Consumption of low carb high fat high protein diets and its metabolic, clinical and nutritional implications: an integrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v10i16.23575

Keywords:

Diet; Carbohydrate-restricted; Body composition; Obesity; Diabetes mellitus; Cardiovascular disease.

Abstract

The consumption of the "fad" diet "Low Carb High fat High Protein" (LCHFHP) is increasingly frequent nowadays because it causes faster weight loss and consequent improvement in quality of life. This integrative review aims to identify the metabolic, clinical and nutritional implications related to the consumption of Low Carb High fat High Protein diets. The bibliographic research was carried out through searches in the electronic databases Pubmed Central and Elsevier, from 2006 to 2018, using the following descriptors: “carbohydrate; dietary carbohydrates; diet, low carbohydrate; diet, carbohydrate-restricted; ketosis; diabetes; active engine; obesity; cardiovascular disease; protein; physical activity.” Initially, 68,219 articles were found. Of these, 40 were pre-selected fulfilling the inclusion criteria. However, among these 40, 28 were within the study profile. Most studies, although demonstrating positive effects with the consumption of the LCHFHP diet, in the short term, in terms of weight loss, reduction in the percentage of body fat, improvement in insulin sensitivity and glycemic control and reduction in the use of medications, showed that these effects were not always attributed to the reduction of carbohydrates in the diet. In addition to these long-term benefits, there was an increase in serum levels of inflammatory biomarkers, in the extent of atherosclerosis and in cardiovascular morbidity and mortality. More studies were carried out, mainly over the long term and with a larger sample, in order to better investigate the benefits or risks arising from the consumption of these diets, as well as the mechanism of action, especially in the face of non-communicable chronic diseases.

References

Al-Khalifa, A., Mathew, T. C., Al-Zaid, N. S., Mathew, E., & Dashti, H. M. (2009). Therapeutic role of low-carbohydrate ketogenic diet in diabetes. Nutrition, 25(11-12), 1177–1185. https://doi.org/10.1016/j.nut.2009.04.004

American Diabetes Association. (2019). Standards of medical care in diabetes - 2017. Alexandria, Va] American Diabetes Association.

Ballard, K. D., Quann, E. E., Kupchak, B. R., Volk, B. M., Kawiecki, D. M., Fernandez, M. L., Seip, R. L., Maresh, C. M., Kraemer, W. J., & Volek, J. S. (2013). Dietary carbohydrate restriction improves insulin sensitivity, blood pressure, microvascular function, and cellular adhesion markers in individuals taking statins. Nutrition Research (New York, N.Y.), 33(11), 905–912. https://doi.org/10.1016/j.nutres.2013.07.022

Bedarida, T., Baron, S., Vessieres, E., Vibert, F., Ayer, A., Marchiol-Fournigault, C., Henrion, D., Paul, J.-L., Noble, F., Golmard, J.-L., Beaudeux, J.-L., Cottart, C.-H., & Nivet-Antoine, V. (2014). High-protein-low-carbohydrate diet: deleterious metabolic and cardiovascular effects depend on age. American Journal of Physiology-Heart and Circulatory Physiology, 307(5), H649–H657. https://doi.org/10.1152/ajpheart.00291.2014

Busetto, L., Marangon, M., & De Stefano, F. (2011). High-protein low-carbohydrate diets: what is the rationale? Diabetes/Metabolism Research and Reviews, 27(3), 230–232. https://doi.org/10.1002/dmrr.1171

Galletly, C., Moran, L., Noakes, M., Clifton, P., Tomlinson, L., & Norman, R. (2007). Psychological benefits of a high-protein, low-carbohydrate diet in obese women with polycystic ovary syndrome—A pilot study. Appetite, 49(3), 590–593. https://doi.org/10.1016/j.appet.2007.03.222

Coleman, M. D., & Nickols-Richardson, S. M. (2005). Urinary ketones reflect serum ketone concentration but do not relate to weight loss in overweight premenopausal women following a low-carbohydrate/high-protein diet. Journal of the American Dietetic Association, 105(4), 608–611. https://doi.org/10.1016/j.jada.2005.01.004

de Luis, D. A., Izaola, O., Aller, R., de la Fuente, B., Bachiller, R., & Romero, E. (2015). Effects of a high-protein/low carbohydrate versus a standard hypocaloric diet on adipocytokine levels and insulin resistance in obese patients along 9months. Journal of Diabetes and Its Complications, 29(7), 950–954. https://doi.org/10.1016/j.jdiacomp.2015.06.002

Ghroubi, S., Elleuch, H., Chikh, T., Kaffel, N., Abid, M., & Elleuch, M. H. (2009). Physical training combined with dietary measures in the treatment of adult obesity. A comparison of two protocols. Annals of Physical and Rehabilitation Medicine, 52(5), 394–413. https://doi.org/10.1016/j.rehab.2008.12.017

Goldstein, T., Kark, J. D., Berry, E. M., Adler, B., Ziv, E., & Raz, I. (2011). The effect of a low carbohydrate energy-unrestricted diet on weight loss in obese type 2 diabetes patients – A randomized controlled trial. E-SPEN, the European E-Journal of Clinical Nutrition and Metabolism, 6(4), e178–e186. https://doi.org/10.1016/j.eclnm.2011.04.003

Ha, K., Joung, H., & Song, Y. (2018). Low-carbohydrate diet and the risk of metabolic syndrome in Korean adults. Nutrition, Metabolism and Cardiovascular Diseases, 28(11), 1122–1132. https://doi.org/10.1016/j.numecd.2018.06.007

Hu, T., & Bazzano, L. A. (2014). The low-carbohydrate diet and cardiovascular risk factors: Evidence from epidemiologic studies. Nutrition, Metabolism and Cardiovascular Diseases, 24(4), 337–343. https://doi.org/10.1016/j.numecd.2013.12.008

Green, J. G., Johnson, N. A., Sachinwalla, T., Cunningham, C. W., Thompson, M. W., & Stannard, S. R. (2010). Low-carbohydrate diet does not affect intramyocellular lipid concentration or insulin sensitivity in lean, physically fit men when protein intake is elevated. Metabolism, 59(11), 1633–1641. https://doi.org/10.1016/j.metabol.2010.03.013

Tay, J., de Bock, M. I., & Mayer-Davis, E. J. (2019). Low-carbohydrate diets in type 2 diabetes. The Lancet Diabetes & Endocrinology, 7(5), 331–333. https://doi.org/10.1016/s2213-8587(18)30368-1

Liu, J., & Lloyd, S. G. (2013). High-fat, low-carbohydrate diet alters myocardial oxidative stress and impairs recovery of cardiac function after ischemia and reperfusion in obese rats. Nutrition Research, 33(4), 311–321. https://doi.org/10.1016/j.nutres.2013.02.005

Merino, J., Kones, R., Ferré, R., Plana, N., Girona, J., Aragonés, G., Ibarretxe, D., Heras, M., & Masana, L. (2013). Low-carbohydrate, high-protein, high-fat diet alters small peripheral artery reactivity in metabolic syndrome patients. Clinica E Investigacion En Arteriosclerosis: Publicacion Oficial de La Sociedad Espanola de Arteriosclerosis, 26(2), 58–65. https://doi.org/10.1016/j.arteri.2013.11.004

Hall, Kevin D., Bemis, T., Brychta, R., Chen, Kong Y., Courville, A., Crayner, Emma J., Goodwin, S., Guo, J., Howard, L., Knuth, Nicolas D., Miller, Bernard V., Prado, Carla M., Siervo, M., Skarulis, Monica C., Walter, M., Walter, Peter J., & Yannai, L. (2015). Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity. Cell Metabolism, 22(3), 427–436. https://doi.org/10.1016/j.cmet.2015.07.021

Handa, K., Inukai, K., Onuma, H., Kudo, A., Nakagawa, F., Tsugawa, K., Kitahara, A., Moriya, R., Takahashi, K., Sumitani, Y., Hosaka, T., Kawakami, H., Oyadomari, S., & Ishida, H. (2014). Long-Term Low Carbohydrate Diet Leads to Deleterious Metabolic Manifestations in Diabetic Mice. PLoS ONE, 9(8). https://doi.org/10.1371/journal.pone.0104948

Kim, J.-Y., Yang, Y.-H., Kim, C.-N., Lee, C.-E., & Kim, K.-I. (2008). Effects of Very-Low-Carbohydrate (Horsemeat- or Beef-Based) Diets and Restricted Feeding on Weight Gain, Feed and Energy Efficiency, as well as Serum Levels of Cholesterol, Triacylglycerol, Glucose, Insulin and Ketone Bodies in Adult Rats. Annals of Nutrition and Metabolism, 53(3-4), 260–267. https://doi.org/10.1159/000189129

Kostogrys, R. B., Franczyk-Żarów, M., Maślak, E., Gajda, M., Mateuszuk, Ł., Jackson, C. L., & Chłopicki, S. (2012). Low carbohydrate, high protein diet promotes atherosclerosis in apolipoprotein E/low-density lipoprotein receptor double knockout mice (apoE/LDLR−/−). Atherosclerosis, 223(2), 327–331. https://doi.org/10.1016/j.atherosclerosis.2012.05.024

Leonard, E. A., & Marshall, R. J. (2018). Cardiovascular Disease in Women. Primary Care, 45(1), 131–141. https://doi.org/10.1016/j.pop.2017.10.004

de Koning, L., Fung, T. T., Liao, X., Chiuve, S. E., Rimm, E. B., Willett, W. C., Spiegelman, D., & Hu, F. B. (2011). Low-carbohydrate diet scores and risk of type 2 diabetes in men. The American Journal of Clinical Nutrition, 93(4), 844–850. https://doi.org/10.3945/ajcn.110.004333

Ruth, M. R., Port, A. M., Shah, M., Bourland, A. C., Istfan, N. W., Nelson, K. P., Gokce, N., & Apovian, C. M. (2013). Consuming a hypocaloric high fat low carbohydrate diet for 12weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects. Metabolism, 62(12), 1779–1787. https://doi.org/10.1016/j.metabol.2013.07.006

Meng, Y., Bai, H., Wang, S., Li, Z., Wang, Q., & Chen, L. (2017). Efficacy of low carbohydrate diet for type 2 diabetes mellitus management: A systematic review and meta-analysis of randomized controlled trials. Diabetes Research and Clinical Practice, 131, 124–131. https://doi.org/10.1016/j.diabres.2017.07.006

Krebs, N. F., Gao, D., Gralla, J., Collins, J. S., & Johnson, S. L. (2010). Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents. The Journal of Pediatrics, 157(2), 252–258. https://doi.org/10.1016/j.jpeds.2010.02.010

Nicholls, S. J., & Nelson, A. J. (2019). HDL and cardiovascular disease. Pathology, 51(2), 142–147. https://doi.org/10.1016/j.pathol.2018.10.017

Nilsson, L. M., Winkvist, A., Eliasson, M., Jansson, J-H., Hallmans, G., Johansson, I., Lindahl, B., Lenner, P., & Van Guelpen, B. (2012). Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort. European Journal of Clinical Nutrition, 66(6), 694–700. https://doi.org/10.1038/ejcn.2012.9

Lagiou, P., Sandin, S., Lof, M., Trichopoulos, D., Adami, H.-O. & Weiderpass, E. (2012). Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. BMJ, 344(jun26 3), e4026–e4026. https://doi.org/10.1136/bmj.e4026

Wang, P., Tate, J. M., & Lloyd, S. G. (2008). Low carbohydrate diet decreases myocardial insulin signaling and increases susceptibility to myocardial ischemia. Life Sciences, 83(25-26), 836–844. https://doi.org/10.1016/j.lfs.2008.09.024

Rho, J. M., & Sankar, R. (2008). The ketogenic diet in a pill: Is this possible? Epilepsia, 49, 127–133. https://doi.org/10.1111/j.1528-1167.2008.01857.x

Samaha, F. F., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., Williams, T., Williams, M., Gracely, E. J., & Stern, L. (2003). A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. New England Journal of Medicine, 348(21), 2074–2081. https://doi.org/10.1056/nejmoa022637

Saslow, L. R., Kim, S., Daubenmier, J. J., Moskowitz, J. T., Phinney, S. D., Goldman, V., Murphy, E. J., Cox, R. M., Moran, P., & Hecht, F. M. (2014). A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or Prediabetes. PLoS ONE, 9(4), e91027. https://doi.org/10.1371/journal.pone.0091027

Sociedade Brasileira De Diabetes. (2017). Diretrizes da Sociedade Brasileira de Diabetes 2017-2018 (CLANNAD, Ed.) [Review of Diretrizes da Sociedade Brasileira de Diabetes 2017-2018]. (Original work published 2018)

Sansbury, B. E., & Hill, B. G. (2014). Regulation of obesity and insulin resistance by nitric oxide. Free Radical Biology and Medicine, 73, 383–399. https://doi.org/10.1016/j.freeradbiomed.2014.05.016

Soenen, S., Bonomi, A. G., Lemmens, S. G. T., Scholte, J., Thijssen, M. A. M. A., van Berkum, F., & Westerterp-Plantenga, M. S. (2012). Relatively high-protein or “low-carb” energy-restricted diets for body weight loss and body weight maintenance? Physiology & Behavior, 107(3), 374–380. https://doi.org/10.1016/j.physbeh.2012.08.004

Shi, Y. F.; Eric, R. H.; Joanna, W.; Christopher, J. S.; Jennifer, J. M.; Kathryn, J. M.; Robert, E. G.; Anthony, R. (2012). Vascular effects of a low-carbohydrate high-protein diet [Review of Vascular effects of a low-carbohydrate high-protein diet]. PNAS, 36(116).

Stocks, T., Taylor, M. A., Ängquist, L., MacDonald, I. A., Arner, P., Holst, C., Oppert, J.-M., Martinez, J. Alfredo., Rössner, S., Polak, J., Langin, D., Saris, W. H. M., Astrup, A., & Sørensen, T. I. A. (2013). Change in Proportional Protein Intake in a 10-Week Energy-Restricted Low- or High-Fat Diet, in Relation to Changes in Body Size and Metabolic Factors. Obesity Facts, 6(3), 217–227. https://doi.org/10.1159/000351726

Hu, T., Yao, L., Reynolds, K., Whelton, P., Niu, T., Li, S., He, J., & Bazzano, L. (2015). The Effects of a Low-Carbohydrate Diet vs. a Low-Fat Diet on Novel Cardiovascular Risk Factors: A Randomized Controlled Trial. Nutrients, 7(9), 7978–7994. https://doi.org/10.3390/nu7095377

von Bibra, H., Wulf, G., St John Sutton, M., Pfützner, A., Schuster, T., & Heilmeyer, P. (2014). Low-carbohydrate/high-protein diet improves diastolic cardiac function and the metabolic syndrome in overweight-obese patients with type 2 diabetes. IJC Metabolic & Endocrine, 2, 11–18. https://doi.org/10.1016/j.ijcme.2013.12.001

Westman, E. C., Yancy, W. S., Mavropoulos, J. C., Marquart, M., & McDuffie, J. R. (2008). The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & Metabolism, 5(1). https://doi.org/10.1186/1743-7075-5-36

Faludi, A. A. et al. (2017). Atualização da diretriz brasileira de dislipidemias e prevenção da aterosclerose (Arquivos Brasileiros de Cardiologia, Ed.; 2nd ed., Vol. 109) [Review of Atualização da diretriz brasileira de dislipidemias e prevenção da aterosclerose].

Wolever, T. M., Gibbs, A. L., Mehling, C., Chiasson, J.-L., Connelly, P. W., Josse, R. G., Leiter, L. A., Maheux, P., Rabasa-Lhoret, R., Rodger, N. W., & Ryan, E. A. (2008). The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. The American Journal of Clinical Nutrition, 87(1), 114–125. https://doi.org/10.1093/ajcn/87.1.114

Published

14/12/2021

How to Cite

PAULA , S. L. de; MATOS, M. R. T. .; MARTINS , Y. C. .; ARAÚJO, N. A. de .; SILVA, F. S. H. da .; SILVA, M. A. .; SANTOS, K. L. S. dos .; OLIVEIRA , G. P. de .; SOBRINHO , W. D. .; SILVA, T. R. da S. .; RODRIGUES, N. C. R. .; TEIXEIRA, L. B. .; AGUIAR, J. R. V. de; DORNELLES, C. .; ALVES, W. de C.; EVANGELISTA, N. M. C. .; FREITAS , M. C. de .; CHAGAS , D. B.; ALVES, L. C.; BESSA, N. G. . Consumption of low carb high fat high protein diets and its metabolic, clinical and nutritional implications: an integrative review. Research, Society and Development, [S. l.], v. 10, n. 16, p. e282101623575, 2021. DOI: 10.33448/rsd-v10i16.23575. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/23575. Acesso em: 12 nov. 2024.

Issue

Section

Review Article