in a cross-sectional pilot survey of self-identified followers of popular diets: Adhering to Dietary Approaches for Personal Taste (ADAPT) Feasibility Survey.

To describe characteristics of self-identified popular diet followers and compare mean BMI across these diets, stratified by time following diet. Cross-sectional, web-based survey administered in 2015. Non-localised, international survey. Self-selected followers of popular diets (n 9019) were recruited to the survey via social media and email announcements by diet community leaders, categorised into eight major diet groups. General linear models were used to compare mean BMI among (1) short-term (<1 year) and long-term (≥1 year) followers within diet groups and (2) those identifying as 'try to eat healthy' (TTEH) to all other diet groups, stratified by time following the specific diet. Participants were 82 % female, 93 % White and 96 % non-Hispanic. Geometric mean BMI was lower (P < 0·05 for all) among longer-term followers (≥1 year) of whole food, plant-based (WFPB), vegan, whole food and low-carb diets compared with shorter-term followers. Among those following their diet for 1-5 years (n 4067), geometric mean BMI (kg/m2) were lower (P < 0·05 for all) for all groups compared with TTEH (26·4 kg/m2): WFPB (23·2 kg/m2), vegan (23·5 kg/m2), Paleo (24·6 kg/m2), vegetarian (25·0 kg/m2), whole food (24·6 kg/m2), Weston A. Price (23·5 kg/m2) and low-carb (24·7 kg/m2). Our findings suggest that BMI is lower among individuals who made active decisions to adhere to a specific diet, particularly more plant-based diets and/or diets limiting highly processed foods, compared with those who simply TTEH. BMI is also lower among individuals who follow intentional eating plans for longer time periods.

Cancer and Alzheimer's disease: intracellular pH scales the metabolic disorders.

Alzheimer's disease (AD) and cancer have much in common than previously recognized. These pathologies share common risk factors (inflammation and aging), with similar epidemiological and biochemical features such as impaired mitochondria. Metabolic reprogramming occurs during aging and inflammation. We assume that inflammation is directly responsible of the Warburg effect in cancer cells, with a decreased oxidative phosphorylation and a compensatory highthroughput glycolysis (HTG). Similarly, the Warburg effect in cancer is thought to support an alkaline intracellular pH (pHi), a key component of unrelenting cell growth. In the brain, inflammation results in increased secretion of lactate by astrocytes. The increased uptake of lactic acid by neurons results in the inverse Warburg effect, such as seen in AD. The neuronal activity is dampened by a fall of pHi. Pronounced cytosol acidification results in decreased mitochondrial energy yield as well as apoptotic cell death. The link between AD and cancer is reinforced by the fact that treatment aiming at restoring the mitochondrial activity have been experimentally shown to be effective in both diseases. Low carb diet, lipoic acid, and/or methylene blue could then appear promising in both sets of these clinically diverse diseases.

720-P: Prurigo Pigmentosa: An Acute Complication of Ketogenic Diet

A 22-year old female with type 1 diabetes (T1DM) presented with generalized rash. She was diagnosed at the age of 9 years and is treated with insulin pump and CGMS (continues glucose monitoring sensors), her recent HbA1c was 7.4%. Four weeks prior to her rash presentation she started a low carbohydrate diet (50 gr of carbs per day) in order to improve her glycemic control. Pruritic erythematous papules, papulovesicular, and vesicles appeared on her axillary region, upper back and groins. Lesions were associated with severe pruritus and negatively affected her quality of life. Various therapies were initiated by dermatologist as: antifungal agent, Itraconazole, and Betamethasone Esters, without any improvement. Her serum beta-hydroxybutyrate levels were between 1.1-1.2 mmol/l. Prurigo pigmentosa, a rare pruritic inflammatory dermatosis secondary to her high ketones levels was diagnosed. Her condition resolved after she increased her carbohydrate intake to 75 gr per day. Beta-hydroxybutyrate level decreased concomitantly to 0.1-0.2 mmol/l. When carbohydrate restriction was rechallenged, she again entered ketosis, followed by recurrence of the pruritic lesions. Carbohydrate intake was increased and subsequently all lesions resolved with remaining reticular hyperpigmentation. During the last few years low carb diets have gained popularity among patients with T1DM. This case illustrates the rare side effect of high ketones body levels. Health care providers should be familiar with this side effect. Disclosure N. levran: None. K. Mazor-Aronovitch: None. S. Grenberger: None. N. Levek: None. B. Sher: None. E. Mauda: None. Z. Landau: None. E. Monsonego-Ornan: None. O. Pinhas-Hamiel: None.

Effects of a Low-Carbohydrate Diet on Cardiometabolic Risk Factors During Weight-Loss Maintenance: A Randomized Controlled Feeding Trial

Abstract Objectives To compare effects of diets varying in carbohydrate (carb) and fat on plasma lipids and lipoprotein subfractions. Methods Participants (N = 164, 70% female, 18–65 y, BMI ≥ 25 kg/m2) achieved 10–14% weight loss on a run-in diet and then were randomized to 3 test diets for 20 weeks of weight-loss maintenance. Percentages of total energy from carb-fat-protein for high-, moderate-, and low-carb diets were 60-20-20 (HI), 40-40-20 (MOD), and 20–60-20 (LO). Relative amounts of added sugar (15% total carb) and saturated fat (35% total fat) were fixed across diets. Plasma was collected at START (post-weight loss) and END of trial. The primary outcome for this ancillary study was lipoprotein insulin resistance (LPIR) – a 6-component weighted score of triglyceride-rich, high-density, and low-density lipoprotein particle (TRL-P, HDL-P, LDL-P) sizes and subfraction concentrations (large/very large TRL-P, large HDL-P, small LDL-P) (NMR spectroscopy, LabCorp). Other outcomes included large LDL-P concentration, triglycerides (TG), and cholesterol (HDL-C, LDL-C). Means (±SE) and END–START changes (mean [95% CI]) were constructed and compared from repeated measures ANOVA. Results Retention was 90% and 147 participants provided evaluable data, with no difference in body weight by diet after randomization. LPIR was 32.6 ± 1.5 at START. Change in LPIR differed by diet (P = 0.009): LO (−5.3 [−9.2, −1.5]), MOD (−0.02 [−4.1, 4.1]), HI (3.6 [−0.6, 7.7]). Diet effects favoring LO compared to HI were observed for large/very large TRL-P (P = 0.005), large HDL-P (P = 0.045), TG (P = 0.006), and HDL-C (P = 0.04). There were no mean differences between diets for particle sizes, LDL-P subfraction concentrations, and LDL-C (START: 79.3 ± 1.8 mg/dL; END–START: HI, 8.2 [4.2, 12.2]; MOD, 11.7 [7.8, 15.7]; LO, 10.0 [6.3, 13.7]). Conclusions With 3-fold higher saturated fat content (21% vs 7% total energy), a low- vs high-carb diet improved LPIR, a biomarker of diabetes risk, and several other components of the metabolic syndrome, with no adverse effects on LDL-P or LDL-C. These results from a large feeding study suggest that carb restriction may help prevent cardiometabolic disease independent of body weight. Funding Sources Nutrition Science Initiative (gifts from Arnold Ventures and Robert Lloyd Corkin Charitable Foundation), New Balance Foundation, Many Voices Foundation, Blue Cross Blue Shield.

The Effect of Chronobiology and Variety of Macronutrients on BMI, Waist, Body Fat and HOMA-IR in Patients with Metabolic Syndrome

Abstract Objectives The aim of this study was to assess the effect of both meal timing and diet composition on BMI, waist, body fat and HOMA-IR in patients with metabolic syndrome (MS). Methods We studied 77 patients with MS (32 men and 45 women). Detailed analysis of baseline food-diaries showed that 43 patients (56%) were mostly eating after 3 p.m., generally skipping breakfast, and had more frequent carbohydrate snacks. We divided patients into two groups. The first group consisted of patients with most caloric intake after 3 PM, and the second group included patients who were evenly consuming their food throughout the day. Following diet were offered: 3-fold meal (food intake was at 7–9a.m., 1–2p.m. and 6–7p.m.) with very low-carbohydrate (LC) breakfast and dinner, lunch consisted of LC, proteins (P), polyunsaturated fatty acids (PUFAs) and non-starchy vegetables(V); there were absolutely no snacks during the day. Daily calorie intake was reduced by 20% from baseline. Diet intervention lasted 12 weeks. No medication were used during this period. Results 60 patients completed the trial (32 and 28 patients in first and second groups respectively). BMI was reduced from 33,1 ± 5,0 kg/m2 to 29,8 ± 4,6 kg/m2, the effect was similar in both groups (Cohen's d = 0,7, P = 0003). Mean body fat decreased from 40,7 ± 7,0% to 35,8 ± 7,5% in 12 weeks and treatment effect was more pronounced in second group (Cohen's d = 0,76, P = 0007). The most significant changes were observed in HOMA-IR, which decreased from 4,0 ± 1,1 to 2,1 ± 1,1, treatment effect was also more pronounced in second group (Cohen's d = 1,22, P = 0001). Waist circumference statistically decreased too (from 100,9 ± 16,8сm to 92,0 ± 14,6сm), although with more modest effect - Cohen's d = 0,58, P = 0003. Maximum effect size was in HOMA-IR changes. whereas minimum in waist circumference. Conclusions Our findings demonstrate that this diet (low carb, hight fat, 3-fold meal diet with lunch before 3 p.m.) is associated with statistically different changes in BMI, waist, body fat and HOMA-IR and the intervention was more effective among patients in second group. Funding Sources Not funded.

SAT-685 Euglycemic Diabetic Ketoacidosis in T1d: The Era of SGLT-2 Inhibitors and Keto-Diet

Introduction Euglycemic diabetic ketoacidosis (DKA) is a challenging diagnosis since near normal blood sugar levels can be misleading. In the present case, we describe a patient with Type 1 Diabetes (T1D) on SGLT2 who underwent a strict low carb diet. Case Report A 70-year-old female with past medical history of unspecified diabetes mellitus and primary hypothyroidism presented to emergency room complaining of nausea and dizziness of four days with decreased oral intake. She was alert and oriented, normal weight (52 kg, BMI 20 kg/m2) with stable vital signs, except for mild tachypnea (22/min). Initial labs showed serum glucose 136 mg/dL, bicarbonate 10 mmol/L (normal 20-31), anion gap of 27, venous blood gas pH 7.1, B-hydroxybutyrate 8.8 mmol/L (normal 0.02-0.27), glucosuria > 500 mg/dL, and moderate ketonuria. Screening for ethyl alcohol and ethylene glycol was negative. Lactic acid, cardiac enzymes, renal and liver function tests were normal. She was diagnosed with diabetes mellitus at age 37, on insulin since then. No alcohol use. Her new primary care physician found an A1C of 9.0% for which metformin 1000mg oral twice a day and empagliflozin 12.5 mg oral daily were added and aspart insulin was discontinued. Daily glargine remained at 20 units daily. She was advised to lose weight for which she started a keto-diet 4 weeks prior to this presentation. She had lost 15 pounds since then accompanied by polyuria and polydipsia. Upon admission, she received IV insulin and IV fluids. An endocrinology consultation was requested for euglycemic DKA secondary to SGLT2 complicated by starvation ketosis. Antibodies against glutamic acid decarboxylase were positive at 250 IU/mL (normal < 5). She was discharged on glargine, aspart insulins and oral medications were discontinued. Conclusion This case shows the importance of identifying the specific type of diabetes for appropriate individualization of therapy. Following a keto-diet in unrecognized T1D can trigger ketoacidosis in the setting of SGLT2 inhibitors leading to euglycemic diabetes ketoacidosis.

Improvement of diagnostic accuracy of 18fluorine-fluorodeoxyglucose PET/computed tomography in detection of infective endocarditis using a 72-h low carbs protocol.

The major challenge in diagnosing infective endocarditis using fluorine-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) is the high physiological myocardial F-FDG uptake, which may interfere with the detection of pathological uptake. Our aim was to retrospectively analyse the impact of a low-carbohydrate, high-protein, high-fat (LCHPHF) diet starting 72 h before the examination with classic overnight fasting. We included 92 patients (51 with LCHPHF diet 72 h before the examination and 41 with overnight fast only). Left ventricular (LV) myocardial F-FDG uptake was visually evaluated, to estimate the effect of LCHPHF on myocardial F-FDG uptake, we used a three-point visual scale: 0, negligible uptake and evaluable examination; 1, mild uptake and doubtful examination and 2, intense uptake and not evaluable examination. SUVmax and SUVmean were calculated putting a region of interest on LV myocardium at the level of the largest cardiac footprint and on the site of suspected lesion. Thus, a ratio between SUV of the suspect lesion and SUV of LV was calculated as SUV ratio. By visual assessment, in LCHPHF diet group 46 patients (96.1%) had score 0, 3 patients (5.9%) had score 1 and nobody had score 2. In control group, 23 patients (56.1%) had a score 2, 12 (29.3%) patients obtained a score 1 with a doubtful examination and 6 patients (14.6%) were classified with a score 0 with reportable examination. We demonstrated that an LCHPHF diet can adequately suppress the physiological myocardial uptake leading to a significant improvement in the interpretability and diagnostic accuracy of F-FDG PET/CT in infective endocarditis.

Beyond Body Weight-Loss: Dietary Strategies Targeting Intrahepatic Fat in NAFLD.

Non-alcoholic fatty liver disease (NAFLD) has emerged as the most prevalent liver disease in industrialized countries. It is regarded as the hepatic manifestation of the metabolic syndrome (MetS) resulting from insulin resistance. Moreover, insulin resistance impairs glycogen synthesis, postprandially diverting a substantial amount of carbohydrates to the liver and storing them there as fat. NAFLD has far-reaching metabolic consequences involving glucose and lipoprotein metabolism disorders and risk of cardiovascular disease, the leading cause of death worldwide. No pharmaceutical options are currently approved for the treatment of NAFLD. Exercise training and dietary interventions remain the cornerstone of NAFLD treatment. Current international guidelines state that the primary goal of nutritional therapy is to reduce energy intake to achieve a 7%–10% reduction in body weight. Meal replacement therapy (formula diets) results in more pronounced weight loss compared to conventional calorie-restricted diets. However, studies have shown that body mass index (BMI) or weight reduction is not obligatory for decreasing hepatic fat content or to restore normal liver function. Recent studies have achieved significant reductions in liver fat with eucaloric diets and without weight loss through macronutrient modifications. Based on this evidence, an integrative nutritional therapeutic concept was formulated that combines the most effective nutrition approaches termed “liver-fasting.” It involves the temporary use of a low calorie diet (total meal replacement with a specific high-protein, high-soluble fiber, lower-carbohydrate formula), followed by stepwise food reintroduction that implements a Mediterranean style low-carb diet as basic nutrition.

A low-carb diet for diabetes: the latest evidence

Low-carb diets have been shown to reverse type 2 diabetes in some people. George Winter investigates the latest findings

Novel Digital Architecture of a "Low Carb Program" for Initiating and Maintaining Long-Term Sustainable Health-Promoting Behavior Change in Patients with Type 2 Diabetes.

Globally, the burden of noncommunicable diseases such as type 2 diabetes is crippling health care systems. Type 2 diabetes, a disease linked with obesity, affects 1 in every 30 people today and is expected to affect 1 in 10 people by 2030. Current provisions are struggling to manage the trajectory of type 2 diabetes prevalence. Offline, face-to-face education for patients with type 2 diabetes has shown to lack long-term impact or the capacity for widespread democratized adoption. Digitally delivered interventions have been developed for patients with type 2 diabetes, and the evidence shows that some interventions provide the capacity to support hyperpersonalization and real-time continuous support to patients, which can result in significant engagement and health outcomes. However, digital health app engagement is notoriously difficult to achieve. This paper reviews the digital behavior change architecture of the Low Carb Program and the application of health behavioral theory underpinning its development and use in scaling novel methods of engaging the population with type 2 diabetes and supporting long-term behavior change.