Low carbohydrate diets and diabetes

Observational studies and some small clinical trials have suggested there may be benefits of low carbohydrate diets for people living with type 2 diabetes.

This three-day symposium set out to discuss the science that supports the potential use of low carbohydrate diets for diabetes treatment and prevention, review the epidemiological and clinical trial evidence supporting their use and discuss practical aspects of implementation.

The symposium began with a presentation of a case series from primary care showing how low carbohydrate diets could in some people dramatically improve glucose control and support weight loss in people living with type 2 diabetes.  There was robust discussion about the relative effects of carbohydrate compared to restriction of energy intake using other dietary approaches which have also shown benefits in diabetes.  The underlying science was considered with review of studies that have helped us understand the biology of ketosis that occurs with carbohydrate restriction and how that might affect appetite control and metabolism, including effects on the liver and risk of metabolic associated fatty liver disease and effects on vascular function.  It was also highlighted that experimental testing of the carbohydrate-insulin hypothesis for the development of type 2 diabetes shows the limitations of this model

From an epidemiological perspective, there is no clear association between dietary carbohydrate consumption and incidence of type 2 diabetes, although data quality from many countries is poor.  It is also clear that many areas of the world have a diet that is habitually high in carbohydrates, and that to change that would require and fundamental and profound change in food systems and supply, so it is clear that low carbohydrate diets, whilst clearly beneficial for some individuals with type 2 diabetes, may not be a universally scalable solution.

Professor Jason Gill, University of Liverpool

Professor John Wilding, University of Liverpool